Back to resultsEffect of Sodium-glucose Cotransporter-2 Inhibitor in Cellular Senescence in Patients With Cardiovascular Diseases or Type 2 Diabetes
Primary Purpose
Diabetes Mellitus, Cellular Senescence, Sodium-Glucose Transporter 2 Inhibitors
Status
Not yet recruiting
Phase
Phase 4
Locations
Korea, Republic of
Study Type
Interventional
Intervention
SGLT2 inhibitor
Glimepiride
Sponsored by
About this trial
This is an interventional treatment trial for Diabetes Mellitus
Eligibility Criteria
<Inclusion criteria for patients with type 2 diabetes and high risk cardiovascular disease> Patients with type 2 diabetes who meet the diagnostic criteria of standard practice guidelines Age between 50 and 85 Patients who signed the consent form Patients who meet at least one of the following as a high-risk group for cardiovascular disease: 1) History of myocardial infarction, within the last 3 months 2) Imaging proven coronary artery disease (2 or more coronary arteries or left main coronary artery disease) 3) History of ischemic or hemorrhagic cerebrovascular disease within the last 3 months 4) Imaging proven obstructive peripheral arterial disease 5) Intima media thickness more than 0.9mm or observed plaque 6) estimated glomerular filtration rate between 30-60 7) BMI more than 25kg/m2 accompanied two or more of the following are present: hypertension, current smoker, imaging proven steatohepatitis, alanine aminotransferase more than 40IU/L <Inclusion criteria for healthy people> Adults 19 years of age or older who do not meet the diagnostic criteria for metabolic syndrome, diabetes, or hyperlipidemia Patients not taking medications related to diabetes or hyperlipidemia BMI less than 25kg/m2 <Exclusion criteria> Those who are unable to participate in clinical trials due to other researchers' judgment Those who cannot read the consent form Patients who refused to fill out the research participation consent form Breastfeeding or pregnant women Type 1 diabetes adrenal insufficiency, growth hormone deficiency, pituitary disease Patients who have undergone bariatric surgery within the past 2 years or gastrointestinal surgery that can cause chronic malabsorption Patients who have taken anti-obesity drugs within the past month or who have received other treatments that can cause weight changes Patients with blood diseases that can cause hemolysis or abnormal red blood cells Patients with active cancer or undergoing chemotherapy Patients with liver disease and cirrhosis who are taking antiviral drugs Patients with autoimmune disease taking steroids and immunosuppressants Organ transplant patients Taking antibiotics or NSAIDs within the last 2 weeks Patients with acute infections in previous 3 months including COVID-19 Previous use of GLP-1 receptor agonist, thiazolidinedione, SGLT2 inhibitor Patients with severe hyperglycemia (HbA1c > 10%)
Sites / Locations
- Yonsei University College of Medicine
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Active Comparator
Arm Label
SGLT2 inhibitor user
Glimepiride user
Arm Description
Outcomes
Primary Outcome Measures
Changes of Cellular senescence markers
Changes of cellular senescence markers (CD57+CD28- T cell, CD87+ monocyte) between SGLT2 inhibitor users and glimepiride users
Secondary Outcome Measures
Changes of Senescence-associated secretory phenotype
SASP (Senescence-associated secretory phenotype) : IL-1/6, TNFa, MCP-1
Changes of Short physical performance battery score
Changes of biochemistry profiles in blood (10^3/μL)
- Changes in Biochemistry profiles in blood WBC count (10^3/μL), Platelet counts (10^3/μL)
Changes of biochemistry profiles in blood (g/dL)
- Changes in Biochemistry profiles in blood Hemoglobin (g/dL)
Changes of biochemistry profiles in blood (%)
- Changes in Biochemistry profiles in blood Hematocrit (%), HbA1c (%)
Changes of biochemistry profiles in blood (mg/dL)
- Changes in Biochemistry profiles in blood Creatinine (mg/dL), Total cholesterol (mg/dL), Triglyceride (mg/dL), HDL-cholesterol (mg/dL), Fasting glucose (mg/dL)
Changes of biochemistry profiles in blood (IU/L)
- Changes in Biochemistry profiles in blood AST (IU/L), ALT (IU/L), γ-Glutamyl transferase (IU/L)
Changes of biochemistry profiles in blood (mg/L)
- Changes in Biochemistry profiles in blood C-Reactive Protein(mg/L)
Changes of biochemistry profiles in blood (μEq/L)
- Changes in Biochemistry profiles in blood Free fatty acid-Fasting (μEq/L)
Changes of biochemistry profiles in blood (μU/mL)
- Changes in Biochemistry profiles in blood Fasting Insulin (μU/mL)
Changes of biochemistry profiles in blood (mmol/L)
- Changes in Biochemistry profiles in blood Beta-hydroxybutyrate (mmol/L)
Changes of body composition using Inbody (kg)
Changes of body composition using Inbody: Skeletal muscle mass (kg) Body fat mass (kg) Right arm muscle mass (kg) Left arm muscle mass (kg) Trunk muscle mass (kg) Right leg muscle mass (kg) Left leg muscle mass (kg)
Changes of body composition using Inbody (cm)
Changes of body composition using Inbody: Weight circumference (cm) Hip circumference (cm)
Changes of body composition using Inbody (cm2)
Changes of body composition using Inbody: Visceral fat area (cm2)
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT05975528
Brief Title
Effect of Sodium-glucose Cotransporter-2 Inhibitor in Cellular Senescence in Patients With Cardiovascular Diseases or Type 2 Diabetes
Official Title
Effect of Sodium-glucose Cotransporter-2 Inhibitor in Cellular Senescence in Patients With Cardiovascular Diseases or Advanced Type 2 Diabetes
Study Type
Interventional
2. Study Status
Record Verification Date
August 2023
Overall Recruitment Status
Not yet recruiting
Study Start Date
August 2023 (Anticipated)
Primary Completion Date
December 31, 2025 (Anticipated)
Study Completion Date
December 31, 2025 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Yonsei University
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Patients with type 2 diabetes (T2D) are more prevalent with aging-related comorbidities and frailty, which leads to a shorter life expectancy than non-diabetic individuals and that this excess mortality is largely attributable to cardiovascular causes.
Therefore, since diabetes accelerates cellular senescence, attenuating aging process in patients with T2D is expected to reduce progression of comorbidities and eventually increase lifespan.
According to previous studies, sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown increased ketone bodies not only in blood but in various tissues including liver, kidney and colon, which could lead to beneficial effects in metabolic diseases. Especially, β-hydroxybutyrate (βHB) inhibits oxidative stress and reduces insulin resistance, which has a positive effect on preventing cardio-renal-metabolic diseases and aging process in patients with T2D.
In this context, SGLT2 inhibitor can be a promising option to alleviate senescence process in patients with T2D. However, despite the accumulating evidence that support anti-senescent effect of SGLT2 inhibitor in preclinical models, no clinical study has investigated association between SGLT2 inhibitor use and senescence patients with T2D.
Thus, the objective of this study is to determine whether the use of SGLT2 inhibitor is associated with anti-senescent effect in patients with T2D, which may expand the indications of SGLT2 inhibitor other than glycemic control.
Detailed Description
<Study design>
Prospective study : Patients with type 2 diabetes who started antidiabetics for the first time or were taking antidiabetics (metformin-based monotherapy or 2- or 3- agent therapy), requiring additional glycemic control by either SGLT2 inhibitor and non-SGLT2 inhibitor(sulfonylurea) are enrolled in this study.
Drug administration period: Total 180 days, but non-SGLT2 inhibitor administration period is 3 months, and then changed to the SGLT2 inhibitor another 3 months. Health people are also recruited for comparison with patients with T2D.
Drug administration: For the SGLT2 inhibitor group, empagliflozin 10mg or dapagliflozin 10mg once daily is administered. For the non-SGLT2 inhibitor group (minimum glimepiride 1mg) was administered depending of the patient's glycemic status and hypoglycemic risk.
< Study methods>
After explaining the contents of the study and obtaining consent during hospitalization or outpatient visit, 20ml of additional whole blood is additionally obtained when blood is collected for routine medical purpose. Also, for those agreed to participate in the study, albuminuria and proteinuria are measured and the remaining specimens (5ml) are stored.
Among all patients participating in the study, blood and urine samples should be collected to measure the following parameters in each visit (1~3): fasting glucose, fasting insulin, fasting c-peptide, HbA1c, beta-hydroxybutyrate, free fatty acid-fasting, postprandial 90 min glucose/insulin/c-peptide, BUN, creatinine, eGFR, AST, ALT, ALP, GGT, total bilirubin, total protein, albumin, uric acid, total cholesterol, triglyceride, HDL, LDL, WBC, hemoglobin, hematocrit, platelet, c-reactive protein, urinalysis with microscopy. In addition, the following tests including liver fibroscan and body composition tests are conducted to check for diabetic complications.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Cellular Senescence, Sodium-Glucose Transporter 2 Inhibitors
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
87 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
SGLT2 inhibitor user
Arm Type
Experimental
Arm Title
Glimepiride user
Arm Type
Active Comparator
Intervention Type
Drug
Intervention Name(s)
SGLT2 inhibitor
Intervention Description
For the SGLT2 inhibitor group, total drug adminstration days are 180 days, but non-SGLT2 inhibitor administration period is 3 months, and then changed to the SGLT2 inhibitor another 3 months.
For the SGLT2 inhibitor group, empagliflozin 10mg or dapagliflozin 10mg once daily is administered.
Intervention Type
Drug
Intervention Name(s)
Glimepiride
Intervention Description
For non-SGLT2 inhibitor (glimepiride) administration period is 3 months, and then changed to the SGLT2 inhibitor another 3 months.
Primary Outcome Measure Information:
Title
Changes of Cellular senescence markers
Description
Changes of cellular senescence markers (CD57+CD28- T cell, CD87+ monocyte) between SGLT2 inhibitor users and glimepiride users
Time Frame
Changes from baseline to 3 months after use of SGLT2 inhibitors
Secondary Outcome Measure Information:
Title
Changes of Senescence-associated secretory phenotype
Description
SASP (Senescence-associated secretory phenotype) : IL-1/6, TNFa, MCP-1
Time Frame
Changes from baseline to 3 months/6 months after use of SGLT2 inhibitors
Title
Changes of Short physical performance battery score
Time Frame
Changes from baseline to 3 months/6 months after use of SGLT2 inhibitors
Title
Changes of biochemistry profiles in blood (10^3/μL)
Description
- Changes in Biochemistry profiles in blood WBC count (10^3/μL), Platelet counts (10^3/μL)
Time Frame
Changes from baseline to 3 months/6 months after use of SGLT2 inhibitors
Title
Changes of biochemistry profiles in blood (g/dL)
Description
- Changes in Biochemistry profiles in blood Hemoglobin (g/dL)
Time Frame
Changes from baseline to 3 months/6 months after use of SGLT2 inhibitors
Title
Changes of biochemistry profiles in blood (%)
Description
- Changes in Biochemistry profiles in blood Hematocrit (%), HbA1c (%)
Time Frame
Changes from baseline to 3 months/6 months after use of SGLT2 inhibitors
Title
Changes of biochemistry profiles in blood (mg/dL)
Description
- Changes in Biochemistry profiles in blood Creatinine (mg/dL), Total cholesterol (mg/dL), Triglyceride (mg/dL), HDL-cholesterol (mg/dL), Fasting glucose (mg/dL)
Time Frame
Changes from baseline to 3 months/6 months after use of SGLT2 inhibitors
Title
Changes of biochemistry profiles in blood (IU/L)
Description
- Changes in Biochemistry profiles in blood AST (IU/L), ALT (IU/L), γ-Glutamyl transferase (IU/L)
Time Frame
Changes from baseline to 3 months/6 months after use of SGLT2 inhibitors
Title
Changes of biochemistry profiles in blood (mg/L)
Description
- Changes in Biochemistry profiles in blood C-Reactive Protein(mg/L)
Time Frame
Changes from baseline to 3 months/6 months after use of SGLT2 inhibitors
Title
Changes of biochemistry profiles in blood (μEq/L)
Description
- Changes in Biochemistry profiles in blood Free fatty acid-Fasting (μEq/L)
Time Frame
Changes from baseline to 3 months/6 months after use of SGLT2 inhibitors
Title
Changes of biochemistry profiles in blood (μU/mL)
Description
- Changes in Biochemistry profiles in blood Fasting Insulin (μU/mL)
Time Frame
Changes from baseline to 3 months/6 months after use of SGLT2 inhibitors
Title
Changes of biochemistry profiles in blood (mmol/L)
Description
- Changes in Biochemistry profiles in blood Beta-hydroxybutyrate (mmol/L)
Time Frame
Changes from baseline to 3 months/6 months after use of SGLT2 inhibitors
Title
Changes of body composition using Inbody (kg)
Description
Changes of body composition using Inbody: Skeletal muscle mass (kg) Body fat mass (kg) Right arm muscle mass (kg) Left arm muscle mass (kg) Trunk muscle mass (kg) Right leg muscle mass (kg) Left leg muscle mass (kg)
Time Frame
Changes from baseline to 3 months/6 months after use of SGLT2 inhibitors
Title
Changes of body composition using Inbody (cm)
Description
Changes of body composition using Inbody: Weight circumference (cm) Hip circumference (cm)
Time Frame
Changes from baseline to 3 months/6 months after use of SGLT2 inhibitors
Title
Changes of body composition using Inbody (cm2)
Description
Changes of body composition using Inbody: Visceral fat area (cm2)
Time Frame
Changes from baseline to 3 months/6 months after use of SGLT2 inhibitors
10. Eligibility
Sex
All
Minimum Age & Unit of Time
50 Years
Maximum Age & Unit of Time
85 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
<Inclusion criteria for patients with type 2 diabetes and high risk cardiovascular disease>
Patients with type 2 diabetes who meet the diagnostic criteria of standard practice guidelines
Age between 50 and 85
Patients who signed the consent form
Patients who meet at least one of the following as a high-risk group for cardiovascular disease:
1) History of myocardial infarction, within the last 3 months 2) Imaging proven coronary artery disease (2 or more coronary arteries or left main coronary artery disease) 3) History of ischemic or hemorrhagic cerebrovascular disease within the last 3 months 4) Imaging proven obstructive peripheral arterial disease 5) Intima media thickness more than 0.9mm or observed plaque 6) estimated glomerular filtration rate between 30-60 7) BMI more than 25kg/m2 accompanied two or more of the following are present: hypertension, current smoker, imaging proven steatohepatitis, alanine aminotransferase more than 40IU/L
<Inclusion criteria for healthy people>
Adults 19 years of age or older who do not meet the diagnostic criteria for metabolic syndrome, diabetes, or hyperlipidemia
Patients not taking medications related to diabetes or hyperlipidemia
BMI less than 25kg/m2
<Exclusion criteria>
Those who are unable to participate in clinical trials due to other researchers' judgment
Those who cannot read the consent form
Patients who refused to fill out the research participation consent form
Breastfeeding or pregnant women
Type 1 diabetes
adrenal insufficiency, growth hormone deficiency, pituitary disease
Patients who have undergone bariatric surgery within the past 2 years or gastrointestinal surgery that can cause chronic malabsorption
Patients who have taken anti-obesity drugs within the past month or who have received other treatments that can cause weight changes
Patients with blood diseases that can cause hemolysis or abnormal red blood cells
Patients with active cancer or undergoing chemotherapy
Patients with liver disease and cirrhosis who are taking antiviral drugs
Patients with autoimmune disease taking steroids and immunosuppressants
Organ transplant patients
Taking antibiotics or NSAIDs within the last 2 weeks
Patients with acute infections in previous 3 months including COVID-19
Previous use of GLP-1 receptor agonist, thiazolidinedione, SGLT2 inhibitor
Patients with severe hyperglycemia (HbA1c > 10%)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Yong-ho Lee
Phone
02-2228-9143
Email
YHOLEE@yuhs.ac
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Yong-ho Lee
Organizational Affiliation
Department of Internal medicine, Yonsei University College of Medicine
Official's Role
Principal Investigator
Facility Information:
Facility Name
Yonsei University College of Medicine
City
Seoul
Country
Korea, Republic of
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Yong-ho Lee
Phone
02-2228-9143
Email
YHOLEE@yuhs.ac
12. IPD Sharing Statement
Plan to Share IPD
No
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Effect of Sodium-glucose Cotransporter-2 Inhibitor in Cellular Senescence in Patients With Cardiovascular Diseases or Type 2 Diabetes
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