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Trial · Interventional

CompletedPhase 4Registry data

DECREASE: Dapagliflozin Plus Exenatide on Central REgulation of Appetite in diabeteS typE 2

Short name DECREASE

Overview

Status
Completed
Phase
Phase 4
Enrollment
65 participants (actual)
Sponsor
Amsterdam UMC, location VUmc · Other
Design
Randomized · Double masking
Countries
1 country

Netherlands

Start
18 Sept 2017
Primary completion
25 Nov 2019
Completion
25 Mar 2020
First posted
4 Dec 2017
Last update posted
11 Jun 2021
Conditions
Type 2 Diabetes Mellitus · Obesity

Timeline

1 trial · 1 completed

  • Completed
  • Ongoing
  • Not yet recruiting
  • Stopped
  • Estimated dates (est.)
  • Results posted
20172018201920202021
  1. Ph 4

    DECREASE

    NCT03361098

    18 Sept 2017 to 25 Mar 2020

Registry summary

Text and fields below are the sponsor's entries at ClinicalTrials.gov, shown as posted.

This is a 16 week, phase 4, randomized and placebo controlled trial, investigating the separate and combined effects of Sodium Glucose coTransporter 2 (SGLT2) inhibition with dapagliflozin and Glucagon Like peptide-1 (GLP-1) receptor agonism with exenatide on food intake, body weight and the neural activity in the central satiety and reward circuits in response to food-related stimuli by blood oxygen level-dependent (BOLD) fMRI in obese type 2 diabetes patients. The investigators hypothesize that treatment with SGLT2 inhibitors is associated with alterations in central reward and satiety circuits in response to food related stimuli, leading to increased appetite and food intake. In addition, the investigators hypothesize that adding a GLP-1 receptor agonist to the treatment with an SGLT2 inhibitor may increase weight loss and prevent the increased food intake during treatment with SGLT2 inhibitors due to effects on neuronal activity of central satiety and reward circuits in response to food-related stimuli in obese patients with T2DM.

Interventions

  • Dapagliflozin 10mgDrug
  • ExenatideDrug
  • placebo exenatideOther
  • placebo dapagliflozinOther

Arms4

  • Experimental

    SGLT2 inhibitor + GLP-1 receptor agonist

    dapagliflozin 10 mg tablet /day and exenatide twice daily subcutaneous injection (week 1-4; 5 microgram, week 5 -16; 10 microgram)

  • Active comparator

    GLP-1 receptor agonist (exenatide) and placebo

    GLP-1 receptor agonist exenatide twice daily in combination with placebo dapagliflozin

  • Active comparator

    SGLT2 inhibitor (dapagliflozin) and placebo

    SGLT2 inhibitor dapagliflozin 10 mg tablet /day in combination with placebo GLP-1 receptor agonist exenatide twice daily

  • Placebo comparator

    double placebo

    placebo dapagliflozin and placebo exenatide twice daily

Primary outcomes1

Outcomes the sponsor listed as primary.

  1. Differences in neuronal activity in the central reward and satiety circuits in response to food-related stimuli by BOLD fMRI signal

    Time frame · at baseline, after 10 days and after 16 weeks

    Registry description

    Differences in neuronal activity in the central reward and satiety circuits in response to food related stimuli by BOLD fMRI signal compared to baseline and 16 weeks of treatment between the exenatide + dapagliflozine, exenatide +placebo, dapagliflozin+placebo and double placebo arms.

Secondary outcomes(12)
  1. Differences in neuronal activity in the central reward and satiety circuits in response to food-related stimuli by BOLD fMRI signal

    Time frame · at baseline, after 10 days and after 16 weeks

    Registry description

    Differences in neuronal activity in the central reward and satiety circuits in response to food related stimuli by BOLD fMRI signal compared to baseline and 1.5 weeks of treatment and 1.5 and 16 weeks of treatment between the exenatide + dapagliflozine, exenatide +placebo, dapagliflozin+placebo and double placebo arms.

  2. Feeding behaviour; ad libitum lunch buffet

    Time frame · at baseline, after 10 days and after 16 weeks

    Registry description

    Feeding behaviour, measured as quantitative (kcal) changes in food choice, during an ad libitum lunch buffet will be compared between the groups (at baseline and 1,5 week, baseline and 16 weeks and 1.5 and 16 weeks of treatment)

  3. Feeding behaviour; ad libitum lunch buffet

    Time frame · at baseline, after 10 days and after 16 weeks

    Registry description

    Feeding behaviour, measured as qualitative (energy density as well as nutrient composition;carbohydrate/fat/protein) changes in food choice, during an ad libitum lunch buffet will be compared between the groups (at baseline and 1,5 week, baseline and 16 weeks and 1.5 and 16 weeks of treatment)

  4. Self-reported hunger

    Time frame · at baseline, after 10 days and after 16 weeks

    Registry description

    Self-reported hunger, satiety and fullness and prospective food consumption will be rated on 100 mm visual analogue scales before and after the meal

  5. Difference in resting energy expenditure measured by indirect calorimetry measurements

    Time frame · at baseline, after 10 days and after 16 weeks

    Registry description

    Difference in resting energy expenditure measured by indirect calorimetry measurements between the groups (baseline and 16 weeks, baseline and 1.5 weeks and 1.5 and 16 weeks of treatment)

  6. Change in bodyweight (kg) and body mass index (kg/m2)

    Time frame · at baseline, after 10 days and after 16 weeks

    Registry description

    Change in bodyweight (kg) and body mass index (kg/m2) between the groups ( at baseline and 1,5 week, baseline and 16 weeks, 1.5 week and 16 weeks)

  7. Difference in bodycomposition measured by bio electrical impedance analysis and waist and hip circumference measurements (cm)

    Time frame · at baseline, after 10 days and after 16 weeks

    Registry description

    Difference in bodycomposition measured by bio electrical impedance analysis and waist and hip circumference measurements (cm) between the groups (0-1.5, 0-16, 1.5-16)

  8. Difference in resting brain activity by fMRI resting state measurements

    Time frame · at baseline, after 10 days and after 16 weeks

    Registry description

    Difference in resting brain activity by fMRI resting state measurements between groups (0-1.5, 0-16, 1.5-16)

  9. Effect on cardiovascular autonomic balance by cardiovascular reflex test with finger plethysmography (Nexfin)

    Time frame · at baseline, after 10 days and after 16 weeks

    Registry description

    Effect on cardiovascular autonomic balance by cardiovascular reflex test with finger plethysmography (Nexfin) measuring bloodpressure, hartfrequency, ECG between the groups (0-16, 0-1.5, 1.5-16)

  10. Arterial stiffness: Pulse Wave analysis

    Time frame · at baseline, after 10 days and after 16 weeks

    Registry description

    Arterial stiffness: Pulse Wave analysis will be assessed using the Sphygmocor system, a non-invasive system using applanation tonometry between the groups (0-16, 0-1.5, 1.5-16)

  11. Renal measurements collecting 24 hour urine

    Time frame · at baseline, after 10 days and after 16 weeks

    Registry description

    Renal measurements collecting 24 hour urine; glucose excretion (0-1.5, 0-16, 1.5-16), creatinine clearance (0-1.5, 0-16, 1.5-16), tubular function; sodium excretion and urinary pH (0-1.5, 0-16, 1.5-16), renal damage markers albumin/creatinine ratio (0-1.5, 0-16, 1.5-16)

  12. Laboratory parameters

    Time frame · at baseline, after 10 days and after 16 weeks

    Registry description

    Change in the plasma/serum biomarkers of metabolism, liver function, estimated renal function (eGFR), electrolytes, and haematocrit

Posted results

Values are shown as posted at ClinicalTrials.gov, with their units. PepBank has not converted, pooled or compared them.

No results are posted for this trial.

Completed trials do not always post results.

Registry data comes from ClinicalTrials.gov. Study results come from studies, not from the registry. How PepBank works

Studies6

Studies that cite this trial.

Studies with results

3 studies on this page

Indexing hint: Randomized controlled trial · 2022

3 results

Effects of Dapagliflozin and Combination Therapy With Exenatide on Food-Cue Induced Brain Activation in Patients With Type 2 Diabetes.

van Ruiten et al. 2022The Journal of clinical endocrinology and metabolismcited by 23

PMID 35134184PMC9113812DOI 10.1210/clinem/dgac043PUB-35134184

Free to read · publisher termsCC BY-NC-ND3 results

Indexing hint: Randomized controlled trial · 2022

7 results

Mechanisms underlying the blood pressure lowering effects of dapagliflozin, exenatide, and their combination in people with type 2 diabetes: a secondary analysis of a randomized trial.

van Ruiten et al. 2022Cardiovascular diabetologycited by 36

PMID 35484607PMC9052512DOI 10.1186/s12933-022-01492-xPUB-35484607

CC BY7 results

Indexing hint: Randomized controlled trial · 2017

8 results

Dapagliflozin once daily plus exenatide once weekly in obese adults without diabetes: Sustained reductions in body weight, glycaemia and blood pressure over 1 year.

Lundkvist et al. 2017Diabetes, obesity & metabolismcited by 53

PMID 28345814PMC5575470DOI 10.1111/dom.12954PUB-28345814

Free to read · publisher termsCC BY-NC8 results

More studies

3 studies on this page

PubMed tag: none · 2016

Endogenous GLP1 and GLP1 analogue alter CNS responses to palatable food consumption.

Ten Kulve et al. 2016The Journal of endocrinologycited by 55

PMID 26769912DOI 10.1530/joe-15-0461PUB-26769912

Full text at the publisher
Publisher page

Indexing hint: Randomized controlled trial · 2016

Corrected

Exenatide once weekly plus dapagliflozin once daily versus exenatide or dapagliflozin alone in patients with type 2 diabetes inadequately controlled with metformin monotherapy (DURATION-8): a 28 week, multicentre, double-blind, phase 3, randomised controlled trial.

Frías et al. 2016The lancet. Diabetes & endocrinologycited by 322

PMID 27651331DOI 10.1016/s2213-8587(16)30267-4PUB-27651331

Full text at the publisher

Indexing hint: Review · 2014

Effects of glucagon-like peptide 1 on appetite and body weight: focus on the CNS.

van Bloemendaal et al. 2014The Journal of endocrinologycited by 245

PMID 24323912DOI 10.1530/joe-13-0414PUB-24323912

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Source link

Eligibility

Who could join, as posted.

Sex
All
Age
from 18 Years up to 75 Years
Healthy volunteers
Not accepted
Inclusion and exclusion criteria, as posted
Inclusion Criteria: * Age 18-75 years * BMI 27-40 kg/m2 * Stable bodyweight (\<5% reported change during the previous 3 months). * Diagnosed with T2DM \> 3 months prior to screening * Treatment with metformin and/or sulphonylurea at a stable dose for at least 3 months. * HbA1c 7.0-10% for patients treated with metformin * HbA1c 7.5-10% for patients treated with metformin and/ or sulphonylurea * For women: post menopausal (excluding possible menstruation cycle effects) Exclusion Criteria: * GLP-1 based therapies, DDP-4 inhibitors, SGLT-2 inhibitors, thiazolidinediones or insulin within 3 months before screening * Weight-lowering agents within 3 months before screening. * Congestive heart failure (NYHA II-IV) * Chronic renal failure (glomerular filtration rate \< 45 mL/min/1.73m2 per Modification of Diet in Renal Disease (MDRD)) * Liver disease * History of gastrointestinal disorders (including gastroparese, pancreatitis and cholelithiasis) * Patients with MEN2 syndrome or history or family history of medullary thyroid carcinoma * Neurological illness * Malignancy (except for basal cell carcinoma) * History of major heart disease * History of major renal disease * Pregnancy or breast feeding * Implantable devices * Substance abuse * Addiction * Alcohol abuse (defined as: for men \> 21 units/week, for women \>14 units/week) * Smoking/ nicotine abuse (defined as: daily smoking / a daily use of nicotine) * Contra-indication for MRI, such as claustrophobia or pacemaker * psychiatric illnesses; mood disorders, eating disorders, anxiety disorders, schizophrenia and other psychotic disorders, dissociative disorders, somatoform disorders, delirium, dementia and other cognitive disorders * Chronic use of centrally acting agents or glucocorticoids within 2 weeks immediately prior to screening * Use of cytostatic or immune modulatory agents * History of allergy for exenatide or other GLP-1 RA * Participation in other studies * Individuals who have received treatment within the last 30 days with a drug that has not received regulatory approval for any indication at the time of study entry * Individuals who are investigator site personnel, directly affiliated with the study, or are immediate family of investigator site personnel directly affiliated with the study. Immediate family is defined as a spouse, parent, child, or sibling, whether biological or legally adopted. * Individuals who have previously completed or withdrawn from this study or any other study investigating GLP-1 receptor agonist or dipeptidyl peptidase (DPP)-4 within 6 months * Visual disability, not correctable with glasses or contact lens * Individuals who, in the opinion of the investigator, are unsuitable in any other way to participate in this study * Poor commandment of the Dutch language or any (mental) disorder that precludes full understanding the purpose, instruction and hence participation in the study * Further exclusion criteria will be in compliance with the EMeA SPC of exenatide and dapagliflozin

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