Clinical diagnosis of T2DM. Age ≥30 and ≤80 years. Currently treated with one or two classes of oral glucose-lowering therapy (given either as separate or combined medications), that do not include a DPP4 inhibitor, a SGLT2 inhibitor or a thiazolidinedione. Diabetes duration ≥12 months. No change in diabetes treatment (new treatments or dose change) within previous 3 months. HbA1c > 58 mmol/mol (>7.5%) and ≤110 mmol/mol (≤12.2%). eGFR ≥60 mL/min/1.73 m². Able and willing to give informed consent.
| Changes in glucose-lowering therapy or dose within last 3 months. ALT >2.5×upper limit of the assay normal range or known liver disease, specifically bilirubin >30 μmol/L that is associated with other evidence of liver failure. Insulin treated within the last 12 months. Treated with study drugs within the last 3 months. Limb ischaemia shown by absence of both pulses in one or both feet. Currently treated with corticosteroids. Currently treated with rifampicin, gemfibrozil, phenytoin and carbamazepine. Active infection (any infection requiring antibiotics). Foot ulcer requiring antibiotics within previous 3 months. Recent (within 3 months) significant surgery or planned surgery (excluding minor procedures). Acute cardiovascular episode (angina, myocardial infarction, stroke, transient ischaemic episode) occurring within the previous 3 months. History of heart failure. Current use of loop diuretic therapy (furosemide or bumetanide). History of bladder carcinoma. Current/ongoing investigation for macroscopic haematuria. History of diabetic ketoacidosis. History of pancreatitis. Pregnant, breastfeeding or planning a pregnancy over the study period. Concurrent participation on another Clinical Trial of an Investigational Medicinal Product (CTIMP) where the IMP is currently being taken, or without sufficient washout period (five times the longest half-life of the study IMPs) and without consultation with the CTIMP research team. Unable or unwilling to give informed consent. Females of childbearing potential must be willing to use an effective method of contraception from the time consent is signed until 7 days after treatment discontinuation. A negative pregnancy test is required within 7 days prior to treatment initiation and will be required for continuation at each study visit.
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