This is a 24-week, multicenter, randomized, open-label, parallel-group, active controlled Phase IV study to assess the efficacy and safety of Dapagliflozin as monotherapy compared with Acarbose in patients with T2DM who were inadequately controlled with diet and exercise. The study is designed to evaluate the efficacy and safety of dapagliflozin monotherapy compared with acarbose monotherapy in patients with T2DM inadequately controlled with diet and exercise.
1\. Study design This is a 24-week, multicenter, randomized, open-label, parallel-group, active controlled Phase IV study The open-label study design rather than double-blind is considered due to the difficulty of placebo supply. The primary efficacy endpoint will be blinded to both patients and investigators, so the measurements as well as the management of the patients will not be impacted by the design of open-label. The study is powered to show non-inferiority of dapagliflozin versus acarbose regarding with HbA1c reduction. A non-inferiority margin of 0.25% for the difference of the reduction in HbA1c is considered in the study. 1. Primary and secondary outcome variables In the clinical guidelines for type 2 diabetes, HbA1c is recommended as gold standard for determination of glycemic control and is therefore chosen as the primary outcome variable. Certain secondary outcome variables have been selected for additional assessment because of their clinical relevance and importance. 2. Dosing and study duration Dapagliflozin will be started from 5 mg once a day, taken orally in the morning, before or after food. In patients tolerating dapagliflozin 5 mg once a day, the dose will be increased to 10 mg once a day from the second week. Acarbose will be started from 50 mg once a day at dinner during the first week and titrated up to 50 mg twice a day at lunch and dinner in the second week, 50 mg three times a day at three meals in the third week, and 100 mg three times a day from the fourth week onwards. The dosing in study is in line with the local labels for dapagliflozin and acarbose. Treatment duration of 24 weeks is considered to be adequate to establish glycemic efficacy of dapagliflozin monotherapy compared with acarbose monotherapy in lowering blood glucose indicated by HbA1c change in patients with T2DM inadequately controlled with diet and exercise. 2\. Benefit/risk and ethical assessment According to the available data so far, glucose lowering effect of dapagliflozin is associated with a favourable safety and tolerability profile, and accompanied with a slightly increased risk of genital infection and urinary tract infection \[9, 10\]. Acarbose is the most widely used oral anti-diabetic drug in china. The common side effects of acarbose treatment are flatulence, borborygmus and diarrhoea, according to the prescribing information and clinical experience from physicians. The treatment regimens in the study are in line the prescribing information for dapagliflozin and acarbose. Patients with potential contraindications or not considered to get benefit from dapagliflozin or acarbose treatment will be excluded from the study by the inclusion/exclusion criteria set in the study. And the patient safety will be closely monitored in the study by Adverse events/Serious Adverse events collecting and assessment, laboratory testing, ECG, glucometer, vital sign and physical examination. Overall, the study drugs investigated and the study design is considered to have a favorable benefit-risk profile in the treatment of patients with T2DM. Methods for assigning treatment groups A block stratified randomization method will be used to assign patients to the treatment groups in this study. Patients will be randomized 1:1 to treatment groups via a central randomization system (interactive voice / web response system \[Interactive Voice Response System/Interactive Web Response System\])(IVRS/IWRS), and drug will be dispensed accordingly. The study population will be stratified based on the level of HbA1c at baseline (HbA1c \< 8.0%、≥ 8.0% \~ \< 9.0% and ≥9.0%)
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
304
Starting dose of dapagliflozin is 5 mg once daily, taken orally in the morning, before or after breakfast. From the third week,the dose can be increased to 10 mg once daily, and last to the end of the study.
Acarbose was started from 50 mg once a day at dinner during the first week and titrated up to 50 mg twice a day at lunch and dinner in the second week, 50 mg three times a day at three meals in the third week, and 100 mg three times a day till the end of the study.
Research Site
Beijing, China
Research Site
Beijing, China
Research Site
Changsha, China
Absolute change from baseline in HbA1c at Week 24
Which will be derived using the HbA1c (%) at week 24 minus HbA1c (%) at baseline.
Time frame: At week 24
Percentage of patients at Week 24 with reduction of HbA1c≥0.5%, body weight≥3% and SBP ≥3mmHg from baseline
Which will be derived using the number of patients who have reduction in HbA1c ≥ 5%, and body weight ≥3% and SBP ≥3 mmHg compared to baseline divided by the total number of patients.
Time frame: From baseline to week 24
Percentage of patients achieving HbA1c<7.0%
Which will be derived using the number of patient who have the HbA1c (%) \< 7.0% after 24 weeks treatment divided by the total number of patients.
Time frame: From baseline to week 24
Percentage of patients with reduction of HbA1c≥0.5%
Which will be derived using the number of patients who have reduction in HbA1c≥0.5% after 24 weeks compared to baseline divided by the total number of patients.
Time frame: From baseline to week 24
Absolute change from baseline in fasting plasma glucose (FPG)
Which will be derived using the value of fasting plasma glucose (FPG) at post-baseline visits minus the value at baseline
Time frame: From baseline to week 24
Absolute change from baseline in 2h postprandial glucose (PPG)
Which will be derived using the value of 2h postprandial glucose (PPG) at the post-baseline visits minus the value at baseline
Time frame: From baseline to week 24
Absolute change from baseline in body weight
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Research Site
Chengdu, China
Research Site
Chongqing, China
Research Site
Guangzhou, China
Research Site
Hangzhou, China
Research Site
Hangzhou, China
Research Site
Hefei, China
Research Site
Jinan, China
...and 10 more locations
Which will be derived using the value of the body weight at the post-baseline visits minus the value at baseline
Time frame: From baseline to week 24
Percentage of patients with reduction of body weight ≥3%
Which will be derived using the number of patients who have reduction in body weight≥3% after 24 weeks compared to baseline divided by the total number of patients.
Time frame: From baseline to week 24
Absolute change from baseline in systolic blood pressure (SBP)
Which will be derived using the value of the systolic blood pressure at the post-baseline visits minus the value at baseline
Time frame: From baseline to week 24
Percentage of patients with reduction of SBP ≥3 mmHg
Which will be derived using the number of patients who have reduction in SBP ≥3 mmHg after 24 weeks compared to baseline divided by the total number of patients.
Time frame: From baseline to week 24