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Diabetes Mellitus, Type 1Phase 3NCT04035031

Effects of Dapagliflozin on Hormonal Glucose Homeostasis in Type 1 Diabetes

A Phase 3 study testing Forxiga 10mg in people with Diabetes Mellitus, Type 1, run by Insel Gruppe AG, University Hospital Bern at 1 site in Switzerland.

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

Inhibitors of sodium-dependent glucose-transporter 2 (including dapagliflozin) represent intensively investigated drugs in the field of diabetes. SGLT-2 inhibition limits glucose reabsorption in renal tubular cells, hereby increasing the amount of glucose excreted via urine in the hyperglycemic state. Read more about this study

Who is it for?
Ages 18 to 65 years
Conditions the study is for
Diabetes Mellitus, Type 1
What is being tested?
Forxiga 10mg
Type of treatment
Pill or oral medicine
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
13 participants
Where
1 siteSwitzerland
Study dates
9 Jan 2020to 12 Nov 2020
Phase
Phase 3
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 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Informed Consent as documented by signature
  • Duration of T1DM > 5 years
  • Male or female sex
  • Body mass index (BMI) between 20 and 29 kg/m2
  • Adherence to safe contraception during the study and for 2 weeks after completion of the study protocol. Safe contraception comprises double barrier methods (hormonal contraception [like: oral contraceptive pills or intrauterine contraceptive devices] together with a mechanical barrier [like: condom, diaphragm]).

Who cannot join

  • Contraindications to SGLT-2 inhibitors
  • Contraindications to lactose
  • Diagnosis of renal and/or hepatic dysfunction
  • History of malignancy of any kind
  • Intake of drugs influencing glucose homeostasis during the last three months (steroids, metformin, sulfonylureas, thiazolidinedione)
  • Known or suspected non-compliance, drug or alcohol abuse.
Show all 12Show fewer
  • Inadequate vein status on both forearms
  • Active smoker (defined as ≥1 or more cigarettes or nicotine-containing equivalents per day)
  • Known pregnancy, positive plasma beta-HCG test prior to study inclusion or intention to become pregnant during the study period.
  • Women who are breast feeding
  • Lack of safe contraception
  • Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, dementia, etc. of the participant

Trial locations and contacts

1 site in 1 country.

Switzerland1 site
  • Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Bern, 3010

Other trials in Switzerland

About this study

Official title: Effects of SGLT-2 Inhibitor Dapagliflozin on Hormonal Glucose Regulation and Ketogenesis in Patients With Type 1 Diabetes - a Randomised, Placebo-controlled, Open-label, Cross-over Intervention Study

Inhibitors of sodium-dependent glucose-transporter 2 (including dapagliflozin) represent intensively investigated drugs in the field of diabetes. SGLT-2 inhibition limits glucose reabsorption in renal tubular cells, hereby increasing the amount of glucose excreted via urine in the hyperglycemic state. Its mechanisms of action are independent of insulin, the indispensable standard of care in Type 1 Diabetes (T1D). Several international diabetes experts highlighted the need for adjunct therapies in T1D.

Subcutaneous application of insulin is non-physiological. Most significant, subcutaneous insulin substitution does not address the bi-hormonal character of T1D. The loss of pancreatic beta cells and subsequent endogenous insulin production uncouples alpha cell derived glucagon secretion from its paracrine suppressor. Consequently, excess glucagon concentrations occur in the fasting and the postprandial state, which promotes hyperglycemia, requires higher doses of subcutaneous insulin, and promotes glycaemic variability.

Recent studies on SGLT-2 inhibition in T1D showed better glycemic control compared to placebo, whereas a higher risk for the development of diabetic ketoacidosis was observed. Knowledge about the underlying mechanisms is scarce. Studies showed that SGLT-inhibition increased Glucagon-like-peptide 1 (GLP-1) in T1D, an incretin hormone capable of suppressing glucagon. On the other side, total concentrations of ketone bodies were higher following SGLT-2 inhibition, irrespective of ongoing subcutaneous or intravenous insulin substitution. The present study aims to investigate the effect of SGLT-2 inhibitor dapagliflozin on hormonal regulators of glucose homeostasis and ketogenesis in T1D. The primary endpoint is the difference of GLP-1 during oral glucose tolerance test clamps (OGGTc). Secondary endpoints comprise total ketone body concentrations, free fatty acids, glucagon, and somatostatin during OGTTc and hyperinsulinemic, euglycemic clamps (HEC) following dapagliflozin and placebo. The study recruits male and female patients with T1DM in a randomized, open label, cross-over intervention study.

Being tested
Forxiga 10mg, Placebo
Medical subject headings
Diabetes Mellitus, Type 1

What participants receive

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

  • Forxiga 10mgDrug

    Also called Dapagliflozin

    Forxiga™ 10mg, dapagliflozin 10mg, oral, once daily for 7 days (70 mg total)

  • PlaceboDrug

    Placebo tablets, starch, oral, once daily for 7 days (7 tablets total)

Study groups in NCT04035031
Study groupRoleWhat they receive
Forxiga first, placebo secondExperimentalForxiga followed by placebo
Receives: Drug: Forxiga 10mg; Drug: Placebo
Placebo first, Forxiga secondExperimentalPlacebo followed by forxiga
Receives: Drug: Forxiga 10mg; Drug: Placebo

What is being measured

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

  1. Area under the curve for glucagon-like peptide I in oral glucose tolerance test clamp

    Glucagon-like peptide I will be measured in oral glucose tolerance test clamp following dapagliflozin and will be compared with concentrations measured following placebo. Active and inactivated glucagon like peptide I will be measured.

    Measured: From time-point 0 to 120 minutes during oral glucose tolerance test clamp, measurement every 15 minutes

  2. Area under the curve for glucagon-like peptide I in oral glucose tolerance test clamp

    Glucagon-like peptide I will be measured in oral glucose tolerance test clamp following dapagliflozin and will be compared with concentrations measured following placebo. Active and inactivated glucagon like peptide I will be measured.

    Measured: During visit 3 (day 7): From time-point 0 to 120 minutes during oral glucose tolerance test clamp, measurement every 15 minutes

  3. Area under the curve for glucagon-like peptide I in oral glucose tolerance test clamp

    Glucagon-like peptide I will be measured in oral glucose tolerance test clamp following dapagliflozin and will be compared with concentrations measured following placebo. Active and inactivated glucagon like peptide I will be measured.

    Measured: During visit 5 (day 31): From time-point 0 to 120 minutes during oral glucose tolerance test clamp, measurement every 15 minutes

Secondary outcomes (9)
  1. Area under the curve for glucagon-like peptide I in euglycemic, hyperinsulinemic clamp

    Glucagon-like peptide I will be measured in euglycemic, hyperinsulinemic clamp following dapagliflozin and will be compared with concentrations measured following placebo. Active and inactivated glucagon like peptide I will be measured.

    Measured: From time-point 0 to 120 minutes during euglycemic, hyperinsulinemic clamp, measurement every 15 minutes

  2. Area under the curve for ketone body concentrations in euglycemic, hyperinsulinemic clamp following dapagliflozin compared with placebo

    Ketone bodies will be measured in euglycemic, hyperinsulinemic clamp following dapagliflozin and will be compared with concentrations measured following placebo. Active and inactivated glucagon like peptide I will be measured.

    Measured: From time-point 0 to 120 minutes during euglycemic, hyperinsulinemic clamp, measurement every 15 minutes

  3. Area under the curve for ketone body concentrations in oral glucose tolerance test clamp following dapagliflozin compared with placebo

    Ketone bodies will be measured in oral glucose tolerance test clamp following dapagliflozin and will be compared with concentrations measured following placebo. Active and inactivated glucagon like peptide I will be measured.

    Measured: From time-point 0 to 120 minutes during oral glucose tolerance test clamp, measurement every 15 minutes

  4. Area under the curve for free fatty acids in euglycemic, hyperinsulinemic clamp following dapagliflozin compared with placebo

    Free fatty acids will be measured in euglycemic, hyperinsulinemic clamp following dapagliflozin and will be compared with concentrations measured following placebo. Active and inactivated glucagon like peptide I will be measured.

    Measured: From time-point 0 to 120 minutes during euglycemic, hyperinsulinemic clamp, measurement every 15 minutes

  5. Area under the curve for free fatty acids in oral glucose tolerance test clamp following dapagliflozin compared with placebo

    Free fatty acids will be measured in oral glucose tolerance test clamp following dapagliflozin and will be compared with concentrations measured following placebo. Active and inactivated glucagon like peptide I will be measured.

    Measured: From time-point 0 to 120 minutes during oral glucose tolerance test clamp, measurement every 15 minutes

  6. Area under the curve for glucagon in euglycemic, hyperinsulinemic clamp following dapagliflozin compared with placebo

    Glucagon will be measured in euglycemic, hyperinsulinemic clamp following dapagliflozin and will be compared with concentrations measured following placebo. Active and inactivated glucagon like peptide I will be measured.

    Measured: From time-point 0 to 120 minutes during euglycemic, hyperinsulinemic clamp, measurement every 15 minutes

  7. Area under the curve for glucagon in oral glucose tolerance test clamp following dapagliflozin compared with placebo

    Glucagon will be measured in oral glucose tolerance test clamp following dapagliflozin and will be compared with concentrations measured following placebo. Active and inactivated glucagon like peptide I will be measured.

    Measured: From time-point 0 to 120 minutes during oral glucose tolerance test clamp, measurement every 15 minutes

  8. Area under the curve for somatostatin in euglycemic, hyperinsulinemic clamp following dapagliflozin compared with placebo

    Somatostatin will be measured in euglycemic, hyperinsulinemic clamp following dapagliflozin and will be compared with concentrations measured following placebo. Active and inactivated glucagon like peptide I will be measured.

    Measured: From time-point 0 to 120 minutes during euglycemic, hyperinsulinemic clamp, measurement every 15 minutes

  9. Area under the curve for somatostatin in oral glucose tolerance test clamp following dapagliflozin compared with placebo

    Somatostatin will be measured in oral glucose tolerance test clamp following dapagliflozin and will be compared with concentrations measured following placebo. Active and inactivated glucagon like peptide I will be measured.

    Measured: From time-point 0 to 120 minutes during oral glucose tolerance test clamp, measurement every 15 minutes

Timeline

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

  1. First posted29 Jul 2019
  2. Study start9 Jan 2020
  3. Primary completion12 Nov 2020
  4. Study completion12 Nov 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 3
Primary purpose
Other
Allocation
Randomised
Intervention model
Crossover
Model description
Randomised, placebo-controlled, open-label, cross over intervention study
Masking
None (open label)
Enrolment
13 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04035031
Sponsor's protocol ID
CUI_002_01
Status last verified
Mar 2023
First submitted
24 Jul 2019
Last updated
14 Mar 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: According to Swiss National Fund (SNF) policy on Open Research Data, Data will be uploaded to an open data registry.

Publications

  • Gubeli A, Steiner N, Limacher A, Mathis D, Melmer A, Laimer M. Dapagliflozin's impact on hormonal regulation and ketogenesis in type 1 diabetes: a randomised controlled crossover trial. Diabetologia. 2025 Oct;68(10):2116-2125. doi: 10.1007/s00125-025-06481-9. Epub 2025 Jul 9.

    PubMed 40629004

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Forxiga 10mg in people with Diabetes Mellitus, Type 1, run by Insel Gruppe AG, University Hospital Bern at 1 site in Switzerland.

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 5 inclusion and 12 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 14 Mar 2023. 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 Switzerland. 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. 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 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

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?

Area under the curve for glucagon-like peptide I in oral glucose tolerance test clamp (time frame: From time-point 0 to 120 minutes during oral glucose tolerance test clamp, measurement every 15 minutes). The study lists 3 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 NCT04035031, which also lists 1 linked publication.

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 14 Mar 2023.

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