Acute Effects of SGLT2 Inhibition on Renal Oxygenation and Autonomic Function in Type 1 Diabetes

Inclusion criteria

healthy controls:

• Written informed consent must be provided before participation
• Male or female patients > 18 years of age
• Capable of lying in a MR-scanner for two hours

Inclusion criteria

persons with type 1 diabetes:

• Written informed consent must be provided before participation
• Male or female patients >18 years of age with a diagnosis of type 1 diabetes (WHO criteria)
• Urinary albumin creatinine ratio (UACR) ≥30 mg/g in 2 out of 3 consecutive samples (albuminuria) prior to randomization assessed from electronic laboratory database.
• Capable of lying in a MR-scanner for two hours

Exclusion criteria

for all:

• Non-diabetic kidney disease as indicated by medical history and/or laboratory findings
• Renal failure (eGFR<15 ml/min/1.73m2), dialysis or kidney transplantation
• Treatment with beta-blocking medication
• Uncontrolled arrhythmia, 2. or 3. degree AV-block or sick sinus syndrome - assessed from a standard 12-lead electrocardiogram
• Pregnancy or breastfeeding (urine HCG is performed on all fertile women)
• Systolic blood pressure < 90 or > 200 mmHg
• Patients who, in the judgement of the investigator, is incapable of participating
• Exclusion criteria for MRI

• Claustrophobia
• Known heart disease
• Known lung disease
• Have had surgery the past six weeks
• Have foreign bodies of metal in the body (e.g. pacemaker, metal plates, metal screws)
• Exclusion criteria for arterial blood gas sampling (only patients with type 1 diabetes)

• Absent pulse
• Raynauds syndrome
• Buergers Disease (thromboangiitis obliterans)
• Inadequate or interrupted circulation
• Anticoagulation treatment
• Coagulopathies (hypo or hyper coagulable states)
• Arterial atherosclerosis
• Insufficient collateral perfusion
• Partial or full thickness burns over the cannulation site
• Synthetic arterial or vascular grafts or infection at the proposed site of cannulation Patients with type 1 diabetes will have the possibility to participate in the study without getting arterial blood gas sampling.