Prevention of Chronic Kidney Disease(CDK) Progression in Type 1 Diabetes With Long Term Use of Sodium-Glucose-coTransporter Inhibitors Avoiding Kidney hypOxia

Inclusion criteria

• Persons ≥ 18 years of age with a diagnosis of type 1 diabetes (age at onset <40 years; permanent insulin treatment initiated within 1 year of diagnosis)
• Albuminuria: UACR > 100 mg/g (in ≥2 out 3 morning spot urine collections prior to randomization)
• estimated Glomerular Filtration Rate(eGFR) ≥25 and < 75 ml/min/1.73m2
• Participants must be on stable renin-angiotensin system blocking treatment 4 weeks before start of study drug and throughout study duration.
• Able to understand the written participant information and give informed consent

Exclusion criteria

• Non-diabetic kidney disease indicated by medical history and/or laboratory findings.
• eGFR< 25 ml/min/1.73m2, dialysis or kidney transplantation.
• Previous diabetic ketoacidosis, except at debut.
• Dysregulated diabetes (HbA1c > 85 mmol/mol)
• Decreased awareness or unawareness
• Pregnancy, lactating or with a wish of pregnancy within the next year
• Low carbohydrate diet
• Receiving therapy with an SGLT inhibitor within 8 weeks prior to enrolment or previous intolerance of an SGLT inhibitor.
• New York Heart Association (NYHA) class IV Congestive Heart Failure at the time of enrolment
• Myocardial infarction, unstable angina, stroke or transient ischemic attack within 12 weeks prior to enrolment
• The receipt of any investigational product 90 days prior to this trial
• Unable to participate in study procedures
• Any clinically significant disorder, except for conditions associated with type 1 diabetes, which in the Investigators opinion could interfere with the results of the trial
• Participation in another intervention study
• Exclusion criteria for MRI: known claustrophobia, known chronic lung disease, surgery within past 6 weeks or having foreign bodies of metal in the body (e.g. pacemaker, metal plates, metal screws)
• Recurrent urogenital infections.