A Single-dose Cross-over Study to Assess Direct and Indirect Effects of Dapagliflozin on Pancreatic Alpha and Beta Cells in Patients With Type 2 Diabetes

Study Overview
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Brief Summary
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The purpose of this study is to evaluate if Dapagliflozin has direct effect on alpha cell glucagon release.

Official Title
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A Single-dose Cross-over Study to Assess Direct and Indirect Effects of Dapagliflozin on Pancreatic Alpha and Beta Cells in Patients With Type 2 Diabetes

Conditions
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Diabetes Mellitus, Type 2

Intervention / Treatment
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* Drug: Dapagliflozin
* Drug: Saxagliptin
* Drug: Glucose


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Males and females aged 18 - 75. Female subjects must meet all of the following criteria: Not breastfeeding Negative pregnancy test result (human chorionic gonadotropin, beta subunit [hCG]) at Visit 0 (screening) (not applicable to hysterectomized females). If of childbearing potential (including perimenopausal women who have had a menstrual period within 1 year), must practice and be willing to continue to practice one of the following highly effective birth control methods during the entire duration of the study: i. Diaphragm or partner use of condom in combination with combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation: Oral Intravaginal Transdermal ii. Diaphragm or partner use of condom in combination with progestogen-only hormonal contraception associated with inhibition of ovulation: Oral Injectable Implantable iii. Placement of an intrauterine device iv. Placement of an intrauterine hormone-releasing system v. Bilateral tubal occlusion vi. Vasectomised partner (provided that the partner is the sole sexual partner of the female subject and that the vasectomised partner has received medical assessment of the surgical success) vii. Sexual abstinence (defined as refraining from heterosexual intercourse) d) Must practice appropriate birth control as stated above for 10 weeks after the last dose of study medication BMI 20 - 35. Clinical T2D diagnosis at least 6 months prior to enrolment. Metformin treatment, with stable dose for at least 1 month. HbA1c 55 - 86 mmol/mol (7,2-10 % DCCT). Exclusion Criteria: History or sign of any clinically significant disease or disorder which, in the opinion of the investigator, may either put the subject at risk because of participation in the study, or influence the results or the subject's ability to participate in the study. Clinical diagnosis of Type 1 diabetes mellitus and/or history of diabetic ketoacidosis or positive Glutamic Acid Decarboxylase Autoantibodies test (GAD antibodies test). Patients treated with antipsychotics, systemic glucocorticoids, neuropsychiatric stimulants, antidepressants with sympathetic activity, beta blockers or other pharmaceuticals rendering patient unfit for study participation as judged by the investigator. Patients treated with antidiabetic medications other than Metformin. Patients with any other endocrine disease except substituted hypothyroidism. Significant abnormal liver function defined as aspartate aminotransferase (AST) >3x upper limit of normal (ULN) and/or alanine aminotransferase (ALT) >3x ULN. Patients with impaired liver or kidney function (eGFR < 60). Known or suspected history of significant drug abuse. History of alcohol abuse or excessive intake of alcohol as judged by investigator. History of severe allergy/hypersensitivity or ongoing allergy/hypersensitivity, as judged by the investigator. Plasma donation within one month of screening or any blood donation or significant blood loss (> 400 ml) during the 3 months prior to screening. Any other condition with in the opinion of the investigator would render the patient unsuitable for inclusion in the study and /or for the patients safety. Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff and/or staff at the study site). Judgment by the investigator that the subject should not participate in the study if considers subject unlikely to comply with study procedures, restrictions and requirements.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: DS-D-DG<br>The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose). | Drug: Dapagliflozin<br> <br> Drug: Saxagliptin<br> <br> Drug: Glucose<br> <br> |
| Experimental: DS-DG-D<br>The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose). | Drug: Dapagliflozin<br> <br> Drug: Saxagliptin<br> <br> Drug: Glucose<br> <br> |
| Experimental: D-DG-DS<br>The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose). | Drug: Dapagliflozin<br> <br> Drug: Saxagliptin<br> <br> Drug: Glucose<br> <br> |
| Experimental: D-DS-DG<br>The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose). | Drug: Dapagliflozin<br> <br> Drug: Saxagliptin<br> <br> Drug: Glucose<br> <br> |
| Experimental: DG-D-DS<br>The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose). | Drug: Dapagliflozin<br> <br> Drug: Saxagliptin<br> <br> Drug: Glucose<br> <br> |
| Experimental: DG-DS-D<br>The arm label indicates the order of the given treatments in this crossover designed study (DS=Dapagliflozin and Saxagliptin, D=Dapagliflozin, DG=Dapagliflozin and Glucose). | Drug: Dapagliflozin<br> <br> Drug: Saxagliptin<br> <br> Drug: Glucose<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in plasma glucagon levels from baseline to 0.5 hour after single-dose administration of drug. | Washout period of 2-6 weeks between the interventions | At start and 0.5 hour after the start of each intervention | 
| Change in plasma glucagon levels from baseline to 1 hour after single-dose administration of drug. |  | At start and 1 hour after the start of each intervention | 
| Change in plasma glucagon levels from baseline to 2 hours after single-dose administration of drug. |  | At start and 2 hours after the start of each intervention | 
| Change in plasma glucagon levels from baseline to 3 hours after single-dose administration of drug. |  | At start and 3 hours after the start of each intervention | 
| Change in plasma glucagon levels from baseline to 5 hours after single-dose administration of drug. |  | At start and 5 hours after the start of each intervention | 
| Change in plasma glucagon levels from baseline to 5.5 hours after single-dose administration of drug. |  | At start and 5.5 hours after the start of each intervention | 
| Change in plasma glucagon levels from baseline to 6 hours after single-dose administration of drug. |  | At start and 6 hours after the start of each intervention | 
| Change in plasma glucagon levels from baseline to 7 hours after single-dose administration of drug. |  | At start and 7 hours after the start of each intervention |