PLUTO: Prevention of Chronic Kidney Disease(CDK) Progression in Type 1 Diabetes With Long Term Use of Sodium-Glucose-coTransporter Inhibitors Avoiding Kidney hypOxia

Sponsor

Steno Diabetes Center Copenhagen (Other)

Overall Status

Not yet recruiting

CT.gov ID

NCT06147232

Collaborator

Juvenile Diabetes Research Foundation (Other), King's College London (Other), Glostrup University Hospital, Copenhagen (Other)

Enrollment

Location

Arms

148

Anticipated Duration (Months)

0.5

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Background: Sodium-glucose-cotransporter (SGLT) inhibition has been observed to reduce risk of cardiovascular events and kidney failure in persons with type 2 diabetes. People with type 1 diabetes also have increased risk of cardiovascular and kidney disease, and may benefit from SGLT-inhibition. The exact mechanism of how SGLT-inhibition benefits the kidneys are yet unknown. Change in renal hypoxia may be a factor.

Objective: The primary aim of this study is to assess the effects of 12 weeks SGLT-1 and 2 inhibition on renal oxygenation in persons with type 1 diabetes and chronic kidney disease.

Further aims are to study if renal oxygen consumption and response to SGLT-inhibition differs between people of African-Caribbean or Northern European decent.

Additionally effects on left ventricular ejection fraction, kidney function and biomarkers in blood and urine will be explored.

Method: 12 weeks treatment with oral sotagliflozin or matching placebo as intervention. Kidney oxygenation and perfusion parameters and left ventricular ejection fraction will be assessed by functional magnetic resonance imaging. Kidney function and biomarkers will be assessed according to local hospital laboratory guidelines.

Design: Randomized, double-blinded, placebo-controlled, cross over intervention study.

Study population: 69 persons with type 1 diabetes and diabetic kidney disease with albuminuria will be included, 39 at Steno Diabetes Center Copenhagen, 30 at King's College London.

Endpoints: Primary end-point: Change from 0 to 12 weeks in dynamic R2*-weighted signal after treatment with sotagliflozin compared to placebo. Secondary endpoints: Change from 0 to 12 weeks with sotagliflozin compared with placebo on renal perfusion, renal artery flow, renal oxygen consumption, renal parenchymal triglyceride fraction, renal fibrosis, left ventricular ejection fraction, urinary albumin-creatinin ratio, ketone bodies, erythropoietin, pro brain natriuretic peptide, and plasma- and urine inflammation- and fibrosis biomarkers as well as difference after 12 weeks treatment in glomerular filtration rate.

Timeframe: Inclusion of patients from february 2024. Last visit september 2025. Presentation spring 2026, publication fall 2026.

Condition or Disease	Intervention/Treatment	Phase
Nephropathy Diabetic Nephropathies Diabetes Mellitus, Type 1 Albuminuria Diabetic Complications Renal Diabetic Complications Cardiovascular Hypoxia	Drug: Sotagliflozin Drug: Placebo	Phase 4

Study Design

Study Type:

Interventional

Anticipated Enrollment :

69 participants

Allocation:

Randomized

Intervention Model:

Crossover Assignment

Intervention Model Description:

randomized, double-blinded, placebo-controlled, cross-over intervention studyrandomized, double-blinded, placebo-controlled, cross-over intervention study

Masking:

Triple (Participant, Care Provider, Investigator)

Primary Purpose:

Treatment

Official Title:

Prevention of CKD Progression in Type 1 Diabetes With Long Term Use of SGLTi Avoiding Kidney hypOxia(PLUTO)

Anticipated Study Start Date :

Feb 1, 2024

Anticipated Primary Completion Date :

Jun 1, 2026

Anticipated Study Completion Date :

Jun 1, 2036

Arms and Interventions

Arm	Intervention/Treatment
Active Comparator: Sotagliflozin In the active arm, participants will be treated with Sotagliflozin 200mg as an oral tablet once daily for 12 weeks.	Drug: Sotagliflozin Sodium-glucose-co-transporter 1 and 2 inhibitor Other Names: Inpefa (TM)
Placebo Comparator: Placebo In the placebo arm, participants will be treated with a matched placebo as an oral tablet once daily for 12 weeks.	Drug: Placebo Placebo tablet

Arm

Intervention/Treatment

Active Comparator: Sotagliflozin

In the active arm, participants will be treated with Sotagliflozin 200mg as an oral tablet once daily for 12 weeks.

Drug: Sotagliflozin

Sodium-glucose-co-transporter 1 and 2 inhibitor

Other Names:

Inpefa (TM)

Placebo Comparator: Placebo

In the placebo arm, participants will be treated with a matched placebo as an oral tablet once daily for 12 weeks.

Drug: Placebo

Placebo tablet

Outcome Measures

Primary Outcome Measures

Change in dynamic R2*-weighted signal (BOLD) as an indirect measure of renal blood oxygenation [0 to 12 weeks in both treatment arms, last measure 30 weeks after randomization.]
difference between change from 0 to 12 weeks after treatment with sotagliflozin compared to treatment with placebo

Secondary Outcome Measures

Change in renal perfusion (medullary and cortical) [From 0 to 12 weeks in each treatment arm. Last measure 30 weeks after randomization]
Measured with MRI by arterial spin labelling in mL/g/min
Change in renal artery flow [From 0 to 12 weeks in each treatment arm. Last measure 30 weeks after randomization]
Renal artery flow measured by using phase contrast (PC) MRI. It is measured in mL/min.
Change in renal oxygen consumption [From 0 to 12 weeks in each treatment arm. Last measure 30 weeks after randomization]
Renal oxygen consumption measured by MRI with T2-relaxation-under-spin-tagging.
Change in renal parenchymal triglyceride fraction [From 0 to 12 weeks in each treatment arm. Last measure 30 weeks after randomization]
Renal parenchymal triglyceride fraction is measured by MRI spectroscopy
Change in renal fibrosis [From 0 to 12 weeks in each treatment arm. Last measure 30 weeks after randomization]
Renal fibrosis is measured by MRI-derived apparent diffusion coefficient
Change in left ventricular ejection fraction [From 0 to 12 weeks in each treatment arm. Last measure 30 weeks after randomization]
Left ventricular ejection fraction is assessed by MRI
Change in albuminuria [From 0 to 12 weeks in each treatment arm. Last measure 30 weeks after randomization.]
Urinary albumin-creatinine ratio (UACR) - morning void spot urine samples collected at home by participants.
Change in levels of ketone bodies [From 0 to 12 weeks in each treatment arm. Last measure 30 weeks after randomization.]
Capillary blood ketones, possibly measured by continous ketone monitoring device
Change in plasma and urine inflammation- and fibrosis biomarkers [From 0 to 12 weeks in each treatment arm. Last measure 30 weeks after randomization.]
Measured from blood and urine samples using a commercially available panel from the company Olink. Includes 92 biomarkers.
Change in endogenous erythropoietin [From 0 to 12 weeks in each treatment arm. Last measure 30 weeks after randomization.]
Analysis on blood samples at regional hospital laboratory.
Change in pro brain natriuretic peptide [From 0 to 12 weeks in each treatment arm. Last measure 30 weeks after randomization.]
Analysis on blood samples at regional hospital laboratory.
Difference in Kidney Function after 12 weeks treatment with sotagliflozin vs placebo [From 12 to 30 weeks after randomization]
Glomerular filtration rate. At Steno Diabetes Center Copenhagen this will be measured by plasma clearance of Tc-99m diethylene-triamine-pentaacetate.

Other Outcome Measures

Ethnicity [From baseline to 30 weeks.]
if African-Caribbean ethnicity is associated with any of the above secondary outcomes or baseline differences in cardio-renal disease markers/imaging measures

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Persons ≥ 18 years of age with a diagnosis of type 1 diabetes (age at onset <40 years; permanent insulin treatment initiated within 1 year of diagnosis)
Albuminuria: UACR > 100 mg/g (in ≥2 out 3 morning spot urine collections prior to randomization)
estimated Glomerular Filtration Rate(eGFR) ≥20 and < 75 ml/min/1.73m2
Participants must be on stable renin-angiotensin system blocking treatment 4 weeks before start of study drug and throughout study duration.
Able to understand the written participant information and give informed consent

Exclusion Criteria:

Non-diabetic kidney disease indicated by medical history and/or laboratory findings.
eGFR< 20 ml/min/1.73m2, dialysis or kidney transplantation.
Previous diabetic ketoacidosis, except at debut.
Dysregulated diabetes (HbA1c > 85 mmol/mol)
Decreased awareness or unawareness
Pregnancy, lactating or with a wish of pregnancy within the next year
Low carbohydrate diet
Receiving therapy with an SGLT inhibitor within 8 weeks prior to enrolment or previous intolerance of an SGLT inhibitor.
New York Heart Association (NYHA) class IV Congestive Heart Failure at the time of enrolment
Myocardial infarction, unstable angina, stroke or transient ischemic attack within 12 weeks prior to enrolment
The receipt of any investigational product 90 days prior to this trial
Unable to participate in study procedures
Any clinically significant disorder, except for conditions associated with type 1 diabetes, which in the Investigators opinion could interfere with the results of the trial
Participation in another intervention study
Exclusion criteria for MRI: known claustrophobia, known chronic lung disease, surgery within past 6 weeks or having foreign bodies of metal in the body (e.g. pacemaker, metal plates, metal screws)
Recurrent urogenital infections.