New funding to investigate medications that can delay kidney complications

A team of researchers have received funding to examine how existing drugs could delay the progression of kidney disease in people living with type 1 diabetes.

Type 1 diabetes charity JDRF has awarded a £1.3 million grant to King’s College London (KCL) and Steno Diabetes Center Copenhagen to look at how SGLT inhibitors can combat kidney disease.

The award from JDRF will enable the researchers to study the effects of sotagliflozin on people with type 1 and kidney disease through a significant clinical trial.

There are currently no approved medications to treat kidney disease in people with type 1 diabetes.

Over the past decade, SGLT inhibitors have proven to be effective for people with type 2 diabetes and people without diabetes, reducing the progression of kidney disease and heart disease.

However, there has been a lack of research exploring SGLT inhibitors as a treatment for people with kidney disease and type 1 diabetes.

This award from JDRF will allow the investigators to assess how this type of therapy works in type 1.

The trial will take place at the Steno Diabetes Center Copenhagen and at KCL, where clinicians will recruit participants from across southeast London.

Researchers will investigate how the drug, sotagliflozin, works on the kidneys using magnetic resonance imaging (MRI), which can provide a measure of kidney function and oxygen content, as well as measure a potential benefit on the heart.

Lead author Dr Peter Rossing said: “In the past decade we have seen amazing results in the treatment of diabetes complications with the drug class SGLT inhibitors. They have reduced progression of kidney and heart disease in people with type 2 diabetes and improve glycemic control in type 1 diabetes, but it is not clear how they work.

“Understanding how SGLT inhibitors work is important for the optimal use of these drugs. With no current approved medication for treatment of kidney disease in people with type 1 diabetes, our study could help pave the way if a benefit is demonstrated.”

Researchers at KCL will have the additional aim of evaluating whether there are potential biological differences between African-Caribbean and non-African-Caribbean people in in kidney baseline measures as well as in treatment responses.

This is relevant, as recent work from KCL highlighted that African-Caribbean people with type 1 diabetes had a higher and faster risk of kidney disease progression, which was independent of traditional risk factors.

Janaka Karalliedde, Clinical Reader in Diabetes and Cardiovascular Disease at King’s College London, says: “To date there are no clinical trials in people with type 1 diabetes of African-Carribean heritage who are often at higher risk of kidney complications of diabetes.

“This landmark study is a really important first milestone in this area and we are delighted to be involved as there is huge potential for new treatments that will make real clinical impact in an under-researched area of type 1 diabetes.”

Rachel Connor, Director of Research Partnerships at JDRF UK said: “We are delighted to provide funding for this much-needed clinical trial which will test whether SGLT-2 inhibitors can slow the progression of kidney disease in people with type 1 diabetes. Kidney disease is challenging to live with.

“Its treatments are demanding, it limits people’s lifestyles and it’s emotionally draining; and yet there are currently no approved medicines for people with type 1 diabetes and kidney disease. If this study shows that SGLT-2 inhibitors can effectively delay kidney complications for people with type 1, the results could be put into practice very swiftly, benefiting the entire type 1 diabetes community, enabling people to live longer, healthier and happier lives.”

SGLT inhibitors work by blocking the protein SGLT-2 in the kidneys. This protein usually helps the kidneys reabsorb glucose from urine that would otherwise be lost when it is excreted.

As a result, when SGLT is blocked, more glucose ends up in the urine and is removed from the body, helping patients with type 2 diabetes manage their condition more effectively.