A Single Centre, Placebo-controlled Study to Evaluate the Combined Effect of Hyperglycaemia and a QTc-prolonging Medication on Cardiac Repolarisation in Male and Female Patients With Insulin Resistant Type 2 Diabetes Mellitus (T2DM)
Diabetes is a significant risk factor for sudden cardiac death, with the QTc interval on electrocardiograms (ECGs) often prolonged in diabetic patients due to factors such as hyperglycaemia and insulin resistance. Drugs like moxifloxacin can further exacerbate this effect, especially in those with diabetes. A previous trial on Type 1 diabetes suggested that hyperglycaemia and moxifloxacin have additive effects, prompting an investigation into whether similar effects occur in Type 2 diabetes (T2DM), particularly in individuals with high insulin resistance. This study aims to evaluate whether moxifloxacin-induced QT-prolongation is amplified by elevated blood glucose levels or insulin deficiency in T2DM patients, considering potential differences between sexes. Blood biomarkers will be analysed to understand the underlying molecular mechanisms. The trial will involve at least 24 male and female participants with insulin-resistant T2DM, aged 18 to 64 years, conducted at Richmond Pharmacology Ltd. Participants will receive treatments with glucose, moxifloxacin, and placebos while closely monitored for side effects during an inpatient stay, followed by outpatient appointments.
• Male or female patients with stable T2DM. Diagnosis of T2DM confirmed by:
• i. Established diagnosis of T2DM documented on medical records and HbA1c at screening ≥ 48 mmol/mol (6.5%) and ≤ 80 mmol/mol (9.5%). Subjects with HbA1c levels \> 80 mmol/mol but ≤ 90 mmol/mol will be considered eligible, subject to approval by an endocrinologist. AND ii. Evidence of high insulin resistance as defined by a HOMA2-IR score within the top quintile of the locally defined cohort, \>0.55 (see Appendix 2).
• 18-64 years (inclusive) of age (at the date of signing informed consent), with a body mass index of 18 to 35 kg/m², inclusive (at screening).
• Satisfactory medical assessment with no clinically significant or relevant abnormalities as determined by medical history, physical examination, vital signs, 12-lead ECG, and clinical laboratory evaluation (haematology, biochemistry, coagulation, and urinalysis) that is reasonably likely to interfere with the participant's ability to complete the study as assessed by the Investigator.
• Stable patients with insulin resistant type 2 diabetes treated with one of the following:
• a. Diet and exercise alone, b. Anti-glycaemic monotherapy on metformin, DPP-4i, pioglitazone, an SU or an SGLT-2i.
• Able to wash-out anti-glycaemic therapy for ten half-lives prior to dosing or at D-7, whichever is longer, and for the duration of the trial period up to the end of Day 4.
• Participants must agree to use the following contraceptive requirements for the applicable duration:
‣ Female participants of non-childbearing potential (WNCBP): Defined as either postmenopausal (evidence of menopause based on a combination of amenorrhea for at least one year and increased serum follicle-stimulating hormone (FSH) level \[\> 30 IU/L\]), or surgical sterilization (evidence of hysterectomy and/or bilateral oophorectomy). CONTRACEPTION REQUIRED: None
⁃ Female participants of childbearing potential (WOCBP) who anticipate being sexually active with a male during the trial (from one complete menstrual cycle prior to the first drug administration until three months after the last drug administration) \*: CONTRACEPTION REQUIRED: Highly effective contraception must start one complete menstrual cycle prior to the first day of dosing and continue until three months after drug administration. Highly effective contraception methods for WOCBP include:
• Combined i.e. (oestrogen- and progestogen-containing) hormonal contraception associated with inhibition of ovulation: \*\*
‣ Oral
⁃ Intravaginal
⁃ Transdermal
∙ Progestogen-only hormonal contraception associated with inhibition of ovulation\*\*
‣ oral
⁃ injectable
⁃ implantable
∙ Intrauterine hormone-releasing system (IUS)\*\*
∙ Intrauterine device (IUD)
∙ Bilateral tubal occlusion
∙ Infertile male partner (e.g., vasectomised, permanently sterile following bilateral orchidectomy, or any other documented cause of infertility)
⁃ Female participants of childbearing potential (WOCBP) who agree to remain abstinent for the duration of the trial (from one complete menstrual cycle prior to the first drug administration until three months after the last drug administration): CONTRACEPTION REQUIRED: Abstinence (N.B. sexual abstinence is considered a highly effective method only if defined as refraining from heterosexual intercourse during the entire period of risk associated with the trial treatments. The reliability of sexual abstinence needs to be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the participant. Calendar, symptothermal and post-ovulation methods of contraception are not considered to be equivalent to abstinence).
⁃ Male participants, who agree to remain abstinent for the duration of the trial (from first drug administration until three months after the last drug administration): CONTRACEPTION REQUIRED: Abstinence (N.B. sexual abstinence is considered a highly effective method only if defined as refraining from heterosexual intercourse during the entire period of risk associated with the trial treatments. The reliability of sexual abstinence needs to be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the participant). If the situation changes post-dose during the trial, participants must use a condom with or without spermicide.
⁃ Male participants, who anticipate being sexually active during the trial period (from first drug administration until three months after the last NIMP administration) with a woman who is either a WOCBP, a woman who is pregnant and/or breast feeding: CONTRACEPTION REQUIRED: From the first day of dosing until the end of the systemic exposure of the trial drug (for this trial this is until the follow-up visit). Acceptable methods are:
• Male condom with or without spermicide
∙ Infertile male (e.g., vasectomised, permanently sterile following bilateral orchidectomy, or any other documented cause of infertility)
• Ability to provide written, personally signed, and dated informed consent to participate in the study, in accordance with the ICH Good Clinical Practice (GCP) Guideline E6 (R2) (2016) and applicable regulations, before completing any study-related procedures. An understanding, ability, and willingness to fully comply with study procedures and restrictions.