Approximately 25% of patients with type 1 diabetes have lost the capacity to timely detect hypoglycaemia, a condition referred to as impaired awareness of hypoglycaemia (IAH) that causes a six-fold higher risk of severe, potentially hazardous, hypoglycaemia. IAH is usually the end-result of a process of habituation to recurrent hypoglycaemia that is potentially reversible. Treatment with sodium glucose cotransporter (SGLT)-2 inhibitors (SGLT-2i) in addition to insulin therapy may decrease the incidence of hypoglycaemia in patients with type 1 diabetes. This study will test the hypothesis that treatment with the SGLT-2 inhibitor, dapagliflozin, added to basal-bolus insulin therapy will improve awareness of hypoglycaemia in patients with type 1 diabetes and IAH. In a randomized doubleblind placebo-controlled cross-over trial, patients will be treated for 8 weeks with dapagliflozin (or placebo), after which hypoglycemic symptoms and counterregulatory hormone responses will be examined during a hyperinsulinemic hypoglycemic glucose clamp study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
15
8 weeks treatment with dapagliflozin on top of insulin treatment
8 weeks treatment with placebo capsules on top of insulin treatment
Radboud university medical center
Nijmegen, Netherlands
Symptom score in response to insulin-induced hypoglycaemia
Symptom scores (autonomic, neuroglycopenic and general) measured during hyperinsulinemic hypoglycaemic glucose clamps. This questionnaire consists of 18 symptoms, which can be scored between 0 (none) to 6 (severe). Total scores range between 0 and 108, the higher the score, the more symptoms patients have during and after hypoglycemia.
Time frame: 45 minutes
Counterregulatory hormone responses to insulin-induced hypoglycaemia
(nor)adrenaline, glucagon, insulin, growth hormone and cortisol responses to hypoglycaemia measured during hyperinsulinemic hypoglycaemic glucose clamps
Time frame: 45 minutes
Time until glycaemic recovery from hypoglycaemia
measured during hyperinsulinemic hypoglycaemic glucose clamps
Time frame: 45 minutes
Maximal glucose excursion post-hypoglycaemia
Maximal glucose level (mmol/l) measured during the 90 minutes after ending the hypoglycaemic phase of the clamp (during restoration of euglycaemia)
Time frame: 45 minutes
Time until glucose peak post-hypoglycaemia
measured during hyperinsulinemic hypoglycaemic glucose clamps
Time frame: 45 minutes
Area under the glucose concentration curve post-hypoglycaemia
measured during hyperinsulinemic hypoglycaemic glucose clamps
Time frame: 45 minutes
Number of severe hypoglycaemic events during follow-up
measured during follow-up
Time frame: 16 weeks
Number of nocturnal hypoglycaemic events during follow-up
measured during follow-up
Time frame: 16 weeks
Number of any hypoglycaemic events during follow-up
measured during follow-up
Time frame: 16 weeks
Time spent under hypoglycaemic conditions measured by glucose sensor monitoring
measured during follow-up
Time frame: 2 weeks
Glucose variability as measured by glucose sensor monitoring
measured during follow-up
Time frame: 2 weeks
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