Background
Methods and experimental design
Study design and Intervention
Study objectives
Objective | Definition |
---|---|
Primary | 1. To investigate the impact of empagliflozin on plasma IL-6 level in patients with T2DM patients and coronary artery disease (established by coronary angiography) |
Secondary | 1. Inflammatory biomarkers Changes in serum hs-CRP levels Changes in plasma IL-1b levels 2. Oxidative stress status Changes in lymphocytic reactive oxygen species Changes in plasma levels of malondialdehyde Changes in plasma carbonyl levels Changes in plasma antioxidant capacity Changes in plasma reduced glutathione levels Changes in catalase enzyme activity Changes in plasma superoxide dismutase enzyme activity 3. Platelet function Changes in CD62-P expression on the platelet surface 4. Glycemic status Changes in fasting blood glucose levels Changes in HbA1c levels Changes in HOMA-IR |
Additional secondary (Considered for sub-studies) | 1. Changes is cardiac biomarkers Changes in serum hs-Troponin I levels Changes in serum BNP levels Changes in serum NT-proBNP levels 2. Echocardiographic parameters Changes in left ventricular systolic function Changes in left ventricular diastolic function Changes in right ventricular function 3. Hematopoietic status and renal function Changes in serum erythropoietin levels Changes in blood hematocrit levels Changes in hemoglobin levels Changes in urine micro albuminuria levels 4. Changes in lipid profile Changes in serum total cholesterol levels Changes in serum LDL cholesterol levels Changes in serum HDL cholesterol levels Changes in serum triglyceride levels 5. Electrocardiographic parameters Changes in PR interval duration Changes in QRS complex duration Changes in QT interval duration Changes in ST segment deviation Changes in T wave alternans |
Ethics considerations
Trial population and eligibility assessment
Inclusion criteria | 1. Age between 40 and 75 years 2. HbA1c between 6.5 and 9.5% 3. Documented known diabetes mellitus type 2 under continuous fixed-dose anti-diabetic treatment for at least 3 months prior to the randomization 4. Documented known coronary artery disease established by coronary angiography under continuous fixed-dose of anti-ischemic treatment for at least 3 months prior to the randomization 5. BMI less than 40 kg/m2 6. Fixed diet and physical activity 7. eGFR greater than 45 ml/min/1.73m2 8. Informed consent given in written form 9. Resting heart rate between 60 to 100 b/min |
Exclusion criteria | 1. Pregnancy 2. Heart Failure (NYHA class 3–4) 3. Left ventricular ejection fraction < 40% 4. Use of anti-coagulant or anti-platelet drugs (except aspirin 80 mg/daily) for at least 3 months prior to the blood sampling 5. Consumption of alcohol, continuous anti-inflammatory drugs (except aspirin 80 mg/daily) or anti-oxidant supplement 6. Use of pioglitazone 7. History of allergic reaction to SGLT2-i medications 8. History of SGLT2-i medication usage 9. Gastrointestinal malabsorption disease 10. History of CABG, ACS, TIA, CVA or PCI during past 3 month 11. History or presence of malignancy 12. Severe HTN Resting systolic blood pressure ≥ 180 mmHg and/or Resting diastolic blood pressure ≥ 120 mmHg 13. Anemia (Hb < 10 g/dl) 14. Platelet count < 100,000/µl 15. History of infection during 1 one month prior to blood sampling 16. History of heart or lung transplant 17. Major psychiatric disorders 18. History of DKA 19. Elevated liver enzymes > 3 times upper normal limit 20. Use of drugs which prolong QT interval 21. Presence of arrhythmia 22. Electrolyte imbalance 23. Patients with pace maker |
Randomization and follow-up
Blinding
Outcomes
Primary outcome
Secondary outcomes for the primary objective
Additional secondary outcomes
Outcome | Method of measurement | Mechanism | Time of measurement |
---|---|---|---|
Changes in plasma IL-6 and 1-beta levels | Plasma IL-6 and IL-1b Elisa kits | Key cytokines in development and maintenance of inflammation | Week 0 and 26 |
Changes in oxidative stress (Lymphocytic ROS, plasma MDA, Carbonyl, T-AOC, GSHr, CAT activity and SOD enzyme activity levels) | Flow cytometry (DCFDA as dye)a, spectrophotometry, colorimetric and FRAP assays | ROS, MDA and carbonyl increase in inflammation and causes cell damage GSHr, AOC, CAT activity and SOD activity increase in inflammation and reduce oxidative stress | Week 0 and 26 |
Changes in serum hs-CRP level | Turbidimetric assay | Circulating concentrations rise in response to inflammation | Week 0 and 26 |
Changes in platelet functionb | Flow cytometry (MFI of CD62-P expression on platelet surface) | Platelet activity increases in DM and inflammation causing platelet dysfunction | Week 0 and 26 |
Changes in HbA1c, FBS and Basal Insulin level | Enzymatic assay | Indicate the glycemic status which is reduce with anti-glycemic drugs | Week 0 and 26 |
Changes in HOMA-IRc | fasting insulin (mU/mL) × fasting glucose (mg/dL)/405 | A method used to quantify insulin resistance which increases in DM and insulin resistance conditions | Week 0 and 26 |
Changes in serum hs-troponin I, BNP and NT-proBNP levels | Chemiluminescence assay | Specific cardiac biomarkers increase in cardiomyocyte damage and tension | Week 0 and 26 |
Changes in blood Hb, Hct and serum erythropoietin | CBC and serum erythropoietin Elisa kit | Reflects the hematopoietic status | Week 0 and 26 |
Changes in urine micro-albuminuria and albumin to creatinine ratio | Photometry and enzymatic assays | Reflects the renal and glomerular function. May increase in in DM as a microvascular adverse event | Week 0 and 26 |
Changes in lipid profile (serum TG, cholesterol, HDL,LDL cholesterols) | Enzymatic assay | Lipid disorders increase in DM which raises the cardiovascular complications that may decrease with empagliflozin treatment | Week 0 and 26 |
Changes in echocardiography parameters | 2D trans-thoracic Echocardiography | Reflects left ventricular systolic and diastolic and right ventricular function | Week 0 and 26 |
Changes in electrocardiographic parameters | Electrocardiography | Reflects the electrophysiological activity of the heart | Week 0 and 26 |