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Heart FailurePhase 4SUGAR-DM-HFNCT03485092

Studies of Empagliflozin and Its Cardiovascular, Renal and Metabolic Effects

A Phase 4 study testing Empagliflozin 10 MG in people with Heart Failure and Diabetes Mellitus, run by NHS Greater Glasgow and Clyde at 1 site in United Kingdom.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The investigators hypothesise that empagliflozin 10mg daily will have haemodynamic, cardiac, and renal benefits compared to placebo over 36 weeks in heart failure patients with type 2 diabetes (or pre-diabetes), leading to measurable improvements in clinical measures of cardiac structure and function (LVESVI, and LV… Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Heart Failure, Diabetes Mellitus
What is being tested?
Empagliflozin 10 MG
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
105 participants
Where
1 siteUnited Kingdom
Study dates
16 Mar 2018to 28 Mar 2020
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Written informed consent
  • Male or female, aged ≥18 years age
  • Type 2 DM (diet-controlled or on stable treatment) or prediabetes
  • Stable treatment defined as no change in oral therapy agents or doses for diabetes mellitus and (where applicable) <10% change in average total daily insulin dose over last 6 weeks
  • HbA1c ≤97 mmol/mol (11%) (routine available data from medical records, recorded in the last year)
  • Prediabetes defined as HbA1c 39-47 mmol/mol (5.7-6.4%) at the time of screening (specifically for the prediabetes group, HbA1c will be repeated at the time of screening if there are no recent results within the last 3 months, in order to confirm the diagnosis of prediabetes)
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  • Heart failure (as defined by the presence of typical signs and symptoms of heart failure with documented reduced ejection fraction (ref SIGN and ESC guidelines))
  • NYHA class II-IV
  • LVEF ≤40%
  • On stable doses of ACEI, ARB or ARNI for 4 weeks prior to randomisation unless contraindicated or not tolerated. They should also be taking a beta-blocker at a stable dose for 4 weeks unless contraindicated or not tolerated
  • Women of childbearing potential (WOCBP) must be currently adhering to, or be willing to use, highly effective birth control methods for study treatment duration including:
  • Combined hormonal contraception (oestrogen and progestogen containing medication) either orally, intravaginally, or transdermally
  • Progesterone only hormonal contraception either orally, injected, or implanted
  • Intrauterine device (IUD)
  • Intrauterine hormone release system (IUS)
  • Bilateral fallopian tube occlusion
  • Vasectomised partner
  • Complete sexual abstinence where this is their preferred and usual lifestyle
  • WOCBP comprises women who have experienced menarche and who have not undergone successful surgical sterilisation (hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or who are not post-menopausal. Post-menopausal is defined as:
  • o Women who have had amenorrhea for ≥12 consecutive months (without another medical cause)

Who cannot join

  • Type 1 DM
  • History of hospital admission with a diagnosis of diabetic ketoacidosis (DKA)
  • Insulin use within 1 year of diagnosis of diabetes
  • History of acute or chronic pancreatitis
  • eGFR <30 ml/min/1.73m2 (derived using CKD EPI)
  • Persistent/permanent atrial fibrillation/flutter (conditions which significantly impede MRI image interpretability)
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  • Acute coronary syndrome, stroke or surgery within 1 month (small type 2 MI in the context of acute HF does not apply)
  • BMI >52 kg/m2
  • Liver disease, defined by serum levels of alanine aminotransferase, aspartate aminotransferase, or alkaline phosphatase above 3 x upper limit of normal (ULN) during screening
  • Bariatric surgery within the past two years and other gastrointestinal surgeries that induce chronic malabsorption
  • Any condition outside the cardiovascular and renal disease area, such as but not limited to malignancy, with a life expectancy of less than 2 years based on investigator's clinical judgement
  • Active malignancy requiring treatment at the time of visit 1 (with the exception of successfully treated basal cell or treated squamous cell carcinoma, adjuvant hormonal therapy for breast cancer and hormone therapy for prostate cancer)
  • Blood dyscrasias or any disorders causing haemolysis or unstable red blood cells (e.g. malaria, babesiosis, haemolytic anaemia)
  • Treatment with systemic steroids at time of informed consent or change in dosage of thyroid hormones within 6 weeks prior to informed consent
  • Any uncontrolled endocrine disorder except Type 2 DM
  • Alcohol or drug abuse within 3 months of informed consent that would interfere with trial participation or any ongoing condition leading to decreased compliance with study procedures or study drug intake
  • Known hypersensitivity to the empagliflozin or excipients
  • Known hypersensitivity to gadolinium
  • Inability to give informed consent
  • SGLT2 inhibitor use (current or previous)
  • Devices or any other contraindication to MRI scans
  • Currently pregnant, planning pregnancy, or currently breastfeeding
  • History of previous lower limb amputation
  • Current participation in another interventional medical study or within the last 90 days
  • Anyone who, in the investigators' opinion, is not suitable to participate in the trial for other reasons

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • Queen Elizabeth University Hospital

    Glasgow, Scotland, G51 4TF

Other trials in United Kingdom

About this study

Official title: Studies of Empagliflozin and Its Cardiovascular, Renal and Metabolic Effects in Patients With Diabetes Mellitus (or Pre-diabetes) and Heart Failure (SUGAR-DM-HF)

The investigators hypothesise that empagliflozin 10mg daily will have haemodynamic, cardiac, and renal benefits compared to placebo over 36 weeks in heart failure patients with type 2 diabetes (or pre-diabetes), leading to measurable improvements in clinical measures of cardiac structure and function (LVESVI, and LV strain) as well as renal blood flow.

Read the detailed description

The results of the EMPA-REG OUTCOME trial on CVD outcomes and heart failure hospitalisation suggests that empagliflozin works quickly to lessen CVD mortality and reduce heart failure hospitalisations in patients with diabetes and existing cardiovascular disease. The lack of effect on non-fatal MI and stroke would suggest limited impact on atherothrombotic mechanisms. It is important to understand the mechanisms by which empagliflozin is acting in more detail, in order that the drug can be more widely targeted at patient groups that might benefit most; particularly patients with heart failure and diabetes (or pre-diabetes) (as discussed in the rationale).

The investigators have hypothesised, in a detailed published review, that the benefit derives from the specific effects of sodium-glucose linked transporter-2 (SGLT2) inhibition on renal sodium and glucose handling, leading to both diuresis and improvements in diabetes-related maladaptive renal arteriolar responses. These haemodynamic and renal effects are likely to be beneficial in patients with clinical or subclinical cardiac dysfunction. The net result of these processes is an improvement in cardiac systolic and diastolic function and, thereby, a lower risk of heart failure hospitalisation (HFH) and sudden cardiac death.

The investigators have therefore designed the present trial to perform a comprehensive clinical trial to interrogate in detail the effects of empagliflozin on specific pathways (inclusive of cardiac and renal effects) in patients with type 2 diabetes (or pre-diabetes) and heart failure.

Being tested
Empagliflozin 10 MG, Placebo Oral Tablet
Keywords
heart failure, diabetes mellitus, empagliflozin, Randomised, placebo controlled trial
Medical subject headings
Heart Failure, Diabetes Mellitus

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Empagliflozin 10 MGDrug

    Empagliflozin 10mg tablets for oral self administration once a day

  • Placebo Oral TabletDrug

    placebo tablets for oral self administration once a day

Study groups in NCT03485092
Study groupRoleWhat they receive
EmpagliflozinActive comparatorEmpagliflozin 10mg tablets for oral self-administration once daily
Receives: Drug: Empagliflozin 10 MG
Placebo Oral TabletPlacebo comparatorplacebo tablets for oral self-administration once daily
Receives: Drug: Placebo Oral Tablet

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Left Ventricular End Systolic Volume Index (LVESVI)

    Cardiac structure measured by left ventricular end-systolic volume index measured by cardiac magnetic resonance imaging as mL/m2

    Measured: 36 weeks

  2. left ventricular global longitudinal strain (GLS)

    Cardiac structure measured by left ventricular global longitudinal strain measured by cardiac magnetic resonance imaging GLS%

    Measured: 36 weeks

Secondary outcomes (16)
  1. Left ventricular end diastolic volume index (LVEDVI)

    Left ventricular end diastolic volume index (LVEDVI) measured by Cardiac MR in ml/m2

    Measured: 36 weeks

  2. Left ventricular ejection fraction (LVEF)

    Left ventricular ejection fraction (LVEF) measured by Cardiac MR in percentage

    Measured: 36 weeks

  3. Left ventricular mass index (LVMI)

    Left ventricular mass index (LVMI) measured by cardiac MR in grams/m2

    Measured: 36 weeks

  4. Left ventricular global function index (LVGFI)

    Left ventricular global function index (LVGFI) measured by cardiac MR in percentage

    Measured: 36 weeks

  5. Left atrial volume index (LAVI)

    Left atrial volume index (LAVI) measured by cardiac MR in ml/m2

    Measured: 36 weeks

  6. Microvascular perfusion

    Microvascular perfusion measured by Gadolinium enhanced Cardiac magnetic resonance imaging measured as ml/min/g

    Measured: 36 weeks

  7. Extracellular volume fraction

    Extracellular volume fraction measured by Gadolinium enhanced Cardiac magnetic resonance imaging measured as %

    Measured: 36 weeks

  8. Kansas City Cardiomyopathy Questionnaire (KCCQ) Total Symptom Score (TSS)

    Kansas City Cardiomyopathy Questionnaire Total Symptom score (TSS) measured by mean overall difference and responder analysis (higher score = better outcome)

    Measured: 36 weeks

  9. 6 minute walk distance (Exercise Capacity)

    Exercise capacity measured by six minute walk test measured in m

    Measured: 36 weeks

  10. Pulmonary congestion

    Pulmonary congestion as B-lines measured using lung ultrasound

    Measured: 36 weeks

  11. Biomarker profile -glycated haemaglobin (HbA1c)

    biomarker profile of HbA1c (mmol/mol)

    Measured: 36 weeks

  12. Biomarker profile - creatine

    biomarker profile of creatine (umol/L)

    Measured: 36 weeks

  13. Biomarker profile - estimated glomerular filtration rate (eGFR)

    biomarker profile of eGFR (ml/min/m2)

    Measured: 36 weeks

  14. Biomarker profile - liver function tests (LFTs)

    biomarker profile of LFTs (U/L)

    Measured: 36 weeks

  15. Biomarker profile - uric acid

    biomarker profile of uric acid (umol/L)

    Measured: 36 weeks

  16. Intensification of diuretic therapy

    Intensification of diuretic therapy through addition and/or increase dose of diuretic medication

    Measured: 36 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Apr 2018
  2. Study start16 Mar 2018
  3. Primary completion28 Mar 2020
  4. Study completion28 Mar 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Randomised, placebo controlled trial
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
105 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03485092
Sponsor's protocol ID
GN15CA580
Acronym
SUGAR-DM-HF
Status last verified
Sep 2020
First submitted
19 Mar 2018
Last updated
18 Sep 2020
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, Mattheus M, Devins T, Johansen OE, Woerle HJ, Broedl UC, Inzucchi SE; EMPA-REG OUTCOME Investigators. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015 Nov 26;373(22):2117-28. doi: 10.1056/NEJMoa1504720. Epub 2015 Sep 17.

    PubMed 26378978
  • Kanie T, Mizuno A, Takaoka Y, Suzuki T, Yoneoka D, Nishikawa Y, Tam WWS, Morze J, Rynkiewicz A, Xin Y, Wu O, Providencia R, Kwong JS. Dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter-2 inhibitors for people with cardiovascular disease: a network meta-analysis. Cochrane Database Syst Rev. 2021 Oct 25;10(10):CD013650. doi: 10.1002/14651858.CD013650.pub2.

    PubMed 34693515
  • Lee MMY, Brooksbank KJM, Wetherall K, Mangion K, Roditi G, Campbell RT, Berry C, Chong V, Coyle L, Docherty KF, Dreisbach JG, Labinjoh C, Lang NN, Lennie V, McConnachie A, Murphy CL, Petrie CJ, Petrie JR, Speirits IA, Sourbron S, Welsh P, Woodward R, Radjenovic A, Mark PB, McMurray JJV, Jhund PS, Petrie MC, Sattar N. Effect of Empagliflozin on Left Ventricular Volumes in Patients With Type 2 Diabetes, or Prediabetes, and Heart Failure With Reduced Ejection Fraction (SUGAR-DM-HF). Circulation. 2021 Feb 9;143(6):516-525. doi: 10.1161/CIRCULATIONAHA.120.052186. Epub 2020 Nov 13.

    PubMed 33186500

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Empagliflozin 10 MG in people with Heart Failure and Diabetes Mellitus, run by NHS Greater Glasgow and Clyde at 1 site in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 20 inclusion and 25 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 18 Sep 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Left Ventricular End Systolic Volume Index (LVESVI) (time frame: 36 weeks). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03485092, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Sep 2020.

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