Skip to main content
Top
Published in: Diabetes Therapy 1/2020

Open Access 01-01-2020 | Metformin | Study Protocol

Rationale, Design, and Methods of the Study of Comparison of Canagliflozin vs. Teneligliptin Against Basic Metabolic Risks in Patients with Type 2 Diabetes Mellitus (CANTABILE study): Protocol for a Randomized, Parallel-Group Comparison Trial

Authors: Cheol Son, Masato Kasahara, Tomohiro Tanaka, Noriko Satoh-Asahara, Toru Kusakabe, Kunihiro Nishimura, Yoshihiro Miyamoto, Shu Kasama, Kiminori Hosoda

Published in: Diabetes Therapy | Issue 1/2020

Login to get access

Abstract

Background

Dipeptidyl peptidase-4 (DPP-4) inhibitors and sodium-glucose co-transporter 2 (SGLT2) inhibitors are widely used antidiabetic drugs. However, to date, no studies have directly compared the effects of these two drugs on the components of the metabolic syndrome in patients with type 2 diabetes mellitus (T2DM).

Objectives

The Comparison of Canagliflozin vs. Teneligliptin against Basic Metabolic Risks in Patients with T2DM (CANTABILE) study aims to examine whether the DPP-4 inhibitor (teneligliptin) or the SGLT2 inhibitor (canagliflozin) is the more effective drug for reducing metabolic risk factors as a composite in Japanese patients with T2DM.

Methods

The CANTABILE study is a prospective, multicenter, open-label, randomized, parallel-group comparison study. A total of 200 patients with T2DM treated with metformin alone or without glucose-lowering agents will be enrolled if they have one or more of the metabolic risk factors, such as obesity, borderline high blood pressure, and dyslipidemia. They will then will be randomized into the Teneligliptin group or the Canagliflozin group and treated for 24 weeks. The primary endpoint is the composite ratio of subjects with one or more improved metabolic risk factors. The secondary endpoints are the changes in each component of the primary endpoint.

Planned outcomes

The CANTABILE study provides valuable evidence to indicate the suitability of SGLT2 inhibitors or DPP-4 inhibitors for Japanese patients with T2DM and metabolic risks.

Trial Registration Number

University Hospital Medical Information Network Clinical Trial Registry number: UMIN000030343.

Funding

Mitsubishi Tanabe Pharma Corporation.
Literature
1.
go back to reference King RJ, Grant PJ. Diabetes and cardiovascular disease: pathophysiology of a life-threatening epidemic. Herz. 2016;41(3):184–92.CrossRef King RJ, Grant PJ. Diabetes and cardiovascular disease: pathophysiology of a life-threatening epidemic. Herz. 2016;41(3):184–92.CrossRef
2.
go back to reference [No authors listed]. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837–53. [No authors listed]. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837–53.
3.
go back to reference Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545–59. Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545–59.
4.
go back to reference Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129–39.CrossRef Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129–39.CrossRef
5.
go back to reference ADVANCE Collaborative Group, Patel A, MacMahon S, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72. ADVANCE Collaborative Group, Patel A, MacMahon S, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72.
6.
go back to reference Gaede P, Valentine WJ, Palmer AJ, et al. Cost-effectiveness of intensified versus conventional multifactorial intervention in type 2 diabetes: results and projections from the Steno-2 study. Diabetes Care. 2008;31(8):1510–5.CrossRef Gaede P, Valentine WJ, Palmer AJ, et al. Cost-effectiveness of intensified versus conventional multifactorial intervention in type 2 diabetes: results and projections from the Steno-2 study. Diabetes Care. 2008;31(8):1510–5.CrossRef
7.
go back to reference Ueki K, Sasako T, Okazaki Y, et al. Effect of an intensified multifactorial intervention on cardiovascular outcomes and mortality in type 2 diabetes (J-DOIT3): an open-label, randomised controlled trial. Lancet Diabetes Endocrinol. 2017;5(12):951–64.CrossRef Ueki K, Sasako T, Okazaki Y, et al. Effect of an intensified multifactorial intervention on cardiovascular outcomes and mortality in type 2 diabetes (J-DOIT3): an open-label, randomised controlled trial. Lancet Diabetes Endocrinol. 2017;5(12):951–64.CrossRef
8.
go back to reference Matsuzawa Y, Funahashi T, Nakamura T. The concept of metabolic syndrome: contribution of visceral fat accumulation and its molecular mechanism. J Atheroscler Thromb. 2011;18(8):629–39.CrossRef Matsuzawa Y, Funahashi T, Nakamura T. The concept of metabolic syndrome: contribution of visceral fat accumulation and its molecular mechanism. J Atheroscler Thromb. 2011;18(8):629–39.CrossRef
9.
go back to reference Sone H, Mizuno S, Fujii H, et al. Is the diagnosis of metabolic syndrome useful for predicting cardiovascular disease in Asian diabetic patients? Analysis from the Japan Diabetes Complications Study. Diabetes Care. 2005;28(6):1463–71.CrossRef Sone H, Mizuno S, Fujii H, et al. Is the diagnosis of metabolic syndrome useful for predicting cardiovascular disease in Asian diabetic patients? Analysis from the Japan Diabetes Complications Study. Diabetes Care. 2005;28(6):1463–71.CrossRef
10.
go back to reference Bruno G, Merletti F, Biggeri A, et al. Metabolic syndrome as a predictor of all-cause and cardiovascular mortality in type 2 diabetes: the Casale Monferrato Study. Diabetes Care. 2004;27(11):2689–94.CrossRef Bruno G, Merletti F, Biggeri A, et al. Metabolic syndrome as a predictor of all-cause and cardiovascular mortality in type 2 diabetes: the Casale Monferrato Study. Diabetes Care. 2004;27(11):2689–94.CrossRef
11.
go back to reference Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117–28.CrossRef Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117–28.CrossRef
12.
go back to reference Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377(7):644–57.CrossRef Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377(7):644–57.CrossRef
13.
go back to reference Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019;380(4):347–57.CrossRef Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2019;380(4):347–57.CrossRef
14.
go back to reference Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375(4):311–22.CrossRef Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375(4):311–22.CrossRef
15.
go back to reference Marso SP, Bain SC, Consoli A, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375(19):1834–44.CrossRef Marso SP, Bain SC, Consoli A, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375(19):1834–44.CrossRef
16.
go back to reference Nauck MA, Vilsboll T, Gallwitz B, Garber A, Madsbad S. Incretin-based therapies: viewpoints on the way to consensus. Diabetes Care. 2009;32[Suppl 2]:S223–31.CrossRef Nauck MA, Vilsboll T, Gallwitz B, Garber A, Madsbad S. Incretin-based therapies: viewpoints on the way to consensus. Diabetes Care. 2009;32[Suppl 2]:S223–31.CrossRef
17.
go back to reference Kim YG, Hahn S, Oh TJ, Kwak SH, Park KS, Cho YM. Differences in the glucose-lowering efficacy of dipeptidyl peptidase-4 inhibitors between Asians and non-Asians: a systematic review and meta-analysis. Diabetologia. 2013;56(4):696–708.CrossRef Kim YG, Hahn S, Oh TJ, Kwak SH, Park KS, Cho YM. Differences in the glucose-lowering efficacy of dipeptidyl peptidase-4 inhibitors between Asians and non-Asians: a systematic review and meta-analysis. Diabetologia. 2013;56(4):696–708.CrossRef
18.
go back to reference Yamamoto-Honda R, Takahashi Y, Mori Y, et al. Changes in antidiabetic drug prescription and glycemic control trends in elderly patients with type 2 diabetes mellitus from 2005 to 2013: an analysis of the national center diabetes database (NCDD-03). Int Med. 2018;57(9):1229–40.CrossRef Yamamoto-Honda R, Takahashi Y, Mori Y, et al. Changes in antidiabetic drug prescription and glycemic control trends in elderly patients with type 2 diabetes mellitus from 2005 to 2013: an analysis of the national center diabetes database (NCDD-03). Int Med. 2018;57(9):1229–40.CrossRef
19.
go back to reference Mita T, Katakami N, Yoshii H, et al. Alogliptin, a dipeptidyl peptidase 4 inhibitor, prevents the progression of carotid atherosclerosis in patients with type 2 diabetes: the study of preventive effects of alogliptin on diabetic atherosclerosis (SPEAD-A). Diabetes Care. 2016;39(1):139–48.CrossRef Mita T, Katakami N, Yoshii H, et al. Alogliptin, a dipeptidyl peptidase 4 inhibitor, prevents the progression of carotid atherosclerosis in patients with type 2 diabetes: the study of preventive effects of alogliptin on diabetic atherosclerosis (SPEAD-A). Diabetes Care. 2016;39(1):139–48.CrossRef
20.
go back to reference Mita T, Katakami N, Shiraiwa T, et al. Sitagliptin attenuates the progression of carotid intima-media thickening in insulin-treated patients with type 2 diabetes: the Sitagliptin Preventive Study of Intima-Media Thickness Evaluation (SPIKE): a randomized controlled trial. Diabetes Care. 2016;39(3):455–64.CrossRef Mita T, Katakami N, Shiraiwa T, et al. Sitagliptin attenuates the progression of carotid intima-media thickening in insulin-treated patients with type 2 diabetes: the Sitagliptin Preventive Study of Intima-Media Thickness Evaluation (SPIKE): a randomized controlled trial. Diabetes Care. 2016;39(3):455–64.CrossRef
21.
go back to reference McGill JB. The SGLT2 inhibitor empagliflozin for the treatment of type 2 diabetes mellitus: a bench to bedside review. Diabetes Ther. 2014;5(1):43–63.CrossRef McGill JB. The SGLT2 inhibitor empagliflozin for the treatment of type 2 diabetes mellitus: a bench to bedside review. Diabetes Ther. 2014;5(1):43–63.CrossRef
22.
go back to reference Yamagishi K, Iso H. The criteria for metabolic syndrome and the national health screening and education system in Japan. Epidemiol Health. 2017;39:e2017003.CrossRef Yamagishi K, Iso H. The criteria for metabolic syndrome and the national health screening and education system in Japan. Epidemiol Health. 2017;39:e2017003.CrossRef
23.
go back to reference Giorgino F, Home PD, Tuomilehto J. Glucose control and vascular outcomes in type 2 diabetes: is the picture clear? Diabetes Care. 2016;39[Suppl 2]:S187–95.CrossRef Giorgino F, Home PD, Tuomilehto J. Glucose control and vascular outcomes in type 2 diabetes: is the picture clear? Diabetes Care. 2016;39[Suppl 2]:S187–95.CrossRef
24.
go back to reference Mishriky BM, Cummings DM, Tanenberg RJ. The efficacy and safety of DPP4 inhibitors compared to sulfonylureas as add-on therapy to metformin in patients with Type 2 diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2015;109(2):378–88.CrossRef Mishriky BM, Cummings DM, Tanenberg RJ. The efficacy and safety of DPP4 inhibitors compared to sulfonylureas as add-on therapy to metformin in patients with Type 2 diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2015;109(2):378–88.CrossRef
25.
go back to reference Ou HT, Chang KC, Li CY, Wu JS. Risks of cardiovascular diseases associated with dipeptidyl peptidase-4 inhibitors and other antidiabetic drugs in patients with type 2 diabetes: a nation-wide longitudinal study. Cardiovasc Diabetol. 2016;15:41.CrossRef Ou HT, Chang KC, Li CY, Wu JS. Risks of cardiovascular diseases associated with dipeptidyl peptidase-4 inhibitors and other antidiabetic drugs in patients with type 2 diabetes: a nation-wide longitudinal study. Cardiovasc Diabetol. 2016;15:41.CrossRef
26.
go back to reference Matikainen N, Manttari S, Schweizer A, et al. Vildagliptin therapy reduces postprandial intestinal triglyceride-rich lipoprotein particles in patients with type 2 diabetes. Diabetologia. 2006;49(9):2049–57.CrossRef Matikainen N, Manttari S, Schweizer A, et al. Vildagliptin therapy reduces postprandial intestinal triglyceride-rich lipoprotein particles in patients with type 2 diabetes. Diabetologia. 2006;49(9):2049–57.CrossRef
27.
go back to reference Mulvihill EE, Drucker DJ. Pharmacology, physiology, and mechanisms of action of dipeptidyl peptidase-4 inhibitors. Endocr Rev. 2014;35(6):992–1019.CrossRef Mulvihill EE, Drucker DJ. Pharmacology, physiology, and mechanisms of action of dipeptidyl peptidase-4 inhibitors. Endocr Rev. 2014;35(6):992–1019.CrossRef
28.
go back to reference Salim HM, Fukuda D, Higashikuni Y, et al. Teneligliptin, a dipeptidyl peptidase-4 inhibitor, attenuated pro-inflammatory phenotype of perivascular adipose tissue and inhibited atherogenesis in normoglycemic apolipoprotein-E-deficient mice. Vascul Pharmacol. 2017;96–98:19–25.CrossRef Salim HM, Fukuda D, Higashikuni Y, et al. Teneligliptin, a dipeptidyl peptidase-4 inhibitor, attenuated pro-inflammatory phenotype of perivascular adipose tissue and inhibited atherogenesis in normoglycemic apolipoprotein-E-deficient mice. Vascul Pharmacol. 2017;96–98:19–25.CrossRef
29.
go back to reference Examination Committee of Criteria for “Obesity Disease” in Japan and Japan Society for the Study of Obesity. New criteria for obesity disease in Japan. Circ J. 2002;66(11):987–92.CrossRef Examination Committee of Criteria for “Obesity Disease” in Japan and Japan Society for the Study of Obesity. New criteria for obesity disease in Japan. Circ J. 2002;66(11):987–92.CrossRef
30.
go back to reference WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63.CrossRef WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63.CrossRef
Metadata
Title
Rationale, Design, and Methods of the Study of Comparison of Canagliflozin vs. Teneligliptin Against Basic Metabolic Risks in Patients with Type 2 Diabetes Mellitus (CANTABILE study): Protocol for a Randomized, Parallel-Group Comparison Trial
Authors
Cheol Son
Masato Kasahara
Tomohiro Tanaka
Noriko Satoh-Asahara
Toru Kusakabe
Kunihiro Nishimura
Yoshihiro Miyamoto
Shu Kasama
Kiminori Hosoda
Publication date
01-01-2020
Publisher
Springer Healthcare
Published in
Diabetes Therapy / Issue 1/2020
Print ISSN: 1869-6953
Electronic ISSN: 1869-6961
DOI
https://doi.org/10.1007/s13300-019-00717-9

Other articles of this Issue 1/2020

Diabetes Therapy 1/2020 Go to the issue