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The Effects of Glucagon on Hepatic Metabolism in People With Type 2 Diabetes After Caloric Restriction

Primary Purpose

Type2diabetes

Status
Recruiting
Phase
Phase 2
Locations
United States
Study Type
Interventional
Intervention
Caloric Restriction
Hyperglycemic clamp
Sponsored by
Adrian Vella
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Type2diabetes focused on measuring glucagon, insulin resistance, caloric restriction, hepatic steatosis, amino acid metabolism

Eligibility Criteria

25 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • We will recruit up to 20 weight-stable, subjects with type 2 diabetes
  • BMI ≥ 28 Kg/M2
  • Diabetes is managed by diet alone or a combination of oral agents

Exclusion Criteria:

  • History of prior upper abdominal surgery e.g. gastric banding, pyloroplasty, vagotomy.
  • Active systemic illness or malignancy.
  • Symptomatic macrovascular or microvascular disease.
  • Contraindications to MRI (e.g. metal implants, claustrophobia).
  • Hematocrit < 35%
  • TSH < 0.4 or > 5.5.
  • Consumption of > 2 alcohol drinks per day or > 14 per week or a positive AUDIT questionnaire.

Sites / Locations

  • Mayo Clinic in RochesterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Adults with type 2 diabetes

Arm Description

20 subjects will be studied on one occasion, following 6 weeks of caloric restriction. They will be instructed to consume a diet of 900 kcal daily using meals derived from "Nutritional Guidelines after Bariatric Surgery". Compliance will be monitored by weekly meetings with the dietician using an electronic record of food intake. After this subjects will undergo a hyperglycemic clamp with 2 doses of glucagon infused.

Outcomes

Primary Outcome Measures

Rate of leucine oxidation in response to rising glucagon concentrations
tracer-determined amino acid catabolism

Secondary Outcome Measures

Full Information

First Posted
August 10, 2022
Last Updated
December 27, 2022
Sponsor
Adrian Vella
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1. Study Identification

Unique Protocol Identification Number
NCT05499702
Brief Title
The Effects of Glucagon on Hepatic Metabolism in People With Type 2 Diabetes After Caloric Restriction
Official Title
The Effects of Glucagon on Hepatic Metabolism in People With Type 2 Diabetes After Caloric Restriction
Study Type
Interventional

2. Study Status

Record Verification Date
December 2022
Overall Recruitment Status
Recruiting
Study Start Date
December 15, 2022 (Actual)
Primary Completion Date
December 30, 2024 (Anticipated)
Study Completion Date
March 31, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Adrian Vella

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Caloric restriction (and RYGB) improves insulin action and lowers fasting glucose, glucagon and EGP, without changes in postprandial EGP and glucagon concentrations. Caloric restriction also improves hepatic steatosis and lowers fasting AA. These changes may represent restoration of glucagon's hepatic actions. This experiment will determine whether caloric restriction improves glucagon's actions on hepatic amino acid, carbohydrate and lipid metabolism in T2DM in comparison to a baseline experiment performed separately in people with T2DM.
Detailed Description
T2DM and prediabetes are characterized by abnormal post-prandial suppression of glucagon, which contributes to postprandial hyperglycemia by increasing EGP. Although these effects are magnified by decreased and delayed insulin secretion, they are also apparent when insulin secretion is intact5. In rodents, altered glucagon signaling changes α-cell function and mass - an effect mediated by changes in circulating AA concentrations. Are the elevated concentrations of branched-chain AA and other AA metabolites in T2DM a cause or an effect of global α-cell dysfunction? Could altered glucagon signaling precipitate a vicious cycle resulting in T2DM? This study will determine how caloric restriction alters hepatic glucagon action. Elevated fasting AA concentrations are associated with T2DM risk. In addition, hepatic steatosis has been associated with an impaired ability of glucagon to stimulate hepatic clearance of AAs. Prior studies have shown that caloric restriction lowers fasting glucose, EGP and glucagon. However, the effects on these parameters in the postprandial period are unclear. This experiment will examine to what degree the improvements produced by caloric restriction can be explained by improved hepatic glucagon action. Because caloric restriction decreases hepatic fat content the experiment will also determine if a reduction in hepatic fat content is associated with changes in glucagon's effects on hepatic AA, glucose, and lipid metabolism.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Type2diabetes
Keywords
glucagon, insulin resistance, caloric restriction, hepatic steatosis, amino acid metabolism

7. Study Design

Primary Purpose
Basic Science
Study Phase
Phase 2
Interventional Study Model
Single Group Assignment
Model Description
caloric restriction for six weeks
Masking
None (Open Label)
Allocation
N/A
Enrollment
20 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Adults with type 2 diabetes
Arm Type
Experimental
Arm Description
20 subjects will be studied on one occasion, following 6 weeks of caloric restriction. They will be instructed to consume a diet of 900 kcal daily using meals derived from "Nutritional Guidelines after Bariatric Surgery". Compliance will be monitored by weekly meetings with the dietician using an electronic record of food intake. After this subjects will undergo a hyperglycemic clamp with 2 doses of glucagon infused.
Intervention Type
Behavioral
Intervention Name(s)
Caloric Restriction
Intervention Description
Subjects will be instructed to consume a diet of 900 kcal daily using meals derived from "Nutritional Guidelines after Bariatric Surgery". Compliance will be monitored by weekly meetings with the dietician using an electronic record of food intake
Intervention Type
Drug
Intervention Name(s)
Hyperglycemic clamp
Intervention Description
Hyperglycemic clamp to measure the effect of glucagon on hepatic metabolism
Primary Outcome Measure Information:
Title
Rate of leucine oxidation in response to rising glucagon concentrations
Description
tracer-determined amino acid catabolism
Time Frame
240 minutes of study

10. Eligibility

Sex
All
Minimum Age & Unit of Time
25 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: We will recruit up to 20 weight-stable, subjects with type 2 diabetes BMI ≥ 28 Kg/M2 Diabetes is managed by diet alone or a combination of oral agents Exclusion Criteria: History of prior upper abdominal surgery e.g. gastric banding, pyloroplasty, vagotomy. Active systemic illness or malignancy. Symptomatic macrovascular or microvascular disease. Contraindications to MRI (e.g. metal implants, claustrophobia). Hematocrit < 35% TSH < 0.4 or > 5.5. Consumption of > 2 alcohol drinks per day or > 14 per week or a positive AUDIT questionnaire.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Jeanette Laugen
Phone
5072558110
Email
Laugen.Jeanette@mayo.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Adrian Vella
Organizational Affiliation
Mayo Clinic
Official's Role
Principal Investigator
Facility Information:
Facility Name
Mayo Clinic in Rochester
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Individual Site Status
Recruiting

12. IPD Sharing Statement

Plan to Share IPD
No

Learn more about this trial

The Effects of Glucagon on Hepatic Metabolism in People With Type 2 Diabetes After Caloric Restriction

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