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A Single-dose Cross-over Study to Assess Direct and Indirect Effects of Dapagliflozin on Pancreatic Alpha and Beta Cells in Patients With Type 2 Diabetes

Primary Purpose

Diabetes Mellitus, Type 2

Status
Completed
Phase
Phase 4
Locations
Sweden
Study Type
Interventional
Intervention
Dapagliflozin
Saxagliptin
Glucose
Sponsored by
Uppsala University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetes Mellitus, Type 2

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. Males and females aged 18 - 75.
  2. Female subjects must meet all of the following criteria:

    1. Not breastfeeding
    2. Negative pregnancy test result (human chorionic gonadotropin, beta subunit [hCG]) at Visit 0 (screening) (not applicable to hysterectomized females).
    3. If of childbearing potential (including perimenopausal women who have had a menstrual period within 1 year), must practice and be willing to continue to practice one of the following highly effective birth control methods during the entire duration of the study:

    i. Diaphragm or partner use of condom in combination with combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation:

    • Oral
    • Intravaginal
    • Transdermal ii. Diaphragm or partner use of condom in combination with progestogen-only hormonal contraception associated with inhibition of ovulation:
    • Oral
    • Injectable
    • Implantable iii. Placement of an intrauterine device iv. Placement of an intrauterine hormone-releasing system v. Bilateral tubal occlusion vi. Vasectomised partner (provided that the partner is the sole sexual partner of the female subject and that the vasectomised partner has received medical assessment of the surgical success) vii. Sexual abstinence (defined as refraining from heterosexual intercourse) d) Must practice appropriate birth control as stated above for 10 weeks after the last dose of study medication
  3. BMI 20 - 35.
  4. Clinical T2D diagnosis at least 6 months prior to enrolment.
  5. Metformin treatment, with stable dose for at least 1 month.
  6. HbA1c 55 - 86 mmol/mol (7,2-10 % DCCT).

Exclusion Criteria:

  1. History or sign of any clinically significant disease or disorder which, in the opinion of the investigator, may either put the subject at risk because of participation in the study, or influence the results or the subject's ability to participate in the study.
  2. Clinical diagnosis of Type 1 diabetes mellitus and/or history of diabetic ketoacidosis or positive Glutamic Acid Decarboxylase Autoantibodies test (GAD antibodies test).
  3. Patients treated with antipsychotics, systemic glucocorticoids, neuropsychiatric stimulants, antidepressants with sympathetic activity, beta blockers or other pharmaceuticals rendering patient unfit for study participation as judged by the investigator.
  4. Patients treated with antidiabetic medications other than Metformin.
  5. Patients with any other endocrine disease except substituted hypothyroidism.
  6. Significant abnormal liver function defined as aspartate aminotransferase (AST) >3x upper limit of normal (ULN) and/or alanine aminotransferase (ALT) >3x ULN.
  7. Patients with impaired liver or kidney function (eGFR < 60).
  8. Known or suspected history of significant drug abuse.
  9. History of alcohol abuse or excessive intake of alcohol as judged by investigator.
  10. History of severe allergy/hypersensitivity or ongoing allergy/hypersensitivity, as judged by the investigator.
  11. Plasma donation within one month of screening or any blood donation or significant blood loss (> 400 ml) during the 3 months prior to screening.
  12. Any other condition with in the opinion of the investigator would render the patient unsuitable for inclusion in the study and /or for the patients safety.
  13. Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff and/or staff at the study site).
  14. Judgment by the investigator that the subject should not participate in the study if considers subject unlikely to comply with study procedures, restrictions and requirements.

Sites / Locations

  • Dept of Medical Sciences Uppsala University Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm 5

Arm 6

Arm Type

Experimental

Experimental

Experimental

Experimental

Experimental

Experimental

Arm Label

DS-D-DG

DS-DG-D

D-DG-DS

D-DS-DG

DG-D-DS

DG-DS-D

Arm Description

The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose).

The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose).

The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose).

The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose).

The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose).

The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose).

Outcomes

Primary Outcome Measures

Change in plasma glucagon levels from baseline to 0.5 hour after single-dose administration of drug.
Washout period of 2-6 weeks between the interventions
Change in plasma glucagon levels from baseline to 1 hour after single-dose administration of drug.
Change in plasma glucagon levels from baseline to 2 hours after single-dose administration of drug.
Change in plasma glucagon levels from baseline to 3 hours after single-dose administration of drug.
Change in plasma glucagon levels from baseline to 5 hours after single-dose administration of drug.
Change in plasma glucagon levels from baseline to 5.5 hours after single-dose administration of drug.
Change in plasma glucagon levels from baseline to 6 hours after single-dose administration of drug.
Change in plasma glucagon levels from baseline to 7 hours after single-dose administration of drug.

Secondary Outcome Measures

Full Information

First Posted
April 14, 2016
Last Updated
December 9, 2016
Sponsor
Uppsala University
Collaborators
AstraZeneca
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1. Study Identification

Unique Protocol Identification Number
NCT02765204
Brief Title
A Single-dose Cross-over Study to Assess Direct and Indirect Effects of Dapagliflozin on Pancreatic Alpha and Beta Cells in Patients With Type 2 Diabetes
Official Title
A Single-dose Cross-over Study to Assess Direct and Indirect Effects of Dapagliflozin on Pancreatic Alpha and Beta Cells in Patients With Type 2 Diabetes
Study Type
Interventional

2. Study Status

Record Verification Date
December 2016
Overall Recruitment Status
Completed
Study Start Date
March 2016 (undefined)
Primary Completion Date
December 2016 (Actual)
Study Completion Date
December 2016 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Uppsala University
Collaborators
AstraZeneca

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of this study is to evaluate if Dapagliflozin has direct effect on alpha cell glucagon release.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Type 2

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
15 (Actual)

8. Arms, Groups, and Interventions

Arm Title
DS-D-DG
Arm Type
Experimental
Arm Description
The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose).
Arm Title
DS-DG-D
Arm Type
Experimental
Arm Description
The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose).
Arm Title
D-DG-DS
Arm Type
Experimental
Arm Description
The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose).
Arm Title
D-DS-DG
Arm Type
Experimental
Arm Description
The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose).
Arm Title
DG-D-DS
Arm Type
Experimental
Arm Description
The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose).
Arm Title
DG-DS-D
Arm Type
Experimental
Arm Description
The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose).
Intervention Type
Drug
Intervention Name(s)
Dapagliflozin
Intervention Type
Drug
Intervention Name(s)
Saxagliptin
Intervention Type
Drug
Intervention Name(s)
Glucose
Primary Outcome Measure Information:
Title
Change in plasma glucagon levels from baseline to 0.5 hour after single-dose administration of drug.
Description
Washout period of 2-6 weeks between the interventions
Time Frame
At start and 0.5 hour after the start of each intervention
Title
Change in plasma glucagon levels from baseline to 1 hour after single-dose administration of drug.
Time Frame
At start and 1 hour after the start of each intervention
Title
Change in plasma glucagon levels from baseline to 2 hours after single-dose administration of drug.
Time Frame
At start and 2 hours after the start of each intervention
Title
Change in plasma glucagon levels from baseline to 3 hours after single-dose administration of drug.
Time Frame
At start and 3 hours after the start of each intervention
Title
Change in plasma glucagon levels from baseline to 5 hours after single-dose administration of drug.
Time Frame
At start and 5 hours after the start of each intervention
Title
Change in plasma glucagon levels from baseline to 5.5 hours after single-dose administration of drug.
Time Frame
At start and 5.5 hours after the start of each intervention
Title
Change in plasma glucagon levels from baseline to 6 hours after single-dose administration of drug.
Time Frame
At start and 6 hours after the start of each intervention
Title
Change in plasma glucagon levels from baseline to 7 hours after single-dose administration of drug.
Time Frame
At start and 7 hours after the start of each intervention

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Males and females aged 18 - 75. Female subjects must meet all of the following criteria: Not breastfeeding Negative pregnancy test result (human chorionic gonadotropin, beta subunit [hCG]) at Visit 0 (screening) (not applicable to hysterectomized females). If of childbearing potential (including perimenopausal women who have had a menstrual period within 1 year), must practice and be willing to continue to practice one of the following highly effective birth control methods during the entire duration of the study: i. Diaphragm or partner use of condom in combination with combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation: Oral Intravaginal Transdermal ii. Diaphragm or partner use of condom in combination with progestogen-only hormonal contraception associated with inhibition of ovulation: Oral Injectable Implantable iii. Placement of an intrauterine device iv. Placement of an intrauterine hormone-releasing system v. Bilateral tubal occlusion vi. Vasectomised partner (provided that the partner is the sole sexual partner of the female subject and that the vasectomised partner has received medical assessment of the surgical success) vii. Sexual abstinence (defined as refraining from heterosexual intercourse) d) Must practice appropriate birth control as stated above for 10 weeks after the last dose of study medication BMI 20 - 35. Clinical T2D diagnosis at least 6 months prior to enrolment. Metformin treatment, with stable dose for at least 1 month. HbA1c 55 - 86 mmol/mol (7,2-10 % DCCT). Exclusion Criteria: History or sign of any clinically significant disease or disorder which, in the opinion of the investigator, may either put the subject at risk because of participation in the study, or influence the results or the subject's ability to participate in the study. Clinical diagnosis of Type 1 diabetes mellitus and/or history of diabetic ketoacidosis or positive Glutamic Acid Decarboxylase Autoantibodies test (GAD antibodies test). Patients treated with antipsychotics, systemic glucocorticoids, neuropsychiatric stimulants, antidepressants with sympathetic activity, beta blockers or other pharmaceuticals rendering patient unfit for study participation as judged by the investigator. Patients treated with antidiabetic medications other than Metformin. Patients with any other endocrine disease except substituted hypothyroidism. Significant abnormal liver function defined as aspartate aminotransferase (AST) >3x upper limit of normal (ULN) and/or alanine aminotransferase (ALT) >3x ULN. Patients with impaired liver or kidney function (eGFR < 60). Known or suspected history of significant drug abuse. History of alcohol abuse or excessive intake of alcohol as judged by investigator. History of severe allergy/hypersensitivity or ongoing allergy/hypersensitivity, as judged by the investigator. Plasma donation within one month of screening or any blood donation or significant blood loss (> 400 ml) during the 3 months prior to screening. Any other condition with in the opinion of the investigator would render the patient unsuitable for inclusion in the study and /or for the patients safety. Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff and/or staff at the study site). Judgment by the investigator that the subject should not participate in the study if considers subject unlikely to comply with study procedures, restrictions and requirements.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jan W Eriksson, MD PhD
Organizational Affiliation
Uppsala University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Dept of Medical Sciences Uppsala University Hospital
City
Uppsala
ZIP/Postal Code
75185
Country
Sweden

12. IPD Sharing Statement

Citations:
PubMed Identifier
30137410
Citation
Lundkvist P, Pereira MJ, Kamble PG, Katsogiannos P, Langkilde AM, Esterline R, Johnsson E, Eriksson JW. Glucagon Levels During Short-Term SGLT2 Inhibition Are Largely Regulated by Glucose Changes in Patients With Type 2 Diabetes. J Clin Endocrinol Metab. 2019 Jan 1;104(1):193-201. doi: 10.1210/jc.2018-00969.
Results Reference
derived

Learn more about this trial

A Single-dose Cross-over Study to Assess Direct and Indirect Effects of Dapagliflozin on Pancreatic Alpha and Beta Cells in Patients With Type 2 Diabetes

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