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Effects of 2 Weeks Treatment With Dapagliflozin in Subjects With an Impaired Glucose Homeostasis on Nocturnal Substrate Oxidation (MaasFlex)

Primary Purpose

Prediabetic State, Substrate Oxidation

Status
Completed
Phase
Phase 4
Locations
Netherlands
Study Type
Interventional
Intervention
Dapagliflozin 10mg
Placebo matching to Dapagliflozin 10 mg
Sponsored by
Maastricht University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Prediabetic State focused on measuring Dapagliflozin, Disrupted glucose homeostasis, Nocturnal substrate oxidation, Glucose metabolism

Eligibility Criteria

40 Years - 75 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Provision of signed and dated informed consent prior to any study specific procedures.
  2. Males aged ≥ 40 and ≤ 75 years and post-menopausal women (defined as at least 1 year post cessation of menses) aged ≥ 50 and ≤ 75 years
  3. Body mass index (BMI) ≥ 27 and ≤ 38 kg/m2.
  4. Sedentary lifestyle (not more than 3 hours of programmed exercise per week).
  5. Stable dietary habits.
  6. Impaired glucose homeostasis based on one or a combination of the following criteria:

    • Impaired Glucose Tolerance (IGT): plasma glucose values ≥ 7.8 mmol/l and ≤ 11.1 mmol/l 120 minutes after consumption of the glucose drink during the 2h, 3-point OGTT.
    • Impaired Fasting Glucose (IFG): fasting plasma glucose ≥ 6.1 mmol/l and ≤ 6.9 mmol/l.
    • Insulin Resistance: glucose clearance rate ≤ 360 ml/kg/min, as calculated by Oral Glucose Insulin Sensitivity 120 (OGIS120) model based on the 2h, 3-point OGTT.
    • HbA1c ≥ 5.7% and ≤ 6.4%.

Exclusion Criteria:

  1. Clinical diagnosis of Type 1 or 2 Diabetes Mellitus.
  2. Active cardiovascular disease: participants who experienced a heart attack in the last year, or participants who are currently under regular control of a physician for a heart condition.
  3. Weight gain or loss > 5 kg in the last 3 months, ongoing weight-loss diet (hypocaloric diet) or use of weight loss agents.
  4. Regular smoking and other regular nicotine use.
  5. Anaemia.
  6. Uncontrolled hypertension.
  7. Clinically significant out of range values of serum levels of either alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) in the Investigator's opinion.
  8. Unstable or rapidly progressing renal disease or estimated Glomerular Filtration Rate (eGFR) <60 mL/min (Cockcroft-Gault formula).
  9. Use of anti-coagulant treatment and other concomitant medication will be evaluated on a case to case basis with a general physician.
  10. Use of medication such as oral glucocorticoids, anti-estrogens or other medications that are known to markedly influence insulin sensitivity.
  11. Use of loop diuretics.
  12. Intake of dietary supplements except multi-vitamins and minerals.
  13. Alcohol consumption of > 14 drinks per week for women and > 21 drinks per week for men (1 drink = 35 cl beer, 14 cl wine or 4 cl hard liquor).
  14. Known hypersensitivity to dapagliflozin or any of the excipients of the product.
  15. For women only - currently pregnant (confirmed with positive pregnancy test) or breast-feeding.
  16. Participation in another biomedical study within 1 month before the screening visit.
  17. Any contraindication for MRI scanning.
  18. Participants who do not want to be informed about unexpected medical findings, or do not wish that their physician be informed about coincidental findings, cannot participate in the study.

Sites / Locations

  • Maastricht University and Medical Centre

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Dapagliflozin 10 mg

Placebo matching to dapagliflozin 10 mg

Arm Description

Patients will receive dapagliflozin 10 mg in tablet for a maximum of 14 days based on randomization sequence in Period 1. Patients that received 10 mg dapagliflozin in the first treatment period will receive matching placebo in the second treatment period for a maximum of 14 days.

Patients will receive matching placebo in tablet for a maximum of 14 days based on randomization sequence. Patients who received placebo in the first treatment will receive 10 mg dapagliflozin in the second treatment period, for a maximum of 14 days

Outcomes

Primary Outcome Measures

Change in nightly substrate oxidation measured as respiration quotient (RQ) during the sleeping period
Comparison of dapagliflozin versus placebo after 14 days of treatment on nightly substrate oxidation as measured by respiratory quotient (VCO2/VO2) during the sleeping period.

Secondary Outcome Measures

Change in morning and late afternoon hepatic glycogen content
Comparison of dapagliflozin versus placebo after 14 days of treatment on hepatic glycogen content determined by non-invasive 13C-MRS (magnetic resonance spectroscopy) in the morning and evening
Change in 24h substrate oxidation as determined by indirect calorimetry in a whole-body respiratory chamber and based on urinary nitrogen excretion
Comparison of dapagliflozin versus placebo after 14 days of treatment on 24h substrate oxidation as determined by indirect calorimetry in a whole-body respiratory chamber and based on urinary nitrogen excretion
Change in 24h plasma markers
Comparison of dapagliflozin versus placebo after 14 days of treatment on 24h plasma markers including plasma glucose, NEFA, total amino acid levels incl BCAA levels, insulin and glucagon
Change in muscle mitochondrial function
Comparison of dapagliflozin versus placebo after 14 days of treatment on muscle mitochondrial function as determined by high resolution respirometry
Change in intrahepatic lipid content and composition
Comparison of dapagliflozin versus placebo after 14 days of treatment on intrahepatic lipid content and composition as determined by non-invasive 1H-MRS (magnetic resonance spectroscopy )
Change in intramyocellular lipid content and composition - including acylcarnitine levels
Comparison of dapagliflozin versus placebo after 14 days of treatment on intramyocellular lipid content and composition-including acylcarnitine levels as determined in muscle biopsies
Change in muscle glycogen content
Comparison of dapagliflozin versus placebo after 14 days of treatment on muscle glycogen content as determined biochemically in muscle biopsies
Change in systolic and diastolic blood pressure
Comparison of dapagliflozin versus placebo after 14 days of treatment on systolic and diastolic blood pressure

Full Information

First Posted
October 23, 2018
Last Updated
August 18, 2021
Sponsor
Maastricht University
Collaborators
AstraZeneca
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1. Study Identification

Unique Protocol Identification Number
NCT03721874
Brief Title
Effects of 2 Weeks Treatment With Dapagliflozin in Subjects With an Impaired Glucose Homeostasis on Nocturnal Substrate Oxidation
Acronym
MaasFlex
Official Title
MaasFlex: Double-Blind, Randomized, Phase IV, Mechanistic, Placebo-Controlled, Cross-Over, Single-Center Study to Evaluate the Effects of 2 Weeks Dapagliflozin Treatment on Nocturnal Substrate Oxidation, Glucose Metabolism and Muscle Mitochondrial Function in Individuals With Impaired Glucose Homeostasis
Study Type
Interventional

2. Study Status

Record Verification Date
August 2021
Overall Recruitment Status
Completed
Study Start Date
April 30, 2019 (Actual)
Primary Completion Date
June 29, 2021 (Actual)
Study Completion Date
June 29, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Maastricht University
Collaborators
AstraZeneca

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to investigate the effect of 2 weeks dapagliflozin treatment in individuals with a disrupted glucose homeostasis on the switch between carbohydrate and lipid oxidation during the night
Detailed Description
To investigate if dapagliflozin improves nocturnal substrate oxidation expressed as respiration quotient (RQ) during the sleeping period in comparison with placebo after 2-weeks double blind treatment in subjects with a disrupted glucose homeostasis.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Prediabetic State, Substrate Oxidation
Keywords
Dapagliflozin, Disrupted glucose homeostasis, Nocturnal substrate oxidation, Glucose metabolism

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 4
Interventional Study Model
Crossover Assignment
Model Description
Double-Blind, Randomized, Phase IV, Mechanistic, Placebo-Controlled, Cross-Over, Single-Center Study
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
16 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Dapagliflozin 10 mg
Arm Type
Active Comparator
Arm Description
Patients will receive dapagliflozin 10 mg in tablet for a maximum of 14 days based on randomization sequence in Period 1. Patients that received 10 mg dapagliflozin in the first treatment period will receive matching placebo in the second treatment period for a maximum of 14 days.
Arm Title
Placebo matching to dapagliflozin 10 mg
Arm Type
Placebo Comparator
Arm Description
Patients will receive matching placebo in tablet for a maximum of 14 days based on randomization sequence. Patients who received placebo in the first treatment will receive 10 mg dapagliflozin in the second treatment period, for a maximum of 14 days
Intervention Type
Drug
Intervention Name(s)
Dapagliflozin 10mg
Intervention Description
The study consist of 2 weeks treatment period 1, 6-8 weeks wash-out period and 2 weeks treatment period 2. The subject may be administered dapagliflozin 10 mg during Period 1 or Period 2.
Intervention Type
Drug
Intervention Name(s)
Placebo matching to Dapagliflozin 10 mg
Intervention Description
The study consist of 2 weeks treatment period 1, 6-8 weeks wash-out period and 2 weeks treatment period 2. The subject may be administered placebo during Period 1 or Period 2.
Primary Outcome Measure Information:
Title
Change in nightly substrate oxidation measured as respiration quotient (RQ) during the sleeping period
Description
Comparison of dapagliflozin versus placebo after 14 days of treatment on nightly substrate oxidation as measured by respiratory quotient (VCO2/VO2) during the sleeping period.
Time Frame
From screening to day 14
Secondary Outcome Measure Information:
Title
Change in morning and late afternoon hepatic glycogen content
Description
Comparison of dapagliflozin versus placebo after 14 days of treatment on hepatic glycogen content determined by non-invasive 13C-MRS (magnetic resonance spectroscopy) in the morning and evening
Time Frame
1 hour
Title
Change in 24h substrate oxidation as determined by indirect calorimetry in a whole-body respiratory chamber and based on urinary nitrogen excretion
Description
Comparison of dapagliflozin versus placebo after 14 days of treatment on 24h substrate oxidation as determined by indirect calorimetry in a whole-body respiratory chamber and based on urinary nitrogen excretion
Time Frame
24 hours
Title
Change in 24h plasma markers
Description
Comparison of dapagliflozin versus placebo after 14 days of treatment on 24h plasma markers including plasma glucose, NEFA, total amino acid levels incl BCAA levels, insulin and glucagon
Time Frame
24 hours
Title
Change in muscle mitochondrial function
Description
Comparison of dapagliflozin versus placebo after 14 days of treatment on muscle mitochondrial function as determined by high resolution respirometry
Time Frame
60 minutes
Title
Change in intrahepatic lipid content and composition
Description
Comparison of dapagliflozin versus placebo after 14 days of treatment on intrahepatic lipid content and composition as determined by non-invasive 1H-MRS (magnetic resonance spectroscopy )
Time Frame
45 minutes
Title
Change in intramyocellular lipid content and composition - including acylcarnitine levels
Description
Comparison of dapagliflozin versus placebo after 14 days of treatment on intramyocellular lipid content and composition-including acylcarnitine levels as determined in muscle biopsies
Time Frame
45 minutes
Title
Change in muscle glycogen content
Description
Comparison of dapagliflozin versus placebo after 14 days of treatment on muscle glycogen content as determined biochemically in muscle biopsies
Time Frame
45 minutes
Title
Change in systolic and diastolic blood pressure
Description
Comparison of dapagliflozin versus placebo after 14 days of treatment on systolic and diastolic blood pressure
Time Frame
45 minutes

10. Eligibility

Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Provision of signed and dated informed consent prior to any study specific procedures. Males aged ≥ 40 and ≤ 75 years and post-menopausal women (defined as at least 1 year post cessation of menses) aged ≥ 50 and ≤ 75 years Body mass index (BMI) ≥ 27 and ≤ 38 kg/m2. Sedentary lifestyle (not more than 3 hours of programmed exercise per week). Stable dietary habits. Impaired glucose homeostasis based on one or a combination of the following criteria: Impaired Glucose Tolerance (IGT): plasma glucose values ≥ 7.8 mmol/l and ≤ 11.1 mmol/l 120 minutes after consumption of the glucose drink during the 2h, 3-point OGTT. Impaired Fasting Glucose (IFG): fasting plasma glucose ≥ 6.1 mmol/l and ≤ 6.9 mmol/l. Insulin Resistance: glucose clearance rate ≤ 360 ml/kg/min, as calculated by Oral Glucose Insulin Sensitivity 120 (OGIS120) model based on the 2h, 3-point OGTT. HbA1c ≥ 5.7% and ≤ 6.4%. Exclusion Criteria: Clinical diagnosis of Type 1 or 2 Diabetes Mellitus. Active cardiovascular disease: participants who experienced a heart attack in the last year, or participants who are currently under regular control of a physician for a heart condition. Weight gain or loss > 5 kg in the last 3 months, ongoing weight-loss diet (hypocaloric diet) or use of weight loss agents. Regular smoking and other regular nicotine use. Anaemia. Uncontrolled hypertension. Clinically significant out of range values of serum levels of either alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) in the Investigator's opinion. Unstable or rapidly progressing renal disease or estimated Glomerular Filtration Rate (eGFR) <60 mL/min (Cockcroft-Gault formula). Use of anti-coagulant treatment and other concomitant medication will be evaluated on a case to case basis with a general physician. Use of medication such as oral glucocorticoids, anti-estrogens or other medications that are known to markedly influence insulin sensitivity. Use of loop diuretics. Intake of dietary supplements except multi-vitamins and minerals. Alcohol consumption of > 14 drinks per week for women and > 21 drinks per week for men (1 drink = 35 cl beer, 14 cl wine or 4 cl hard liquor). Known hypersensitivity to dapagliflozin or any of the excipients of the product. For women only - currently pregnant (confirmed with positive pregnancy test) or breast-feeding. Participation in another biomedical study within 1 month before the screening visit. Any contraindication for MRI scanning. Participants who do not want to be informed about unexpected medical findings, or do not wish that their physician be informed about coincidental findings, cannot participate in the study.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Patrick Schrauwen, Prof. dr.
Organizational Affiliation
principle investigator
Official's Role
Principal Investigator
Facility Information:
Facility Name
Maastricht University and Medical Centre
City
Maastricht
State/Province
Limburg
ZIP/Postal Code
6200 MD
Country
Netherlands

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

Effects of 2 Weeks Treatment With Dapagliflozin in Subjects With an Impaired Glucose Homeostasis on Nocturnal Substrate Oxidation

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