SGLT2 Inhibition in Older Obese Adults With Pre-diabetes

• Status: Recruiting
• Trial end date: 2023-08-01
• Target enrollment: 0
• Participant gender: All

Summary

Inhibitors of the sodium-glucose co-transporter (SGLT2) are FDA-approved for the treatment of type 2 diabetes (T2DM). Their mechanism of action involves lowering of blood glucose concentration secondary to increased glucose excretion of glucose by the kidney. These drugs also improve body weight, blood pressure, and cardiac function. Based on these pleiotropic effects, including its calorie restriction-mimetic properties, the study team hypothesize that SGLT2 drugs will impact several basic aging-related processes, including reductions in oxidative damage to DNA and proteins, advanced glycation end products (AGE) and receptor for AGE (RAGE), cellular senescence, and mitochondrial function.

• Phase: Phase 1/Phase 2
• Accepts Healthy Volunteers?: Accepts Healthy Volunteers

Details

• Lead Sponsor: The University of Texas Health Science Center at San Antonio
• Treatments: 2-(3-(4-ethoxybenzyl)-4-chlorophenyl)-6-hydroxymethyltetrahydro-2H-pyran-3,4,5-triol; Dapagliflozin

Criteria

Inclusion Criteria:

1. Men or post-menopausal women.

2. Age= 60+ years.

3. All ethnic groups.

4. Body Mass index (BMI) between 30-38 kg/m2.

5. Diagnosis of pre-diabetes (HbA1c 5.7-6.4% and 2 hr. Oral Glucose Tolerance Test (OGTT) glucose between 140-199 mg/dL, evaluated at Visit 1 and 2).

6. Stable body weight (±3% for ≥3 months).

7. Willing to adhere to medication regimen for three months.

8. Montreal Cognitive Assessment score ≥21

Exclusion Criteria:

1. Diagnosis of diabetes based on American Diabetes Association (ADA) criteria

2. Impaired renal function with estimated Glomerular Filtration Rate (eGFR) < 45 mL/min/1.73m2 .

3. Impaired liver function with labs ≥3 times upper limits of normal range

4. Abnormal hematocrit with lower limits of ≤30%

5. Abnormal triglycerides with upper limits ≥600 mg/dL

6. Abnormal Thyroid stimulating hormone (TSH) values ≤0.3 and ≥10

7. Urinalysis results with ˃ 5-10 white blood cell count

8. Concomitant medications known to affect glucose and lipid homeostasis (anti-diabetes medications, glucocorticoids, atypical antipsychotics, anti-transplant rejection medications, anti-retrovirals).

9. Current treatment with anticoagulants (warfarin). Aspirin (up to 325 mg) and clopidogrel will be permitted if these can be held for seven days prior to the biopsies.

10. History of recent cardiovascular event in the last 6 months or Heart Failure (New York Heart Classification greater than class III-IV; recent EKG changes that suggest active heart disease

11. Poorly controlled blood pressure (systolic BP>180, diastolic BP>100 mmHg).

12. Active inflammatory, autoimmune, infectious, hepatic, gastrointestinal, malignant, and uncontrolled psychiatric disease (Subjects with depression, anxiety, PTSD, etc. can enroll if controlled and on stable medication)

13. Blood donation within 2 months prior to enrollment

14. History of frequent UTI