Effectiveness of Empagliflozin Added to Automated Insulin Delivery (AID) Systems in Adults With Type 1 Diabetes With Sub-optimal Glycemic Outcomes

Phase 4RecruitingNCT06021145

McGill University Health Centre/Research Institute of the McGill University Health Centre46 enrolled

Overview

The goal of this 26-week multicenter, randomized, parallel, placebo-controlled trial is to test the effectiveness of empagliflozin use in conjunction with automated insulin delivery (AID) to improve glucose control in individuals with type 1 diabetes who do not meet target recommendations for time in range (3.9-10.0 mmol/L). The main question it aims to answer is: \- Will use of empagliflozin (2.5 mg/day) increase time spent in the target range of 3.9 to 10.0 mmol/L compared to placebo for individuals on an AID system who do not meet glycemic targets? Participants will either take 2.5 mg of empagliflozin or a placebo daily for 26 weeks while remaining on their current AID system.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

QUADRUPLE

Enrollment

Conditions

Type 1 Diabetes

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Individuals ≥ 18 years of age. * A clinical diagnosis of type 1 diabetes for at least one year, as per the investigators' clinical judgment (confirmatory C-peptide and antibodies will not be required). * Minimum 3-month use of a commercial advanced AID system. * Time in range (3.9 to 10.0 mmol/L) \< 70% on their personal AID system in the 30 days prior to screening (with minimum 70% time spent in closed-loop mode). * Agreement to use a highly effective method of birth control for individuals of child-bearing age and active avoidance of pregnancy during the trial. Child-bearing potential refers to participants of the female sex post-menarche who have not reached menopause and who do not have a disclosed medical condition causing sterility (ex: hysterectomy). Post-menopausal state refers to the absence of menses for 12 months without any alternative cause. Exclusion Criteria: * Current or ≤ 2 week use of any anti-hyperglycemic agent other than insulin (such as SGTL2i). * Current or ≤ 1 month use of Glucagon-like Peptide 1 (GLP1)-Receptor Agonists. * Current or ≤ 1 month use of supraphysiological doses of oral or intravenous glucocorticoids. * Planned or ongoing very low carbohydrate diet (\< 50g/day). * Glomerular filtration rate (eGFR) \< 30 mL/min/1.73 m2 as per CKD-EPI formula with creatinine levels measured within the last 12 months. * Use of hydroxyurea. * Planned or ongoing pregnancy. * Breastfeeding. * Ongoing active risk of recurrent genito-urinary infections, as per the clinical judgement of the investigators. * Severe hypoglycemic episode within 1 month of screening, defined as an event resulting in seizure, loss of consciousness, or need to present to the emergency department. * Diabetic ketoacidosis within 6 months of screening, defined as an event requiring the need to present to medical attention and administration of intravenous insulin. * Any serious medical illness likely to interfere with the ability to complete the trial per the judgment of the investigators. * Clinically significant retinopathy as judged by the investigator. * Recent (\< 3 months) acute macrovascular event (ex: acute coronary syndrome or cardiac surgery). * Prior serious reaction to SGLT2i. * Use of the Medtronic 670G or 770G system in the last 30 days. * In the opinion of the investigator, inability to observe the contraindications of the study drugs, or failure to comply to the study protocol or research team's recommendations (e.g., changing pump parameters, ketone measurements).

Outcomes

Primary Outcomes

Percentage of time of glucose levels spent in the target range (empagliflozin vs placebo)

Target range is defined to be between 3.9 and 10.0 mmol/L of placebo on an automated insulin delivery system vs empagliflozin (2.5 mg) on an automated insulin delivery system. Percent measured as per continuous glucose monitor (CGM) data.

Time frame: 4 weeks

Secondary Outcomes

Percentage of time spent in the glucose range between 3.9 and 7.8 mmol/L

Percent as per CGM data

Time frame: 4 weeks

Percentage of time spent in the glucose range below 3.9 mmol/L and 3.0 mmol/L

Percent as per CGM data

Time frame: 4 weeks

Percentage of time spent in the glucose range above 10.0 mmol/L and 13.9 mmol/L

Percent as per CGM data

Time frame: 4 weeks

Mean glucose levels

Defined as per CGM data, in mmol/L

Time frame: 4 weeks

Standard deviation of glucose levels

Defined as per CGM data, in mmol/L

Time frame: 4 weeks

Coefficient of variance of glucose levels

Percent as per CGM data

Time frame: 4 weeks

Total insulin delivery (overall, basal, and bolus)

Defined as per participant's pump data

Time frame: 4 weeks

Mean daily carbohydrate intake

Defined as per participant's pump data

Time frame: 4 weeks

HbA1c

Percent as per blood test

Time frame: 26 weeks

Estimated glomerular filtration rate (eGFR)

mL/min/1.73 m\^2 as per blood test

Time frame: 26 weeks

Lipid profile

Includes measurements in mmol/L as per blood test: total cholesterol, triglycerides, HDL-C, LDL-C, nonHDL-C

Time frame: 26 weeks

Brain Natriuretic Peptide (NT-pro-BNP)

ng/L as per blood test

Time frame: 26 weeks

Liver profile - bilirubin

umol/L as per blood test

Time frame: 26 weeks

Liver profile - alanine transaminase (ALT) and alkaline phosphatase (ALP)

U/L as per blood test

Time frame: 26 weeks

Measurement of body mass: weight and height

Body measurement as described (weight in kilograms and height in meters). Weight and height will be combined to report body mass index in kg/m\^2.

Time frame: 26 weeks

Waist and hip circumference, and waist-to-hip ratio

Body measurements as described (waist and hip circumference in centimeters). Waist and hip cirumference will be combined to report waist-to-hip ratio.

Time frame: 26 weeks

Heart rate

Body measurement as described (beats per minutes)

Time frame: 26 weeks

Blood pressure

Body measurement as described (diastolic and systolic pressure; mmHg)

Time frame: 26 weeks

Average scores between interventions based on Type 1 Diabetes Distress Scale Questionnaire

Self-report scale (1 min = "not a problem" to 6 max = "a very serious problem") that assesses a participant's distress surrounding their diabetes with higher scores correlating to higher distress.

Time frame: 26 weeks

Average scores between interventions based on Hypoglycemic Fear Survey - II

Likert scale (1 min to 5 max) that assesses a participant's worry surrounding hypoglycemia with higher scores indicating increased fear of hypoglycemia.

Time frame: 26 weeks

Average scores between interventions based on Diabetes Treatment Satisfaction Questionnaire

Self-report scale (0 min = "very dissatisfied" to 6 max = "very satisfied") that assesses a participant's satisfaction surrounding the treatment for their diabetes with higher scores indicating greater satisfaction with treatment.

Time frame: 26 weeks

Fasting ketone levels

As per ketone test strip and meter; measured by participant

Time frame: 7 days

Effectiveness of Empagliflozin Added to Automated Insulin Delivery (AID) Systems in Adults With Type 1 Diabetes With Sub-optimal Glycemic Outcomes

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts