The Effects of SGLTi on Diabetic Cardiomyopathy

Type2 Diabetes Clinical Trial

— SGLTi  

Official title:

The Effects of SGLT Inhibition on Diabetic Cardiomyopathy

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT04200586
• Other study ID #: Version no.3
• Status: Active, not recruiting
• Phase: Phase 4
• Start date: April 9, 2020
• Est. completion date: September 30, 2021

Study information

• Verified date: August 2021
• Source: The University of Hong Kong
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Diabetic cardiomyopathy is associated with significant morbidity and mortality. It is considered as a cardiac muscle disorder secondary to diabetes mellitus (DM). Certain studies show the clinical benefit of SGLT-s inhibitors on reducing cardiovascular outcomes amongst patients with type II DM that go beyond the correction of hyperglycemic perse. Thus an observational imaging study is proposed to identify mechanistic insights of the drug group over cardiovascular events.

Description:

Diabetic cardiomyopathy is defined as ventricular dysfunction in diabetic patients in the absence of coronary artery disease and hypertension. It is considered as a cardiac muscle disorder due to the metabolic consequences of DM characterized by left ventricular hypertrophy, left ventricular diastolic dysfunction (in the early stage), and/or systolic dysfunction. To date, there is no specific treatment proven effective for the condition due to the incomplete understanding of the pathogenesis.

Recent studies however prove the efficacy of SGLT-2 inhibitors on reducing the primary composite end point of cardiovascular outcomes including hospitalization for heart failure, cardiovascular death, and all-cause death amongst patients with type II DM. Such clinical benefit is apparently mainly stemmed from the reduction in heart failure related mortality and sudden cardiac death rather than the macro-vascular events such as myocardial infarct and stroke, suggesting addition benefits going beyond the correction of hyperglycemia perse. These studies thus raise the possibility that the drug may have direct effects on the myocardium that conferring the clinical benefit not related the modification of traditional risk factors such as glycemic control, lipid, blood pressure, and obesity.

A single-arm, observational cardiac magnetic resonance imaging study is proposed in type II diabetic patients before and 2 months after initiation of dapagliflozin. The aim is to identify mechanistic insights leading to the unexpected clinical benefit of SGLT inhibition.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 30
• Est. completion date: September 30, 2021
• Est. primary completion date: March 4, 2021
• Accepts healthy volunteers: No
• Gender: All
• Age group: 40 Years to 90 Years

Eligibility

Inclusion Criteria:

• type 2 diabetes

• 40-90 years old

• HbA1c >= 6.5%

• history of heart failure with reduced ejection fraction

• indications for SGLT inhibition on clinical ground

Exclusion Criteria:

• angina pectoris or chest discomfort

• prior coronary artery bypass grafts

• coronary artery stenting within 6 months of study enrolment

• pervious myocardial infarct

• any contraindication for stress CMR testing

• renal impairment with eGFR <45ml/min/1.73m2

• limited life expectancy <5 years, for example due to pulmonary disease, cancer or

• significant hepatic failure

• contraindication to dapagliflozin or other SGLT2 inhibitors

• unable to take dapagliflozin

• patients currently on and SGLT2 inhibitor

• planned need for concomitant cardiac surgery or coronary intervention

• refusal or inability to sign an informed consent

• potential for on-compliance towards the requirements in the trial protocol (especially the medical treatment) or follow-up visits

Related Conditions & MeSH terms

• Cardiomyopathies
• Diabetic Cardiomyopathies
• Heart Failure With Reduced Ejection Fraction
• Type2 Diabetes

Intervention

Drug:
• Dapagliflozin
Dapagliflozin, one of the SGLT-2 inhibitors, will be prescribed to DM patients on clinical ground.

Locations

Country	Name	City	State
Hong Kong	Queen Mary Hospital	Hong Kong

Sponsors (1)

Lead Sponsor	Collaborator
The University of Hong Kong

Country where clinical trial is conducted

Hong Kong, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in myocardial perfusion reserve index	Change in myocardial perfusion reserve index calculated from cardiac MRI	8-12 weeks