E.1 Medical condition or disease under investigation |
E.1.1 | Medical condition(s) being investigated |
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E.1.1.1 | Medical condition in easily understood language |
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E.1.1.2 | Therapeutic area | Diseases [C] - Hormonal diseases [C19] |
MedDRA Classification |
E.1.2 Medical condition or disease under investigation |
E.1.2 | Version | 21.1 |
E.1.2 | Level | PT |
E.1.2 | Classification code | 10067584 |
E.1.2 | Term | Type 1 diabetes mellitus |
E.1.2 | System Organ Class | 10027433 - Metabolism and nutrition disorders |
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E.1.3 | Condition being studied is a rare disease | No |
E.2 Objective of the trial |
E.2.1 | Main objective of the trial |
To assess whether the addition of a drug designed to increase the amount of sugar removed from the body (dapagliflozin) and semaglutide to insulin (triple therapy) improves blood glucose control in patients with type 1 diabetes compared with semaglutide and insulin (dual therapy) and insulin only (standard) treatment.
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E.2.2 | Secondary objectives of the trial |
To assess whether 1: Semaglutide in addition to insulin treatment over 26 and 52 weeks will significantly improve HbA1c levels compared with insulin therapy alone.
2: Combined dapagliflozin and semaglutide treatment in addition to insulin will significantly improve glucose control and the percent of time spent in normal zone range (80-160mg/dl) with lower insulin requirements compared with semaglutide and insulin (dual therapy) or insulin only (standard) treatment treatment alone.
3: combined dapagliflozin and semaglutide treatment will improve postprandial glucose excursions and suppress postprandial glucagon compared with semaglutide and insulin or insulin therapy alone.
4: Combined dapagliflozin and semaglutide in addition to insulin therapy will reduce blood pressure compared with semaglutide and insulin (dual therapy) or insulin only (standard) treatment.
5: Combined dapagliflozin and semaglutide in addition to insulin therapy (triple therapy) will result in weight loss co |
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E.2.3 | Trial contains a sub-study | No |
E.3 | Principal inclusion criteria |
1) Type 1 Diabetes for at least 1 year on stable multiple daily (four or more) injections (MDI) of insulin or continuous subcutaneous insulin infusion (CSII) for the previous three months. 2) C-peptide < 0.23 nM 3) Minimum dose of insulin: 0.5 U/kg for MDI and 0.4 U/kg for CSII 4) Regularly measuring blood glucose four or more times daily by fingerprick, (or by "flash" or continuous glucose monitoring). 5) HbA1c >7.5% 6) Well versed in Carbohydrate (CHO) counting* 7) Age 18-70 years. 8) BMI ≥25 kg/m2.
*In the opinion of the site Principal Investigator
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E.4 | Principal exclusion criteria |
1) Type 1 diabetes for < 12 months, type 2 diabetes, chronic pancreatitis, MODY 2) Previous use of any agent other than insulin for glycaemic control in the last three months. 3) History of diabetic ketoacidosis (DKA) requiring medical intervention (e.g. emergency room visit and/or hospitalisation) within three months prior to the screening visit. 4) Following ketogenic diet, low (<50g/day) carbohydrate diet or intermittent fasting. 5) Hypoglycaemia unawareness* or frequent episodes of severe hypoglycaemia as defined by more than one episode requiring medical assistance, emergency care (paramedics or emergency room care), or glucagon therapy administered by a third-party individual within three months prior to the screening visit 6) Symptoms of poorly controlled diabetes 7) Participation in a weight loss program with ongoing weight loss, or in an intensive exercise program 8) History of bariatric or other weight-loss surgery within 12 months prior to the screening visit 9) History of Addison’s disease or chronic adrenal insufficiency 10) History of diabetes insipidus 11) Hepatic disease or cirrhosis 12) Aspartate Aminotransferase (AST) > 3 X Upper limit of normal (ULN) and/or Alanine aminotransferase (ALT) > 3 X ULN 13) Serum Total Bilirubin > 2 X ULN unless exclusively caused by Gilbert’s Syndrome 14) Haemoglobin < 110 g/L (11.0 g/dL) for men; haemoglobin < 100 g/L (10.0 g/dL) for women 15) Coronary event or procedure (myocardial infarction, unstable angina, coronary artery bypass, surgery or coronary angioplasty) in the previous three months or history of congestive heart failure 16) End stage renal disease on haemodialysis and/or eGFR < 60 ml/min/1.73m2 17) HIV or Hepatitis B/C positive status 18) Any other life-threatening, non-cardiac disease 19) History of pancreatitis or cystic fibrosis 20) Women who are pregnant, planning pregnancy or breast-feeding and women of childbearing potential (WOCBP) who are not established on a method of adequate contraception considered highly effective (see Appendix 2) and willing to continue it for the duration of the study and for at least two months after last dose of IMP. 21) Inability to give informed consent 22) History of gastroparesis 23) History of medullary thyroid carcinoma or MEN 2 syndrome 24) History of hypersensitivity reaction to GLP-1 agonists or SGLT2 inhibitors or known hypersensitivity to any of the excipients 25) Known gallstones (history of cholecystectomy is not an exclusion criterion) 26) History of alcohol problem or drug abuse 27) Hypertriglyceridemia (>500 mg/dl) 28) Recurrent genital mycotic infection (more than one episode in last six months) 29) Hypovolaemia 30) Any malignancy except treated in situ malignancy and basal cell carcinoma of the ski 31) Unexplained haematuria (dipstick positive on two occasions one week apart) and/or active bladder cancer 32) Proliferative retinopathy (on basis of photographic retinal screening which must have been performed within the last 12 months 33) Use of an investigational agent or therapeutic regimen within 90 days of study 34) Participation in any other concurrent interventional clinical trial 35) Unlikely to be able to comply with study requirements* * In the opinion of the site Principal Investigator
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E.5 End points |
E.5.1 | Primary end point(s) |
The Primary Outcome measure of this study is to assess in people with type 1 diabetes whether triple therapy (dapagliflozin, semaglutide and insulin) reduces HbA1c in comparison with dual therapy (placebo, semaglutide, and insulin).
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E.5.2 | Secondary end point(s) |
Efficacy: Change in HbA1c Mean fasting blood glucose Mean blood glucose* Percentage time in range (3.9 - 10.0 mmol/)* Standard deviation of blood glucose* Percentage time in hyperglycaemia Level 1 (10.1 - 13.9 mmol/L/)* Percentage time in hyperglycaemia Level 2 (>13.9 mmol/L) * Percent time in hypoglycaemia Level 1 (3.0 - 3.8 mmol/)* (* by masked DEXCOM G6 CGM) Insulin requirement Bodyweight Systolic and diastolic BP Number of antihypertensive medications Diabetes Specific Quality of Life Scale (DSQOLS) Problem Areas In Diabetes (PAID) questionnaire Safety: Rate of hypoglycemic events Level 2 (<3.0 mmol/L/ <54mg/dl) Rate of hypoglycemic events Level 3 (severe event with altered mental and/or physical status requiring assistance) Rate of diabetic ketoacidosis defined as elevated serum or urine ketones (greater than the upper limit of the normal range), and serum bicarbonate < 15 mmol/L or blood pH < 7.3 |
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E.6 and E.7 Scope of the trial |
E.6 | Scope of the trial |
E.6.1 | Diagnosis | No |
E.6.2 | Prophylaxis | No |
E.6.3 | Therapy | Yes |
E.6.4 | Safety | Yes |
E.6.5 | Efficacy | Yes |
E.6.6 | Pharmacokinetic | No |
E.6.7 | Pharmacodynamic | No |
E.6.8 | Bioequivalence | No |
E.6.9 | Dose response | No |
E.6.10 | Pharmacogenetic | No |
E.6.11 | Pharmacogenomic | No |
E.6.12 | Pharmacoeconomic | No |
E.6.13 | Others | No |
E.7 | Trial type and phase |
E.7.1 | Human pharmacology (Phase I) | No |
E.7.1.1 | First administration to humans | No |
E.7.1.2 | Bioequivalence study | No |
E.7.1.3 | Other | No |
E.7.1.3.1 | Other trial type description | |
E.7.2 | Therapeutic exploratory (Phase II) | No |
E.7.3 | Therapeutic confirmatory (Phase III) | Yes |
E.7.4 | Therapeutic use (Phase IV) | No |
E.8 Design of the trial |
E.8.1 | Controlled | Yes |
E.8.1.1 | Randomised | Yes |
E.8.1.2 | Open | Yes |
E.8.1.3 | Single blind | No |
E.8.1.4 | Double blind | Yes |
E.8.1.5 | Parallel group | Yes |
E.8.1.6 | Cross over | No |
E.8.1.7 | Other | Information not present in EudraCT |
E.8.2 | Comparator of controlled trial |
E.8.2.1 | Other medicinal product(s) | Yes |
E.8.2.2 | Placebo | Yes |
E.8.2.3 | Other | No |
E.8.2.4 | Number of treatment arms in the trial | 3 |
E.8.3 |
The trial involves single site in the Member State concerned
| Yes |
E.8.4 | The trial involves multiple sites in the Member State concerned | Information not present in EudraCT |
E.8.5 | The trial involves multiple Member States | No |
E.8.6 Trial involving sites outside the EEA |
E.8.6.1 | Trial being conducted both within and outside the EEA | Yes |
E.8.6.2 | Trial being conducted completely outside of the EEA | Yes |
E.8.6.3 | If E.8.6.1 or E.8.6.2 are Yes, specify the regions in which trial sites are planned |
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E.8.7 | Trial has a data monitoring committee | Yes |
E.8.8 |
Definition of the end of the trial and justification where it is not the last
visit of the last subject undergoing the trial
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E.8.9 Initial estimate of the duration of the trial |
E.8.9.1 | In the Member State concerned years | 2 |
E.8.9.1 | In the Member State concerned months | 5 |
E.8.9.1 | In the Member State concerned days | 31 |
E.8.9.2 | In all countries concerned by the trial years | 3 |
E.8.9.2 | In all countries concerned by the trial months | 3 |
E.8.9.2 | In all countries concerned by the trial days | 31 |