ClinicalTrials.gg
Not yet recruitingNCT07421518KARMAUpdated Feb 19, 2026

Ketone Monitoring Approaches for Diabetic Ketoacidosis Risk Mitigation in People With T1D on Adjunctive SGLT-2 Inhibitors

A Phase 2 interventional study of SGLT-2 inhibitor (Sotagliflozin) and Insulin withdrawal test (IWT) in Type 1 Diabetes and Type 2 Diabetes, sponsored by AdventHealth Translational Research Institute. Not yet recruiting at 1 site in United States. Open to participants aged 18 Years to 40 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2026-02-19.

Sponsored by AdventHealth Translational Research Institute · Phase 2, Interventional, and Prevention

Phase
Phase 2
Study type
Interventional
Enrollment
75
Allocation
Not applicable
Ages
18 Years to 40 Years
Sex
All
01

Study summary

The purpose of this research is to see how well a special education plan using continuous ketone monitoring (DGK) works to lower the risk of a condition called diabetic ketoacidosis (DKA) in people with type 1 diabetes (T1D) taking SGLT2 inhibitors (a type of medication commonly used to treat type 2 diabetes). This special education plan is compared to a general education plan and considers the higher risk of DKA when using medicines like SGLT2 inhibitors.

02

Conditions studied

  • Type 1 Diabetes
  • Type 2 Diabetes
03

In context

Diabetes Mellitus, Type 1

3,754 studies on the registry are indexed under Diabetes Mellitus, Type 1; 600 are open to participants now.

This study's planned enrollment of 75 is above the median of 40 across 2,820 interventional studies indexed under Diabetes Mellitus, Type 1.

Browse Diabetes Mellitus, Type 1 studies →

Lead sponsor

AdventHealth Translational Research Institute is the lead sponsor of 57 studies on the registry; 11 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years to 40 Years
Sexes eligible
All
Accepts healthy volunteers
Yes

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  1. Men and nonpregnant women ≥18 years and older
  2. Diagnosis of T1D according to American Diabetes Association (ADA) criteria
  3. \< 9 %
  4. Participants treated with multiple daily injections of insulin, insulin pump, or advanced insulin delivery systems
  5. Has provided written to participate in the study.
  6. Must be willing to wear the device
  7. Use of adequate for the duration of the study by women of

Exclusion criteria

Exclusion Criteria:

  1. Pregnancy, lactation or planning to become pregnant
  2. Any form of diabetes other than T1D
  3. People with T1D using weekly insulin (when approved)
  4. Use of sodium-glucose cotransporter 2 inhibitors within 4 weeks prior to screening
  5. Chronic systematic (>4 consecutive weeks) within 6 months before screening
  6. History of diabetic ketoacidosis within 6 months of screening
  7. History of multiple (≥ 3 infections) genital mycotic infections within 6 months of screening
  8. Hypotension at screening is defined as systolic blood pressure \< 90 and diastolic blood pressure \< 60 with symptoms of low blood pressure (confusion, dizziness, lightheadedness, fainting, heart palpitations)
  9. History of a level 3 hypoglycemic event (as defined by ADA criteria) within 3 months of screening
  10. Recent myocardial infarction, stroke, hospitalization for unstable angina or heart failure within 3 months prior to screening
  11. Class IV heart failure
  12. estimated glomerular filtration rate (eGFR) \<30 mL/min/1.73m²
  13. Impairment of systems and organs that may increase their risk of participating in the intervention study or compromise the results (for example: end stage kidney disease, active liver dysfunction, gastroparesis, anemia, ), organ transplant.
  14. Cancer treatment (excluding non-melanoma skin cancer treated by excision, carcinoma in situ of the cervix or uterus, ductal breast cancer in situ, resected non- breast or prostate cancer) within one year of screening
  15. Active or C, acquired immunodeficiency syndrome ( infection controlled with suppressive medications is allowed) or tuberculosis
  16. Abnormal liver function at screening defined as any of the following: (AST) >2X reference range (ULN), ALT >2X ULN, serum total (TB) >1.5X ULN
  17. Current or past history of decompensated cirrhosis (defined as variceal bleeding, ascites, or hepatic encephalopathy), and/or known diagnosis of cirrhosis
  18. Heavy alcohol use (for men, ≥5 drinks on any day or ≥15 drinks per week; for women, ≥4 drinks on any day or ≥8 drinks per week) at screening, history of alcohol use disorder or binge drinking
  19. Any condition or factor that would compromise the participant's safety or the scientific integrity of the study (cognitive impairment, bipolar disorder, or history of eating disorder)
  20. Inability to perform the study follow up/ unwilling to wear the device
  21. People who are unwilling to consume at least 20% of calories from carbohydrates
Terms in these criteria, in plain language(14)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

HbA1c

A blood test of average blood sugar over the past two to three months, given as a percentage or in mmol/mol. 6.5% (48 mmol/mol) or more is the usual threshold for diabetes, normally confirmed by a second test.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

NYHA class (heart failure)

The New York Heart Association’s four classes of how much heart failure limits physical activity.

I
No limits: ordinary activity causes no undue tiredness or breathlessness.
II
Slight limits: comfortable at rest, ordinary activity causes symptoms.
III
Marked limits: comfortable at rest, less than ordinary activity causes symptoms.
IV
Symptoms even at rest; any activity makes them worse.

Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.

GFR and eGFR (kidney filtering)

GFR (glomerular filtration rate) is how much blood the kidneys filter each minute. It is usually estimated from a blood test — eGFR, by formulas such as CKD-EPI or MDRD — and some studies ask for it to be measured directly instead. Usually given in mL/min/1.73 m².

Check the method, the units and the minimum the study states. A value of 90 or above is in the normal-or-high range, but kidney damage can show in other tests too.

Metastases

Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.

Hepatitis B tests

Hepatitis B is a virus that infects the liver. These are separate tests: HBsAg positive usually means a current infection (a recent vaccination can briefly cause it too); total anti-HBc (HBcAb) positive means an infection now or in the past; HBV DNA measures how much virus is in the blood.

Some studies accept a past infection if HBV DNA is undetectable, sometimes with antiviral medicine during the study. Check what this study allows.

HIV

The human immunodeficiency virus, which weakens the immune system.

Many studies now accept people whose HIV is controlled on treatment, judged by the viral load and the CD4 count. Check the limits this study sets.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

05

Study design

Phase
Phase 2
Primary purpose
Prevention
Allocation
Not applicable
Intervention model
Sequential assignment
Masking
None (open label)
Enrollment
75 participants (estimated)

Study arms

  • Other
    People with Type 1 Diabetes

    Drug: SGLT-2 inhibitor (Sotagliflozin) · Other: Insulin withdrawal test (IWT)

Interventions

  • Participants will be asked to take the SGLT-2 inhibitor.

    Also known as: Inpefa

  • OtherInsulin withdrawal test (IWT)

    An Insulin withdrawal test (IWT) will be given to participants on an SGLT-2 inhibitor. Participants will be monitored.

06

What researchers measure

Primary outcomes

  1. Ketone events with Beta-hydroxybutyrate (BOHB) >1.5 mmol/L

    Number of ketone events with BOHB \> 1.5 mmol/L for 15 consecutive minutes, as measured by the DGK. The event will end when BOHB is \< 1.5 for 15 consecutive minutes. These events will be measured during the risk mitigation phase (Period 3 and Period 4) of the study.

    Time frame: 6 months

07

Study locations

1 site
08

References and documents

Study documents

PDFs hosted by the registry, ClinicalTrials.gov.

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Start is estimated for Jun 2026; primary completion for Apr 2030, 46 months later.

Of 83 non-industry phase 2 interventional studies under Diabetes Mellitus, Type 1, half reached primary completion within 51 months of starting (the median), counting those still running; a quarter within 31 and three quarters within 76. This study's planned 46 months is close to that.

Counting every sponsor, half of 133 studies reached it within 36 months; a quarter within 17 and three quarters within 63.

How these figures are worked out, and which studies are left out of them.

Registered
Jan 30, 2026
First posted
Feb 19, 2026
StartEst.
Jun 2026
Primary completionEst.
Apr 2030
CompletionEst.
Apr 2030
Last update
Feb 19, 2026
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Feb 19, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT07421518
Lead sponsor
AdventHealth Translational Research Institute
Responsible party
Sponsor
First posted
Feb 19, 2026
Start date
Jun 2026 (estimated)
Primary completion
Apr 2030 (estimated)
Completion
Apr 2030 (estimated)
Last update
Feb 19, 2026

Study contacts

JaWanda Thacker
Contact
CFD.TRI.Recruitment@AdventHealth.com
407-303-7100
Richard Pratley, MD
principal investigator · AdventHealth

Oversight

Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is not yet recruiting, as verified in Feb 2026. You cannot join it, but the record below documents what was studied.

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Discussion

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Studies of the drug tested here: Sotagliflozin

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