Evaluation of the Tubular Effects of Dapagliflozin Using 1HNMR Spectroscopy

NCT ID: NCT02798757

Last Updated: 2019-04-19

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE4
• Total Enrollment: 50 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2016-06-30
• Study Completion Date: 2018-08-31

Brief Summary

This is a phase IV study that will explore the mechanisms of action of a drug (dapagliflozin) that is already commercially available in the country where the study will be conducted (Greece). The drug will be used according to its approved clinical indications (as add-on treatment in patients failed to achieve glycemic targets on metformin monotherapy) and in the approved posology (10 mg/day). Additionally, although there is limited data on the coadministration of dapagliflozin with thiazides, the excellent safety profile of the drug even when it is used in combination with drugs that induce significant volume depletion (such as loop diuretics) suggests that, in properly selected patients, the possibility of important adverse events during the coadministration of dapagliflozin with chlorthalidone is very low. All patients will give written informed consent prior to their enrollment in the study. The study protocol will be approved by the scientific committee of the University Hospital of Ioannina.

Detailed Description

Fifty patients with type 2 diabetes on metformin monotherapy with HbA1c > 7% and blood pressure > 140/90 mmHg will be included. All eligible patients will be given dapagliflozin 10 mg qd for 3 months. Routine laboratory parameters that will be measured on each visit include: 1) for serum samples: glucose, urea, creatinine, uric acid, electrolytes (sodium, potassium, chloride, calcium, phosphate and magnesium and 2) for urine samples: glucose, urea, creatinine, uric acid, electrolytes (sodium, potassium, chloride, calcium, phosphate and magnesium) and alpha-1 microglobulin. It is well known that alpha-1 microglobulin is a low-molecular weight protein that is normally filtered by renal glomeruli and reabsorbed by the proximal tubular cells. Increased excretion of alpha1-microglobulin has been proposed as a non-invasive marker for the diagnosis and monitoring of early tubular disorders such as diabetic nephropathy. In addition, the fractional excretion values (FE) of the electrolytes will be calculated using the formula: FEA(%) = (UrineA/SerumA) /(UrineCr/SerumCr) × 100.

The 1HΝMR spectra of urine samples will be recorded on a 500 MHz spectrometer. In the present study, the main low molecular weight (LMW) constituents of urine that will be quantified are 1) metabolites such as glucose, creatinine, creatine, choline, taurine, dimethylamine, betaine, trimethylaminoxide 2) amino acids such as glycine, valine, alanine, leucine, histidine, lysine, threonine and 3) organic acids such as citrate, hippurate, lactate, acetate, succinate, and formate. In addition, 1HNMR methodology allows for the detection of changes in the concentrations of hundreds of metabolites. These substances are normally present in traces, whereas in pathological conditions their concentrations can be found increased.

Conditions

Diabetes

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Dapagliflozin

All patients will take dapagliflozin, the intervention does not refer to a drug or device but to the specific 1HNMR test spectroscopy

Group Type: EXPERIMENTAL

Dapagliflozin

Intervention Type: DRUG

Urine samples will be collected for 1HNMR spectroscopies

Interventions

Dapagliflozin

Urine samples will be collected for 1HNMR spectroscopies

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

1. Provision of informed consent prior to any study specific procedures

2. Female and/or male aged 18-70 years. Women with childbearing potential can only be included in the study if a serological pregnancy test is negative and a safe contraception method is used throughout the study.

3. Uncontrolled type 2 diabetes mellitus (HbA1c > 7%) on metformin monotherapy (≥ 2000 mg qd or maximum tolerated dose)

4. Stage 1 hypertension (BP 140-159/90-99 mmHg)

Exclusion Criteria

1. Known primary kidney disease (eGFR < 60 ml/min)

2. History of cardiovascular disease

3. Type 1 diabetes

4. History of heart failure

5. Diseases that shorten the life expectancy (cancers, degenerative neurological disorders etc.)

6. Pregnancy-lactation

7. Patients with eGFR values lower than 45 ml/min (on repeated measurements) during the study period will be excluded

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Ioannina

OTHER

Sponsor Role: lead

Responsible Party

Ass Prof Vasilis Tsimihodimos

Assistant Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

University of Ioannina

Ioannina, , Greece

Countries

Greece

References

Filippas-Ntekouan S, Dimou A, Dafopoulos P, Kostara C, Bairaktari E, Chasapi S, Spyroulias G, Koufakis T, Koutsovasilis A, Tsimihodimos V. Effect of dapagliflozin on the serum metabolome in patients with type 2 diabetes mellitus. J Diabetes Metab Disord. 2024 Dec 16;24(1):4. doi: 10.1007/s40200-024-01508-1. eCollection 2025 Jun.

Reference Type: DERIVED

PMID: 39697865 (View on PubMed)

Bletsa E, Filippas-Dekouan S, Kostara C, Dafopoulos P, Dimou A, Pappa E, Chasapi S, Spyroulias G, Koutsovasilis A, Bairaktari E, Ferrannini E, Tsimihodimos V. Effect of Dapagliflozin on Urine Metabolome in Patients with Type 2 Diabetes. J Clin Endocrinol Metab. 2021 Apr 23;106(5):1269-1283. doi: 10.1210/clinem/dgab086.

Reference Type: DERIVED

PMID: 33592103 (View on PubMed)

Other Identifiers

ESR-14-10613 - D1690L00044

Identifier Type: -

Identifier Source: org_study_id