Novel Antidiabetic Medications and Their Effect on Liver Steatosis (NAMELS-18)

NCT ID: NCT05946148

Last Updated: 2023-07-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

78 participants

Study Classification

OBSERVATIONAL

Study Start Date

2018-06-01

Study Completion Date

2021-05-31

Brief Summary

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The goal of this clinical study is to compare the therapeutic effect of Dulaglutide and Empagliflozin in patients with Diabetes Mellitus type 2 and Non-Alcoholic Fatty Liver Disease. The main question it aims to answer is: Is there a beneficial effect regarding liver steatosis in patients receiving either of these 2 medications and which is more effective? Patients will undergo shearwave elastography, magnetic resonance imaging, and ultrasound. Furthermore, calculation of the Fatty Liver Index (FLI), the Fibrosis-4 Index (FIB-4), as well as the Aspartate Aminotransferase to Platelet ratio Index (APRI) and the NAFLD Fibrosis Score (NFS) will be performed.

Researchers will compare 3 groups:

Group 1 will receive oral Empagliflozin, as add-on to their previous treatment regimen, for 52 weeks.

Group 2 will receive subcutaneous Dulaglutide, as add-on to their previous treatment regimen, for 52 weeks.

Group 3 will receive other optimal antidiabetic treatment (apart from agents of the GLP1-ras or SGLT2-is families) for 52 weeks.

Detailed Description

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Rationale:

NAFLD is the most common chronic liver disease worldwide. Presently, relative clinical guidelines focus on weight loss through apporopriate diet and lifestyle. The Glucagon-Like Peptide 1 receptor agonists and the Sodium-Glucose Co-transporter 2 inhibitors constitute novel agents that seem to exert beneficial effects beyond glycemic control. Dulaglutide will be used from the GLP1-ras family and Empagliflozin from the SGLT2-is family.

Research question:

Is the use of Empagliflozin or Dulaglutide effective in improving liver fat fraction in patients with type 2 diabetes mellitus and NAFLD? Which is more beneficial?

Hypothesis:

The investigators hypothesize that both Dulaglutide and Empagliflozin have a role in treating patients with DM2 and NAFLD.

Aim of the study:

To compare the effect of Dulaglutide and Empagliflozin in liver fat fraction of diabetic patients after a year of treatment.

Objectives:

Assess liver steatosis change in patients. Determine percentage of those with \>30% liver fat concentration reduction.

Compare Empagliflozin group with Dulaglutide group and Control group. Evaluate the impact of the medications used on glycemic control, weight loss, liver enzymes, lipids and the Fatty Liver Index (FLI), the Fibrosis-4 Index (FIB-4), as well as the Aspartate Aminotransferase to Platelet ratio Index (APRI) and the NAFLD Fibrosis Score (NFS).

Material and methods:

Site of study:

This study will be conducted in the 2nd Department of Internal Medicine of Hippocration General Hospital, and the Therapeutic Department of General Hospital "Alexandra", Athens, Greece.

Type of study:

This is a prospective open-label observational study.

Subjects allocation:

Group 1: patients will receive oral Empagliflozin, as add-on to their previous treatment regimen, for 52 weeks.

Group 2: patients will receive subcutaneous Dulaglutide, as add-on to their previous treatment regimen, for 52 weeks.

Group 3: patients will receive other optimal antidiabetic treatment (apart from agents of the GLP1-ras or SGLT2-is families) for 52 weeks.

Patients receiving Pioglitazone were not included in the study.

Steps of performance and techniques:

Medical history and complete physical examination. Informed consent. Calculation of BMI, measurement of waist and hip circumference. Blood tests including: Liver function tests, Complete blood count, Urea and Creatinine, Lipid profile (total cholesterol, triglycerides, LDL, HDL), fasting plasma glucose and HbA1c.

Abdominal ultrasound, Magnetic Resonance Imaging-Proton Density Fat Fraction, Shearwave Elastography.

Calculation of the Fatty Liver Index (FLI), the Fibrosis-4 Index (FIB-4), as well as the Aspartate Aminotransferase to Platelet ratio Index (APRI) and the NAFLD Fibrosis Score (NFS).

Assessment of changes between date of entry in the study and 52 weeks of treatment.

Conditions

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Non-Alcoholic Fatty Liver Disease Liver Steatosis

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Empagliflozin group

Oral Empagliflozin 10mg daily, as add-on to their previous treatment regimen.

Empagliflozin

Intervention Type DRUG

Empagliflozin 10mg daily, as add-on to previous treatment regimen.

Dulaglutide group

Subcutaneous Dulaglutide 1.5mg weekly, as add-on to their previous treatment regimen.

Dulaglutide

Intervention Type DRUG

Dulaglutide 1.5mg weekly, as add-on to previous treatment regimen

Control group

Optimal anti-diabetic treatment (apart from agents of the GLP1-ras or SGLT2-is families), targeting glycemic control.

Control Rx

Intervention Type DRUG

Optimal anti-diabetic treatment excluding agents of the GLP1-ras or SGLT2-is families.

Interventions

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Empagliflozin

Empagliflozin 10mg daily, as add-on to previous treatment regimen.

Intervention Type DRUG

Dulaglutide

Dulaglutide 1.5mg weekly, as add-on to previous treatment regimen

Intervention Type DRUG

Control Rx

Optimal anti-diabetic treatment excluding agents of the GLP1-ras or SGLT2-is families.

Intervention Type DRUG

Other Intervention Names

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E D C

Eligibility Criteria

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Inclusion Criteria

Presence of diabetes mellitus type 2 and non-alcoholic fatty liver Stable anti-diabetic treatment regimen for the past 6 months

Exclusion Criteria

Recent (last 5 years) medical history of cancer, pancreatitis, viral hepatitis or any other cause of liver disease (alcohol abuse, autoimmune hepatitis, hemochromatosis, heart failure etc.) Recent alteration (\<6 months) of anti-diabetic regimen. Already established treatment with GLP1-ras or SGLT2-is prior to screening. Treatment with Pioglitazone. Corticotherapy administration. Pregnant or planning for pregnancy.
Minimum Eligible Age

25 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Alexandra Hospital, Athens, Greece

OTHER

Sponsor Role collaborator

Hippocration General Hospital

OTHER

Sponsor Role collaborator

National and Kapodistrian University of Athens

OTHER

Sponsor Role lead

Responsible Party

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KOULLIAS EMMANOUIL

INTERNIST

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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JOHN KOSKINAS, PROFESSOR

Role: STUDY_CHAIR

National and Kapodistrian University of Athens

ANASTASIA THANOPOULOU, AS PROFESSOR

Role: STUDY_DIRECTOR

National and Kapodistrian University of Athens

MELANIE DEUTSCH, AS PROFESSOR

Role: STUDY_CHAIR

National and Kapodistrian University of Athens

Locations

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"Hippocration" General Hospital of Athens

Athens, Attica, Greece

Site Status

Countries

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Greece

Other Identifiers

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SC12/16-6-2016

Identifier Type: -

Identifier Source: org_study_id

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