This Phase 1, mechanistic study evaluated the effects of the GKA TTP399 on ketoacidosis risk in individuals with T1D on insulin pump therapy. The primary goal was to assess safety of TTP399 via a primary endpoint of non-inferiority of TTP399 compared to placebo regarding ketone levels during acute insulin withdrawal (IWT). Indeed, TTP399 did not alter circulating concentrations of beta-hydroxybutyrate (BOHB) or time to cessation of IWT and confirmed non-inferiority. Pre-specified secondary analyses investigated the potential for benefit. No subject treated with TTP399 met the prespecified definition of DKA while 42% of placebo-treated subjects met this criterion. Together, these data suggest that TTP399 does not increase, and may decrease, the risk of diabetic ketoacidosis (DKA) in subjects with T1D.
This finding stands in direct contrast to other promising oral adjunctive therapies tested in T1D. During similar insulin withdrawal experiments, SGLT2i use significantly increased ketonemia in people with T1D during insulin withdrawal1. Moreover, off-label use of SGLT2i in the real world is associated with substantially increased risk of euglycemic DKA2. That TTP399 did not result in increased BOHB during acute insulin withdrawal and instead demonstrated a trend toward lowering risk of metabolic acidosis suggests that TTP399 will not increase the risk of DKA when used in the real world.
The data from this study support prior studies that demonstrate that TTP399 improves glucose control and reduces hypoglycemia and suggest a protective effect of TTP399 against acidosis in people with T1D.
“There is an urgent need to develop adjunctive therapies to improve metabolic control in people with type 1 diabetes,” said
The publication, titled “Impact of the Hepatoselective Glucokinase Activator TTP399 on Ketoacidosis During Insulin Withdrawal in People with Type 1 Diabetes,” will be available online ahead of print on
https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14697
1 Herring et al, Diabetes Care 2020 https://doi.org/10.2337/dc19-2579
2 Peters et al, Diabetes Care. 2015 https://doi.org/10.2337/dc15-0843
About TTP399
TTP399 is a novel, oral, small molecule, liver selective glucokinase activator being developed as an adjunct therapy to insulin in patients with type 1 diabetes. In a recent phase 2 clinical trial, TTP399 showed a 40% reduction in hypoglycemic episodes compared to placebo. In
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