The current study aims to explore the clinical effects and mechanistics of mono- and combination therapy with SGLT-2 inhibitor empagliflozin and DPP-4 inhibitor linagliptin on renal physiology and biomarkers in metformin-treated T2DM patients.
Sodium-glucose linked transporters (SGLT-2) inhibitors and dipeptidyl peptidase-4 (DPP-4) inhibitors are relatively novel glucose-lowering drugs for the treatment of T2DM. These agents seem to exert pleiotropic actions 'beyond glucose control'. SGLT-2 inhibitors decrease proximal sodium reabsorption and decrease glomerular pressure and albuminuria in rodents and type 1 diabetes patients. In addition, SGLT-2 inhibitors reduce, blood pressure and body weight. In rodents, SGLT-2 inhibitors also improved histopathological abnormalities associated with DKD. DPP-4 inhibitors are considered weight neutral, improve lipid profiles and slight reductions in blood pressure have been reported. To date, the potential renoprotective effects and mechanisms of SGLT-2 inhibitors and combination therapy with SGLT-2 inhibitors have not been sufficiently detailed in human type 2 diabetes. The current study aims to explore the clinical effects and mechanistics of mono- and combination therapy with an SGLT-2 inhibitor and a DPP-4 inhibitor on renal physiology and biomarkers in metformin-treated T2DM patients. 66 patients with type 2 diabetes will undergo a 16-week intervention period with 8-week empagliflozin (SGLT-2 inhibitor) monotherapy, followed by 8-week empagliflozin and linagliptin (DPP-4 inhibitor) combination therapy or 8-week linagliptin monotherapy, followed by 8-week linagliptin and empagliflozin combination therapy or 8-week gliclazide (SU derivative), followed by 8-week gliclazide intensification therapy in order to assess changes in the outcome parameters.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
66
Once daily treatment with oral empagliflozin (Jardiance) 10 mg Once daily treatment with oral linagliptin (Tradjenta) 5 mg
Once daily treatment with oral linagliptin (Tradjenta) 5 mg Once daily treatment with oral empagliflozin (Jardiance) 10 mg
Once daily or twice daily treatment with oral glicazide MR 30mg
VU University Medical Center
Amsterdam, North Holland, Netherlands
GFR
Changes from baseline following 16-week treatment on renal hemodynamics in both the fasting and postprandial state, measured as GFR (determined by the inulin-clearance technique)
Time frame: 16 weeks
GFR
Changes from baseline following 8-week treatment on renal hemodynamics in both the fasting and postprandial state, measured as GFR (determined by the inulin-clearance technique)
Time frame: 8 weeks
Renal tubular function
24-hour urine sodium-, potassium-, chloride-, calcium-, magnesium-, phosphate-, uric acid-, bicarbonate-, ammonium-, urea- and glucose excretion, urine osmolality and urinary pH
Time frame: 16 weeks
Renal tubular function
24-hour urine sodium-, potassium-, chloride-, calcium-, magnesium-, phosphate-, uric acid-, bicarbonate-, ammonium-, urea- and glucose excretion, urine osmolality and urinary pH
Time frame: 8 weeks
Renal Damage
24-hour urinary albumin excretion, albumin/creatinine ratio (UCR)
Time frame: 16 weeks
Renal Damage
24-hour urinary albumin excretion, albumin/creatinine ratio (UCR)
Time frame: 10 weeks
Renal Damage
24-hour urinary albumin excretion, albumin/creatinine ratio (UCR)
Time frame: 8 weeks
Renal Damage
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24-hour urinary albumin excretion, albumin/creatinine ratio (UCR)
Time frame: 2 weeks
Heart Rate (Dinamap®)
Measured using an automated oscillometric blood pressure device (Dinamap®)
Time frame: 16 weeks
Heart Rate (Dinamap®)
Measured using an automated oscillometric blood pressure device (Dinamap®)
Time frame: 10 weeks
Heart Rate (Dinamap®)
Measured using an automated oscillometric blood pressure device (Dinamap®)
Time frame: 8 weeks
Heart Rate (Dinamap®)
Measured using an automated oscillometric blood pressure device (Dinamap®)
Time frame: 2 weeks
Blood Pressure (Dinamap®)
Measured using an automated oscillometric blood pressure device (Dinamap®)
Time frame: 16 weeks
Blood Pressure (Dinamap®)
Measured using an automated oscillometric blood pressure device (Dinamap®)
Time frame: 10 weeks
Blood Pressure (Dinamap®)
Measured using an automated oscillometric blood pressure device (Dinamap®)
Time frame: 8 weeks
Blood Pressure (Dinamap®)
Measured using an automated oscillometric blood pressure device (Dinamap®)
Time frame: 2 weeks