The study team will examine the effects of SGLT2i (and SGLT2i-induced increases in plasma ketone concentrations) on skeletal muscle and cardiac ketone uptake, skeletal muscle bioenergetics, cardiopulmonary exercise capacity, and patient-reported functional outcomes.
The study team will examine effects of elevated plasma ketones caused by 12-week treatment with an SGLT2i (empagliflozin) treatment in participants with T2DM and HF. The study team will focus on three possible mechanisms of action for these effects and test the following: (i) Skeletal muscle bioenergetics. Using 31P-MRS, the team will quantitate phosphocreatine \[PCr\], ATP, inorganic phosphate, phosphodiester, and intracellular pH. With 1H-MRS, and will measure intramyocellular lipid content at rest and ATPmax production after exercise. The team will examine the relationships between phosphorous metabolite concentrations, intramyocellular lipid content, and ATP generation before and after 12 weeks of SGLT2 inhibition. (ii) Cardiopulmonary functional capacity. (iii) Improvements in Patient-Reported Outcomes (PRO). The Patient-Reported Outcomes Measure Information System (PROMIS) Item Bank v2.0 - Physical Function - Short Form 20a will be used to evaluate self-reported physical function and well-being. This tool is a well-developed and validated method to obtain patient self-reported parameters of health in adults.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
DOUBLE
Enrollment
30
Empagliflozin 25MG will be administered orally once per day for 3 months
The placebo will be administered orally once per day for 3 months
Texas Diabetes Institute - University Health System
San Antonio, Texas, United States
RECRUITINGUniversity of Texas Health Science Center at San Antonio
San Antonio, Texas, United States
RECRUITINGChange in Phosphocreatine
A measure of phosphocreatine change from baseline to study end
Time frame: Baseline to 3 months
Change in Adenosine Triphosphate (ATP)
A measure of ATP change from baseline to study end
Time frame: Baseline to 3 months
Change in Inorganic Phosphate
A measure of inorganic phosphate change from baseline to study end
Time frame: Baseline to 3 months
Change in Phosphodiester
A measure of phosphodiester change from baseline to study end
Time frame: Baseline to 3 months
ATPmax production
Exercise induced ATPmax production change
Time frame: Baseline to 3 months
Plasma Beta-hydroxybutyrate (β-OH-B)
Change in β-OH-B
Time frame: Baseline to 3 months
Acetoacetate concentrations
Change in acetoacetate concentrations
Time frame: Baseline to 3 months
Cardiopulmonary Function
Change in cardiopulmonary functional capacity using oxygen uptake (VO2)
Time frame: Baseline to 3 months
6 minute walk test
Change in the distance that can be covered in a 6 minute walk test
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Time frame: Baseline to 3 months
Patient-Reported Outcomes Measure Information System (PROMIS)
Change in Physical function will be assessed by the PROMIS Item band v2.0 -Physical Function -Short Form 20a to evaluate patient-reported outcomes of physical function and well being.
Time frame: Baseline to 3 months