Dapagliflozin in Physical Exercise in Type 1 Diabetes
Primary Purpose
Diabetes Mellitus, Type 1
Status
Completed
Phase
Phase 3
Locations
Switzerland
Study Type
Interventional
Intervention
Forxiga 10mg
Placebo
Sponsored by
About this trial
This is an interventional basic science trial for Diabetes Mellitus, Type 1
Eligibility Criteria
Inclusion Criteria:
- Written informed consent
- Diagnosis of T1DM
- Duration of T1DM > 5 years
- Male or female sex
- Insulin therapy via multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII)
- Body mass index (BMI) between 20 and 29 kg/m2
- Adherence to sufficient contraceptive measures (double barrier method combining hormonal with mechanical barriers).
- Ability to perform a 60 minutes exercise session at 50% VO2max.
Exclusion Criteria:
- Diagnosis of renal and/or hepatic dysfunction
- History of malignancy of any kind
- Intake of drugs influencing glucose homeostasis during the last three months
- Alcohol or drug abuse
- Inadequate vein status on both forearms
- Active smoker
- Known pregnancy, positive plasma beta human choriogonadotropine test prior to study inclusion or intention to become pregnant during the study period.
Sites / Locations
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Arms of the Study
Arm 1
Arm 2
Arm Type
Experimental
Experimental
Arm Label
Dapagliflozin first, placebo second
Placebo first, Dapagliflozin second
Arm Description
Dapagliflozin followed by placebo
Placebo followed by dapagliflozin
Outcomes
Primary Outcome Measures
Mean Amplitude of Glucose Excursions (MAGE) after physical exercise
MAGE will be calculated via sensor glucose measurements obtained over 72 hours after physical exercise
Secondary Outcome Measures
Area under the curve for glucagon-like peptide I before, during and after physical exercise
Glucagon-like peptide I will be measured at the beginning, during and after physical exercise following each intervention period
Area under the curve for glucagon before, during and after physical exercise
Glucagon will be measured at the beginning, during and after physical exercise following each intervention period
Full Information
NCT ID
NCT04049110
First Posted
August 5, 2019
Last Updated
August 30, 2023
Sponsor
Insel Gruppe AG, University Hospital Bern
1. Study Identification
Unique Protocol Identification Number
NCT04049110
Brief Title
Dapagliflozin in Physical Exercise in Type 1 Diabetes
Official Title
SGLT-2 Inhibition Using Dapagliflozin During and After Physical Exercise - Effects on Glycemic Variability, Hormonal Regulators of Glucose Homeostasis and Ketone Body in Type 1 Diabetes - a Randomized, Placebo-controlled, Open-label, Cross-over Intervention Study
Study Type
Interventional
2. Study Status
Record Verification Date
August 2023
Overall Recruitment Status
Completed
Study Start Date
August 25, 2020 (Actual)
Primary Completion Date
April 26, 2023 (Actual)
Study Completion Date
May 10, 2023 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Insel Gruppe AG, University Hospital Bern
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
Inhibitors of sodium-dependent glucose-transporter 2 (SGLT-2 inhibitors, including dapagliflozin) inhibit glucose reabsorption in renal tubular cells, hereby increasing glycosuria in the hyperglycemic state. Its mechanisms of action are independent of insulin, which makes SGLT-2 inhibitors a potential adjunct to insulin in type 1 diabetes mellitus (T1DM).
However, a higher risk for diabetic ketoacidosis (DKA) was reported in patients with T1DM taking SGLT-2 inhibitors. DKA depends on an accumulation of ketone bodies in the blood stream, which equals an accumulation of acids that lead to acidosis. The underlying mechanisms of this observation are unknown. Ketone body production depends on the molar ratio of glucagon to insulin, with insulin suppressing but glucagon stimulating ketone body production. This translates into higher production during relative insulin deficiency, carbohydrate deficiency, and prolonged fasting, which occurs during sickness but also physical exercise. Physical exercise is a recommended cornerstone in the treatment of T1DM and current treatment guidelines recommend both, reductions of insulin doses and ingestion of additional carbohydrates to avoid hypoglycemic events. These adaptions might increase relative insulin deficiency, hyperglycemia and glycaemic variability, which might in turn promote ketone body production. The addition of SGLT-2 inhibitors further may promote ketogenesis even though there are reports of SGLT-2 inhibitors increase Glucagon-like-peptide-1 (GLP-1) in patients with T1DM. GLP-1 is a suppressor of glucagon secretion. In summary, knowledge about the effects of SGLT-2 inhibition on ketone body production is scarce, especially during exercise in patients with T1DM.
The study seeks to illustrate the effect of SGLT-2 inhibition on glycemic variability and ketone body production during and after recreational exercise in patients with T1DM. The results of study 2 will provide the basis for future studies investigating the underlying mechanisms of potentially modified ketone body production during and after exercise under SGLT-2 inhibition.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Type 1
7. Study Design
Primary Purpose
Basic Science
Study Phase
Phase 3
Interventional Study Model
Crossover Assignment
Model Description
Randomized, placebo-controlled, open-label, crossover
Masking
None (Open Label)
Allocation
Randomized
Enrollment
39 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Dapagliflozin first, placebo second
Arm Type
Experimental
Arm Description
Dapagliflozin followed by placebo
Arm Title
Placebo first, Dapagliflozin second
Arm Type
Experimental
Arm Description
Placebo followed by dapagliflozin
Intervention Type
Drug
Intervention Name(s)
Forxiga 10mg
Other Intervention Name(s)
Dapagliflozin
Intervention Description
Dapagliflozin 10mg per 24 hours, oral, for 7 consecutive days
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo 1 tablet per 24 hours, oral, for 7 consecutive days
Primary Outcome Measure Information:
Title
Mean Amplitude of Glucose Excursions (MAGE) after physical exercise
Description
MAGE will be calculated via sensor glucose measurements obtained over 72 hours after physical exercise
Time Frame
From completion of physical exercise at day 7 of each intervention period to 72 hours after
Secondary Outcome Measure Information:
Title
Area under the curve for glucagon-like peptide I before, during and after physical exercise
Description
Glucagon-like peptide I will be measured at the beginning, during and after physical exercise following each intervention period
Time Frame
From time-point 0 to 120 minutes before, during and after physical exercise session
Title
Area under the curve for glucagon before, during and after physical exercise
Description
Glucagon will be measured at the beginning, during and after physical exercise following each intervention period
Time Frame
From time-point 0 to 120 minutes before, during and after physical exercise session
Other Pre-specified Outcome Measures:
Title
Area under the curve for ketone bodies before, during and after physical exercise
Description
Ketone bodies will be measured at the beginning, during and after physical exercise
Time Frame
From time-point 0 to 120 minutes before, during and after physical exercise session
Title
Area under the curve for free fatty acids bodies before, during and after physical exercise
Description
Free fatty acids will be measured at the beginning, during and after physical exercise
Time Frame
From time-point 0 to 120 minutes before, during and after physical exercise session
Title
Area under the curve for somatostatin before, during and after physical exercise
Description
Somatostatin will be measured at the beginning, during and after physical exercise
Time Frame
From time-point 0 to 120 minutes before, during and after physical exercise session
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Written informed consent
Diagnosis of T1DM
Duration of T1DM > 5 years
Male or female sex
Insulin therapy via multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII)
Body mass index (BMI) between 20 and 29 kg/m2
Adherence to sufficient contraceptive measures (double barrier method combining hormonal with mechanical barriers).
Ability to perform a 60 minutes exercise session at 50% VO2max.
Exclusion Criteria:
Diagnosis of renal and/or hepatic dysfunction
History of malignancy of any kind
Intake of drugs influencing glucose homeostasis during the last three months
Alcohol or drug abuse
Inadequate vein status on both forearms
Active smoker
Known pregnancy, positive plasma beta human choriogonadotropine test prior to study inclusion or intention to become pregnant during the study period.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Christoph Stettler, Prof. MD
Organizational Affiliation
Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, University Clinics Bern, Inselspital, Bern, Switzerland
Official's Role
Principal Investigator
Facility Information:
Facility Name
Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
City
Bern
ZIP/Postal Code
3010
Country
Switzerland
12. IPD Sharing Statement
Plan to Share IPD
Yes
IPD Sharing Time Frame
From July, 30th 2021 ongoing
IPD Sharing Access Criteria
Contact with the Study Sponsor
Learn more about this trial
Dapagliflozin in Physical Exercise in Type 1 Diabetes
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