Type 1 Diabetes Mellitus
Conditions
Keywords
High level of sugar (glucose) in the blood
Brief summary
This Phase 3 study was intended to demonstrate superiority of either Sotagliflozin high dose or low dose versus placebo on glycosylated hemoglobin A1C (A1C) reduction at Week 24 when used as an adjunct in adult participants with type 1 diabetes mellitus (T1D) who have inadequate glycemic control with insulin therapy.
Interventions
High dose Sotagliflozin, once daily, before the first meal of the day
Placebo, once daily, before the first meal of the day
Sponsors
Study design
Eligibility
Inclusion criteria
* Participant who gave written informed consent to participate in the study in accordance with local regulations. * Adult participants 18 years and older with a diagnosis of T1D made at least 1 year prior to informed consent. * Participants treated with insulin or insulin analog delivered via continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI). * Willing and were able to perform Self-monitoring of blood glucose (SMBG) and completed the study diary as required per protocol. * At the Screening Visit, A1C was between 7.0% to 11.0%. * Females of childbearing potential must use an adequate method of contraception and have a negative pregnancy test.
Exclusion criteria
* Use of antidiabetic agent other than insulin or insulin analog at the time of screening. * Use of sodium-glucose cotransporter (SGLT) inhibitors within 8 weeks prior to screening. * Chronic systemic corticosteroid use. * Type 2 diabetes mellitus (T2DM), or severely uncontrolled T1D as determined by the Investigator.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in A1C at Week 24 | Baseline to Week 24 | Baseline value was defined as the last value collected prior to the first dose of double-blind study medication. Least square (LS) means were obtained from a mixed-effects model for repeated measures (MMRM) that included fixed, categorical effects of treatment, randomization strata of insulin delivery method (MDI, CSII), randomization strata of Week -2 A1C (\<= 8.5%, \>8.5%), time (study week), a treatment-by-time interaction, and baseline A1C-by-time interaction as a covariate. A negative change from baseline (a reduction of A1C value at Week 24) indicates an improvement. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Body Weight at Week 24 | Baseline to Week 24 | Baseline value was defined as the last value collected prior to the first dose of double-blind study medication. LS means were obtained from MMRM model. A negative change from baseline indicates a loss in body weight from baseline to Week 24. |
| Change From Baseline in Mean Daily Bolus Insulin Dose at Week 24 | Baseline to Week 24 | The mean bolus insulin dose in international units/day (IU/day) for Week 24 was the average over the 3 to 5 days prior to the Week 24 visit. The Baseline value was defined as the last value collected prior to the first dose of double-blind study medication. LS means were obtained from MMRM model including all available post baseline values. A negative change from baseline indicated a reduction in the amount of bolus insulin used and a positive change from baseline indicated an increase in the amount of bolus insulin used between baseline and Week 24. |
| Change From Baseline in Fasting Plasma Glucose (FPG) at Week 24 | Baseline to Week 24 | The Baseline value was defined as the last value collected prior to the first dose of double-blind study medication. LS means were obtained from MMRM model including all available post baseline values. A negative change from baseline indicates a lower glucose level at Week 24 compared to baseline and a positive change from baseline indicates an increase in glucose level at Week 24 compared to baseline. |
| Percentage of Participants With A1C <7.0% at Week 24 and no Episode of Severe Hypoglycemia, and no Episode of Diabetic Ketoacidosis (DKA) From Baseline to Week 24 | Baseline to Week 24 | The composite endpoint included blood samples for the assessment of Hemoglobin A1C to determine the participants with a value \<7.0% and a central blinded adjudication process to determine whether participants experienced either DKA or severe hypoglycemia. Only positively adjudicated severe hypoglycemia and diabetic ketoacidosis were included in the analysis. |
| Change From Baseline in 2-Item Diabetes Distress Screen 2 (DDS2) Score at Week 24 | Baseline to Week 24 | DDS2 is a 2-item diabetes distress screening instrument where participants rated the degree to which the following items caused distress: (1) feeling overwhelmed by the demands of living with diabetes, and (2) feeling that I am often failing with my diabetes regimen using a 6-point scale: where 1=no distress to 6=severe distress for a total possible score of 2 to 12. LS means were obtained from MMRM model including all available post baseline values. A negative change from baseline indicates improvement. |
| Percent Change From Baseline in Body Weight at Week 24 | Baseline to Week 24 | Baseline value was defined as the last value collected prior to the first dose of double-blind study medication. LS means were obtained from MMRM model. A negative percent change from baseline indicates a loss in body weight from baseline to Week 24. |
| Change From Baseline in Diabetes Treatment Satisfaction Questionnaire (DTSQ) Score at Week 24 | Baseline to Week 24 | The DTSQ instrument contains 8 items assessing overall treatment satisfaction, treatment convenience and flexibility, satisfaction with understanding of diabetes, willingness to continue present treatment and to recommend it to others, and frequency of unacceptably high and unacceptably low blood glucose levels. 6 items (1, 4, 5, 6, 7 and 8) (excluding perceived hyperglycemia and hypoglycemia items) were scored using a 7- point scale where 0=very dissatisfied to 6= very satisfied for a total possible score of 0 (very dissatisfied) to 36 (very satisfied), where higher scores indicate higher satisfaction from treatment. Two items (Q2 and 3), which were not included, measured perceived hyperglycemia and hypoglycemia, respectively. The baseline value was defined as the last value collected prior to the first dose of double-blind study medication. LS means were obtained from MMRM model including all available post baseline values. A positive change from baseline indicates improvement. |
Countries
Austria, Belgium, Bulgaria, France, Germany, Hungary, Israel, Italy, Lithuania, Netherlands, Poland, Romania, Slovakia, Spain, Sweden, Switzerland, United Kingdom
Participant flow
Recruitment details
Participants took part in the study at 96 investigative sites throughout 17 countries from 21 May 2015 to 23 June 2017.
Pre-assignment details
995 participants were screened and 782 participants with a diagnosis of Type 1 diabetes mellitus were randomized equally in 1 of 3 treatment groups: sotagliflozin 400 mg, sotagliflozin 200 mg or placebo.
Participants by arm
| Arm | Count |
|---|---|
| Placebo Two placebo-matching sotagliflozin tablets, once daily, orally, before the first meal of the day for 24 weeks followed by a 28-week extension period. | 258 |
| Sotagliflozin 200 mg Sotagliflozin 200 mg (one 200 mg tablet and one placebo tablet), once daily, orally, before the first meal of the day for 24 weeks followed by a 28-week extension period. | 261 |
| Sotagliflozin 400 mg Sotagliflozin 400 mg (two 200 mg tablets), once daily, orally, before the first meal of the day for 24 weeks followed by a 28-week extension period. | 263 |
| Total | 782 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Adverse Event | 9 | 10 | 18 |
| Overall Study | Death | 1 | 0 | 0 |
| Overall Study | Lost to Follow-up | 1 | 1 | 0 |
| Overall Study | Noncompliance with study drug | 1 | 0 | 0 |
| Overall Study | Other | 4 | 2 | 3 |
| Overall Study | Physician Decision | 1 | 1 | 3 |
| Overall Study | Pregnancy | 1 | 1 | 0 |
| Overall Study | Protocol Violation | 1 | 2 | 0 |
| Overall Study | Withdrawal by Subject | 14 | 18 | 12 |
Baseline characteristics
| Characteristic | Placebo | Sotagliflozin 200 mg | Sotagliflozin 400 mg | Total |
|---|---|---|---|---|
| Age, Continuous | 39.7 Years STANDARD_DEVIATION 13.42 | 42.3 Years STANDARD_DEVIATION 13.59 | 41.7 Years STANDARD_DEVIATION 13.23 | 41.2 Years STANDARD_DEVIATION 13.44 |
| Age, Customized Adults (18-64 years) | 244 Participants | 252 Participants | 253 Participants | 749 Participants |
| Age, Customized From 65-84 years | 14 Participants | 9 Participants | 10 Participants | 33 Participants |
| Body Weight | 81.08 Kilograms (kg) STANDARD_DEVIATION 16.857 | 81.93 Kilograms (kg) STANDARD_DEVIATION 17.386 | 81.97 Kilograms (kg) STANDARD_DEVIATION 17.963 | 81.66 Kilograms (kg) STANDARD_DEVIATION 17.394 |
| Daily Total Insulin Dose | 0.75 International units per kilogram (IU/kg) STANDARD_DEVIATION 0.295 | 0.73 International units per kilogram (IU/kg) STANDARD_DEVIATION 0.277 | 0.74 International units per kilogram (IU/kg) STANDARD_DEVIATION 0.267 | 0.74 International units per kilogram (IU/kg) STANDARD_DEVIATION 0.28 |
| Duration of Diabetes | 18.1 Years STANDARD_DEVIATION 10.72 | 18.2 Years STANDARD_DEVIATION 10.82 | 18.9 Years STANDARD_DEVIATION 11.18 | 18.4 Years STANDARD_DEVIATION 10.9 |
| Hemoglobin A1C (A1C) <= 8.5% | 200 Participants | 203 Participants | 204 Participants | 607 Participants |
| Hemoglobin A1C (A1C) >8.5% | 58 Participants | 58 Participants | 59 Participants | 175 Participants |
| Hemoglobin A1C Value at Actual Week -2 Value <= 8.5% | 202 Participants | 205 Participants | 208 Participants | 615 Participants |
| Hemoglobin A1C Value at Actual Week -2 Value >8.5% | 56 Participants | 56 Participants | 55 Participants | 167 Participants |
| Insulin Delivery Method Continuous Subcutaneous Insulin Infusion (CSII) | 66 Participants | 68 Participants | 67 Participants | 201 Participants |
| Insulin Delivery Method Multiple Daily Injections (MDI) | 192 Participants | 193 Participants | 196 Participants | 581 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 3 Participants | 3 Participants | 6 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants | 0 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 7 Participants | 6 Participants | 10 Participants | 23 Participants |
| Race (NIH/OMB) White | 250 Participants | 252 Participants | 250 Participants | 752 Participants |
| Sex: Female, Male Female | 124 Participants | 122 Participants | 130 Participants | 376 Participants |
| Sex: Female, Male Male | 134 Participants | 139 Participants | 133 Participants | 406 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 2 / 258 | 0 / 261 | 0 / 263 |
| other Total, other adverse events | 46 / 258 | 52 / 261 | 64 / 263 |
| serious Total, serious adverse events | 17 / 258 | 26 / 261 | 21 / 263 |
Outcome results
Change From Baseline in A1C at Week 24
Baseline value was defined as the last value collected prior to the first dose of double-blind study medication. Least square (LS) means were obtained from a mixed-effects model for repeated measures (MMRM) that included fixed, categorical effects of treatment, randomization strata of insulin delivery method (MDI, CSII), randomization strata of Week -2 A1C (\<= 8.5%, \>8.5%), time (study week), a treatment-by-time interaction, and baseline A1C-by-time interaction as a covariate. A negative change from baseline (a reduction of A1C value at Week 24) indicates an improvement.
Time frame: Baseline to Week 24
Population: Analysis included participants from the modified intent to treat (mITT) population. Here, overall number of participants analyzed = participants with available data for this outcome measure.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in A1C at Week 24 | -0.02 Percentage of A1C | Standard Error 0.044 |
| Sotagliflozin 200 mg | Change From Baseline in A1C at Week 24 | -0.39 Percentage of A1C | Standard Error 0.044 |
| Sotagliflozin 400 mg | Change From Baseline in A1C at Week 24 | -0.37 Percentage of A1C | Standard Error 0.043 |
Change From Baseline in 2-Item Diabetes Distress Screen 2 (DDS2) Score at Week 24
DDS2 is a 2-item diabetes distress screening instrument where participants rated the degree to which the following items caused distress: (1) feeling overwhelmed by the demands of living with diabetes, and (2) feeling that I am often failing with my diabetes regimen using a 6-point scale: where 1=no distress to 6=severe distress for a total possible score of 2 to 12. LS means were obtained from MMRM model including all available post baseline values. A negative change from baseline indicates improvement.
Time frame: Baseline to Week 24
Population: Analysis included participants from the mITT population. Here, overall number of participants analyzed = participants with available data for this outcome measure.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in 2-Item Diabetes Distress Screen 2 (DDS2) Score at Week 24 | 0.0 Score on a scale | Standard Error 0.12 |
| Sotagliflozin 200 mg | Change From Baseline in 2-Item Diabetes Distress Screen 2 (DDS2) Score at Week 24 | -0.3 Score on a scale | Standard Error 0.12 |
| Sotagliflozin 400 mg | Change From Baseline in 2-Item Diabetes Distress Screen 2 (DDS2) Score at Week 24 | -0.4 Score on a scale | Standard Error 0.11 |
Change From Baseline in Body Weight at Week 24
Baseline value was defined as the last value collected prior to the first dose of double-blind study medication. LS means were obtained from MMRM model. A negative change from baseline indicates a loss in body weight from baseline to Week 24.
Time frame: Baseline to Week 24
Population: Analysis included participants from the mITT population. Here, overall number of participants analyzed = participants with available data for this outcome measure.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in Body Weight at Week 24 | 0.11 Kilograms (kg) | Standard Error 0.201 |
| Sotagliflozin 200 mg | Change From Baseline in Body Weight at Week 24 | -1.88 Kilograms (kg) | Standard Error 0.2 |
| Sotagliflozin 400 mg | Change From Baseline in Body Weight at Week 24 | -2.47 Kilograms (kg) | Standard Error 0.199 |
Change From Baseline in Diabetes Treatment Satisfaction Questionnaire (DTSQ) Score at Week 24
The DTSQ instrument contains 8 items assessing overall treatment satisfaction, treatment convenience and flexibility, satisfaction with understanding of diabetes, willingness to continue present treatment and to recommend it to others, and frequency of unacceptably high and unacceptably low blood glucose levels. 6 items (1, 4, 5, 6, 7 and 8) (excluding perceived hyperglycemia and hypoglycemia items) were scored using a 7- point scale where 0=very dissatisfied to 6= very satisfied for a total possible score of 0 (very dissatisfied) to 36 (very satisfied), where higher scores indicate higher satisfaction from treatment. Two items (Q2 and 3), which were not included, measured perceived hyperglycemia and hypoglycemia, respectively. The baseline value was defined as the last value collected prior to the first dose of double-blind study medication. LS means were obtained from MMRM model including all available post baseline values. A positive change from baseline indicates improvement.
Time frame: Baseline to Week 24
Population: Analysis included participants from the mITT population. Here, overall number of participants analyzed = participants with available data for this outcome measure.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in Diabetes Treatment Satisfaction Questionnaire (DTSQ) Score at Week 24 | -0.1 Score on a scale | Standard Error 0.28 |
| Sotagliflozin 200 mg | Change From Baseline in Diabetes Treatment Satisfaction Questionnaire (DTSQ) Score at Week 24 | 1.9 Score on a scale | Standard Error 0.28 |
| Sotagliflozin 400 mg | Change From Baseline in Diabetes Treatment Satisfaction Questionnaire (DTSQ) Score at Week 24 | 1.6 Score on a scale | Standard Error 0.28 |
Change From Baseline in Fasting Plasma Glucose (FPG) at Week 24
The Baseline value was defined as the last value collected prior to the first dose of double-blind study medication. LS means were obtained from MMRM model including all available post baseline values. A negative change from baseline indicates a lower glucose level at Week 24 compared to baseline and a positive change from baseline indicates an increase in glucose level at Week 24 compared to baseline.
Time frame: Baseline to Week 24
Population: Analysis included participants from the mITT population. Here, overall number of participants analyzed = participants with available data for this outcome measure.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in Fasting Plasma Glucose (FPG) at Week 24 | 8.8 Milligram per deciliter (mg/dL) | Standard Error 3.95 |
| Sotagliflozin 200 mg | Change From Baseline in Fasting Plasma Glucose (FPG) at Week 24 | -12.8 Milligram per deciliter (mg/dL) | Standard Error 3.97 |
| Sotagliflozin 400 mg | Change From Baseline in Fasting Plasma Glucose (FPG) at Week 24 | -16.9 Milligram per deciliter (mg/dL) | Standard Error 3.96 |
Change From Baseline in Mean Daily Bolus Insulin Dose at Week 24
The mean bolus insulin dose in international units/day (IU/day) for Week 24 was the average over the 3 to 5 days prior to the Week 24 visit. The Baseline value was defined as the last value collected prior to the first dose of double-blind study medication. LS means were obtained from MMRM model including all available post baseline values. A negative change from baseline indicated a reduction in the amount of bolus insulin used and a positive change from baseline indicated an increase in the amount of bolus insulin used between baseline and Week 24.
Time frame: Baseline to Week 24
Population: Analysis included participants from the mITT population. Here, overall number of participants analyzed = participants with available data for this outcome measure.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Change From Baseline in Mean Daily Bolus Insulin Dose at Week 24 | -1.19 IU/day | Standard Error 0.635 |
| Sotagliflozin 200 mg | Change From Baseline in Mean Daily Bolus Insulin Dose at Week 24 | -4.38 IU/day | Standard Error 0.636 |
| Sotagliflozin 400 mg | Change From Baseline in Mean Daily Bolus Insulin Dose at Week 24 | -4.78 IU/day | Standard Error 0.634 |
Percentage of Participants With A1C <7.0% at Week 24 and no Episode of Severe Hypoglycemia, and no Episode of Diabetic Ketoacidosis (DKA) From Baseline to Week 24
The composite endpoint included blood samples for the assessment of Hemoglobin A1C to determine the participants with a value \<7.0% and a central blinded adjudication process to determine whether participants experienced either DKA or severe hypoglycemia. Only positively adjudicated severe hypoglycemia and diabetic ketoacidosis were included in the analysis.
Time frame: Baseline to Week 24
Population: Analysis included participants from the mITT population.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Placebo | Percentage of Participants With A1C <7.0% at Week 24 and no Episode of Severe Hypoglycemia, and no Episode of Diabetic Ketoacidosis (DKA) From Baseline to Week 24 | 15.1 Percentage of participants |
| Sotagliflozin 200 mg | Percentage of Participants With A1C <7.0% at Week 24 and no Episode of Severe Hypoglycemia, and no Episode of Diabetic Ketoacidosis (DKA) From Baseline to Week 24 | 31.4 Percentage of participants |
| Sotagliflozin 400 mg | Percentage of Participants With A1C <7.0% at Week 24 and no Episode of Severe Hypoglycemia, and no Episode of Diabetic Ketoacidosis (DKA) From Baseline to Week 24 | 32.3 Percentage of participants |
Percent Change From Baseline in Body Weight at Week 24
Baseline value was defined as the last value collected prior to the first dose of double-blind study medication. LS means were obtained from MMRM model. A negative percent change from baseline indicates a loss in body weight from baseline to Week 24.
Time frame: Baseline to Week 24
Population: Analysis included participants from the mITT population, including all available post baseline values. Here, overall number of participants analyzed = participants with available data for this outcome measure.
| Arm | Measure | Value (LEAST_SQUARES_MEAN) | Dispersion |
|---|---|---|---|
| Placebo | Percent Change From Baseline in Body Weight at Week 24 | 0.10 Percent change | Standard Error 0.245 |
| Sotagliflozin 200 mg | Percent Change From Baseline in Body Weight at Week 24 | -2.38 Percent change | Standard Error 0.245 |
| Sotagliflozin 400 mg | Percent Change From Baseline in Body Weight at Week 24 | -2.99 Percent change | Standard Error 0.244 |