The Impact Of SGLT2 -I on Metabolic Dysfunction -Associated Steatotic Liver Disease In Patients With Type 2 Diabetes Mellitus

Launched by SOHAG UNIVERSITY · Oct 31, 2023

Keywords

ClinConnect Summary

This clinical trial is studying the effects of a group of medications called SGLT2 inhibitors on patients with type 2 diabetes who also have a condition known as metabolic dysfunction-associated steatotic liver disease, which is essentially a type of fatty liver disease. The researchers want to find out if these medications can help improve liver health by reducing liver scarring, fat buildup, and inflammation. They are also interested in seeing which specific SGLT2 inhibitor works best for this purpose.

To participate in the trial, individuals must be at least 20 years old and have been diagnosed with type 2 diabetes for at least six months, with a specific blood sugar level that indicates their diabetes is not well controlled. Other factors, such as having certain liver conditions or using specific medications, may prevent someone from joining the study. Participants can expect to receive treatment and undergo regular check-ups to monitor their health throughout the trial. It's important to note that the study is not yet recruiting participants, so there will be updates on when it will start.

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Eligibility criteria

• Inclusion Criteria:
• * Men or women aged ≥20 years old who will be:
• • 1. Diagnosed with type 2 diabetes since ≥6 months in accordance with World Health Organization criteria (22); and
• • 2. Present with glycated hemoglobin equal to or greater than 7% and less than 10% after at least three months of treatment with metformin monotherapy at the maximal tolerated dosage or sulfonylurea alone or in combination; and
• • 3. Diagnosed with Metabolic associated steatotic liver disease
• Exclusion Criteria:
• • Diagnosis or signs of type 1 diabetes or non-diabetic patients
• • Highly uncontrolled diabetes (HbA1c \>86 mmol/mol \[\>10.0%\])
• • BMI ≥40 kg/m2
• • Other causes of chronic hepatic steatosis (e.g., Hepatitis B virus ,Hepatitis c virus, autoimmune disease, Wilson disease, drugs, alpha one antitrypsin deficiency).
• • Patients use of drugs known to cause hepatic steatosis (e.g., amiodarone, valproate, tamoxifen, methotrexate, steroids)
• • Treatment with glucose-lowering drugs that influence liver fat, including thiazolidinediones, α-glucosidase inhibitors, sodium-glucose cotransporter 2 (SGLT2) inhibitors or any glucagon-like peptide-1 receptor agonists during the previous 3 months.
• • Detection of biliary duct obstruction based on imaging studies.
• • Patients with diagnosis of or clinical features that are suspected for another systemic disease that commonly causes liver disease.
• • Patient with history of liver transplantation
• • Evidence of cirrhosis (on basis of ultrasonography and MRI) or hepatocellular carcinoma (evidence on triphasic CT or MRI).
• • Positive HIV test
• • Treatment with vitamin E during the previous 3 months.
• • Intolerance or allergy SGLT2-I or any other substance in the tablets.
• • Contraindications to SGLT2-I use (history of acute or chronic pancreatitis or pancreatic cancer, or history of recurrent urinary tract or genital infections, current or previous gangrene).
• • History of or presence of (as found at Visit 1) any clinically significant disease or disorder which, in the opinion of the investigator, may either put the patient at risk because of participation in the study, or influence the results or the patient's ability to participate in the study.
• • Creatinine clearance \<90 ml/min at screening (Cockcroft-Gault formula).
• • Severe hepatic injury and/or significant abnormal liver function defined as aspartate aminotransferase \>5× upper limit of normal (ULN) and/or alanine aminotransferase \>5× ULN.
• • Total bilirubin \>2.0 mg/dl (34.2 μmol/l)\\
• • History of bariatric surgery or ongoing weight-loss diet (hypocaloric diet) or use of weight-loss agents unless the diet or treatment has been stopped at least 3 months before screening and that the patient has had a stable body weight (+/- 3 kg) during the 3 months before screening.
• • Any clinically significant abnormalities in clinical chemistry, hematology or urinalysis results as judged by the investigator. This includes signs of liver disease other than non-alcoholic fatty liver disease that motivated further investigations or treatment based on clinical judgment.
• • Drug abuse or alcohol abuse.
• • Women who are pregnant, lactating or planning to become pregnant during the study period, or women of childbearing potential who are not using acceptable contraceptive methods. A woman is considered of childbearing potential if she is not surgically sterile or is less than 1 year since last menstrual period. Acceptable contraceptive methods will be combined (estrogen- and progesterone-containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal, transdermal), progesterone-only hormonal contraception associated with inhibition of ovulation (oral, injectable, implantable), intrauterine device, intrauterine hormone-releasing system, bilateral tubal occlusion and vasectomized.
• • Any other condition the investigator believed would interfere with the patient's ability to provide informed consent, comply with study instructions, or which might confound the interpretation of the study results or put the patient at undue risk.
• • Any blood donation/blood loss \>500 ml during the 3 months prior to Visit 1 or during the study.
• • Patients with active malignancy
• • Patients with established hemolytic disease
• • Refused to consent to this study.
• • The patient will be excluded from the study after the randomization if the second compound of combination therapy is inconsistent with the standard of medical care in diabetes -2022.
• • Patient use of anti-inflammatory medications or corticosteroids during the observational period
• • Missing the follow up.