Can Addition of Pioglitazone to SGLT2 Inhibitor in Type 1 Diabetic Patients Amplify the Decrease in HbA1c and Prevent the Increase in Plasma Ketone Concentration?
The University of Texas Health Science Center at San Antonio
Summary
Purpose: To examine the effect of addition of combination therapy with dapagliflozin plus pioglitazone to insulin on glucose control and plasma ketone concentration in patients with type 1 diabetes (T1DM) Research Design: 120 patients with type 1 diabetes who otherwise are healthy constitute the study population. After screening, eligible subjects will start 4 week run in. At week 4, subjects will receive dapagliflozin for 12 weeks. At week 16, subjects will be randomized to receive in a double blind fashion pioglitazone or placebo for 16 weeks. Methods: the following techniques will be employed in the present study: (1) mixed meal tolerance test; (2) indirect calorimetry; (3) continuous glucose monitoring. Clinical Relevance: the results of the present study will demonstrate that the addition of pioglitazone to SGLT2 inhibitor in T1DM patients produces greater reduction in the HbA1c without increasing risk of ketoacidosis and hypoglycemia.
Description
Insulin deficiency, due to autoimmune destruction of beta cells, is the primary factor responsible for the development of T1DM, and insulin replacement therapy is the mainstay for the management of hyperglycemia. However, insulin therapy often is associated with adverse events, including weight gain which promotes insulin resistance leading to an increase in insulin demand. This results in a self-perpetuating vicious cycle whereby the increase in insulin dose causes weight gain that worsens insulin sensitivity, and further enhances insulin requirement. Hyperinsulinemia per se also induces insu…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- No
Inclusion Criteria: * Age \>18 years * T1DM * Good general health * Fasting C-peptide concentration \<0.7 ng/ml * Poor glycemic control (HbA1c=7.0-11.0%) * Treatment with multiple daily insulin injections or insulin pump * Total daily insulin dose ≥0.6 U/kg per day * Stable insulin dose (±4 units) in the preceding three months. * eGFR≥60 ml/min * Weight stable over the preceding 3 months (± 3 pounds) * Do not participate in an excessively heavy exercise program Exclusion Criteria: * T2DM * Daily insulin dose \<0.6 U/kg per day * Fasting C-peptide \>0.7 ng/ml * HbA1c \<7.0% or \>11.0% * eGFR…
Interventions
- DrugPioglitazone 45 mg
patients will be started on 15 mg and the dose escalated to the maximal tolerated dose
- DrugPlacebo
PATIENTS WILL RECEIVE PLACEBO
Locations (3)
- University Health System Texas Diabetic InstituteSan Antonio, Texas
- Endocrinology and Diabetes Center, Rambam Medical CenterHaifa
- Dasman Diabetes InstituteKuwait City