Pre-diabetes in Subject With Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT)

NCT ID: NCT02969798

Last Updated: 2025-08-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

700 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-01-01

Study Completion Date

2027-07-31

Brief Summary

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HYPOTHESIS: Impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) have distinct pathophysiologic etiologies. Therefore, therapeutic interventions designed to correct the specific underlying pathogenic abnormalities in IGT and IFG will be required to optimally prevent the progressive beta cell failure and development of overt type 2 diabetes.

Detailed Description

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SPECIFIC AIMS:

1. To examine the effect of the following pharmacologic interventions on beta cell function, insulin sensitivity, and glucose tolerance status in individuals with isolated impaired glucose tolerance (IGT): (i) treatment with the renal Sodium-glucose co-transporter 2 (SGLT2) inhibitor inhibitor, dapagliflozin; (ii) treatment with the inhibitors of dipeptidyl peptidase 4, also DPP4, saxagliptin ; (iii) treatment with the thiazolidinedione, pioglitazone; (iv) treatment with the biguanide, metformin.
2. To examine the effect of the following pharmacologic interventions on beta cell function, insulin sensitivity, and glucose tolerance status in individuals with isolated impaired fasting glucose (IFG): (i) treatment with the renal SGLT2 inhibitor, dapagliflozin; (ii) treatment with the DPP4 inhibitor, saxagliptin; (iii) treatment with the thiazolidinedione, pioglitazone; (iv) treatment with the biguanide, metformin.
3. To examine the effect of the following pharmacologic interventions on beta cell function, insulin sensitivity, and glucose tolerance status in individuals with combined impaired glucose tolerance (IGT) plus impaired fasting glucose (IFG): i) treatment with the renal SGLT2 inhibitor, dapagliflozin; (ii) treatment with the DPP4 inhibitor, saxagliptin; (iii) treatment with the thiazolidinedione, pioglitazone; (iv) treatment with the biguanide, metformin.

Conditions

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Diabetes Mellitus, Type 2 Impaired Glucose Tolerance (IGT) Impaired Fasting Glucose (IFG)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Healthy normal glucose tolerance (NGT) subjects

Subjects (Fasting Plasma Glucose or FPG \< 100 mg/dl and 2-h PG \< 140 mg/dl) without FH (family history) of diabetes in a first degree relative

Group Type NO_INTERVENTION

No interventions assigned to this group

Isolated IGT with Dapagliflozin

Healthy subjects with isolated IGT (FPG \< 100; 2-h PG = 140-199) will receive dapagliflozin, 10 mg/day

Group Type ACTIVE_COMPARATOR

Dapagliflozin

Intervention Type DRUG

10mg/day

Isolated IGT with Saxagliptin

Healthy subjects with isolated IGT (FPG \< 100; 2-h PG = 140-199) will receive saxagliptin, 5 mg/day

Group Type ACTIVE_COMPARATOR

Saxagliptin

Intervention Type DRUG

5mg/day

Isolated IGT with Pioglitazone

Healthy subjects with isolated IGT (FPG \< 100; 2-h PG = 140-199) will receive pioglitazone, the dose will increase from 15 mg/day to 30 mg/day at month two

Group Type ACTIVE_COMPARATOR

Pioglitazone

Intervention Type DRUG

the dose will increase from 15 mg/day to 30 mg/day at month two

Isolated IGT with Metformin

Healthy subjects with isolated IGT (FPG \< 100; 2-h PG = 140-199) will receive Metformin, starting at 1000 mg/day and increased to 2000 mg/day at month 2.

Group Type ACTIVE_COMPARATOR

Metformin

Intervention Type DRUG

starting at 1000 mg/day and increased to 2000 mg/day at month 2.

Isolated IFG with Dapagliflozin

Healthy subjects with isolated IFG (FPG = 100-125; 2-h PG \< 140) will receive dapagloflozin, 10mg/day

Group Type ACTIVE_COMPARATOR

Dapagliflozin

Intervention Type DRUG

10mg/day

Isolated IFG with Saxagliptin

Healthy subjects with isolated IFG (FPG = 100-125; 2-h PG \< 140) will receive saxagliptin, 10mg/day

Group Type ACTIVE_COMPARATOR

Saxagliptin

Intervention Type DRUG

5mg/day

Isolated IFG with Pioglitazone

Healthy subjects with isolated IFG (FPG = 100-125; 2-h PG \< 140) will receive pioglitazone, the dose will increase from 15 mg/day to 30 mg/day at month two

Group Type ACTIVE_COMPARATOR

Pioglitazone

Intervention Type DRUG

the dose will increase from 15 mg/day to 30 mg/day at month two

Isolated IFG with Metformin

Healthy subjects with isolated IFG (FPG = 100-125; 2-h PG \< 140) will receive Metformin, starting at 1000 mg/day and increased to 2000 mg/day at month 2.

Group Type ACTIVE_COMPARATOR

Metformin

Intervention Type DRUG

starting at 1000 mg/day and increased to 2000 mg/day at month 2.

IGT plus IFG with Dapagliflozin

Healthy subjects with IGT plus IFG will receive dapagliflozin, 10mg/day

Group Type ACTIVE_COMPARATOR

Dapagliflozin

Intervention Type DRUG

10mg/day

IGT plus IFG with Saxagliptin

Healthy subjects with IGT plus IFG will receive saxagliptin, 10mg/day

Group Type ACTIVE_COMPARATOR

Saxagliptin

Intervention Type DRUG

5mg/day

IGT plus IFG with Pioglitazone

Healthy subjects with IGT plus IFG will receive pioglitazone, the dose will increase from 15 mg/day to 30 mg/day at month two

Group Type ACTIVE_COMPARATOR

Pioglitazone

Intervention Type DRUG

the dose will increase from 15 mg/day to 30 mg/day at month two

IGT plus IFG with Metformin

Healthy subjects with IGT plus IFG will receive Metformin, starting at 1000 mg/day and increased to 2000 mg/day at month 2.

Group Type ACTIVE_COMPARATOR

Metformin

Intervention Type DRUG

starting at 1000 mg/day and increased to 2000 mg/day at month 2.

Interventions

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Dapagliflozin

10mg/day

Intervention Type DRUG

Saxagliptin

5mg/day

Intervention Type DRUG

Pioglitazone

the dose will increase from 15 mg/day to 30 mg/day at month two

Intervention Type DRUG

Metformin

starting at 1000 mg/day and increased to 2000 mg/day at month 2.

Intervention Type DRUG

Other Intervention Names

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Eligibility Criteria

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Inclusion Criteria

* NGT subjects will serve as controls and will be matched in age, gender, ethnicity, and BMI to IGT and IFG subjects

1. Male or female subjects between the ages of 18 and 65 years of age, inclusive, at Screening.
2. FPG \< 100 mg/dl and 2-h PG \< 140 mg/dl
3. BMI = 24-40 kg/m2;
4. Stable body weight (±4lbs) over the preceding 3 months
5. Subjects with no evidence of major organ system disease as determined by physical exam, history, and screening laboratory data
6. Females of childbearing potential with a negative pregnancy test at Screening and Treatment visits, using one of the following forms of contraception for the duration of participation in the study (i.e., until Follow-up 7-14 days post last dose):

* Oral contraceptive
* Injectable progesterone
* Subdermal implant
* Spermicidal foam/gel/film/cream/suppository
* Diaphragm with spermicide
* Copper or hormonal containing IUD
* Sterile male partner vasectomized \> 6 month pre-dosing.
7. Evidence of a personally signed and dated informed consent document indicating that the subject has been informed of all pertinent aspects of the study.
8. Subjects must be willing and able to comply with scheduled visits, treatment, laboratory tests and study procedures.

Exclusion Criteria

1. Recent (i.e., within three (3) months prior to Screening) evidence or medical history of unstable concurrent disease such as: documented evidence or history of clinically significant hematological, endocrine, pulmonary, gastrointestinal, cardiovascular, hepatic, psychiatric, immunological, or clinically significant neurological disease.
2. Subjects with a family history of diabetes in a first degree relative
3. BMI of less than 24 or greater than 40 kg/m2
4. Unstable body weight (change of greater than ±4lbs over the preceding 3 months
5. Subjects participating in an excessively heavy exercise program
6. Subject with a feeding/sleeping schedule different from a daytime feeding/night time sleeping schedule
7. Subjects taking medications known to alter glucose metabolism (with the exception of metformin and/or pioglitazone) or which effect brain neurosynaptic function are excluded.
8. Subjects with evidence of major organ system disease as determined by physical exam, history, and screening laboratory data
9. Pregnant subjects or subjects unwilling to use birth control during their study enrollment
10. Blood donation of approximately 1 pint (500 mL) within 8 weeks prior to Screening.
11. Other severe acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or investigational product administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the subject inappropriate for entry into this study
12. Subjects with hematuria will be excluded.
13. Subjects with evidence or prior history of heart failure will be excluded
14. Subjects with family history of pancreatic, bladder, and breast cancer will be excluded.
15. Subjects with history of pancreatitis will be excluded.
16. Subjects with eGFR \< 60 ±5 ml/min.1.73m2 will be excluded.
17. Subjects with elevated serum creatinine (\>1.5 mg/dl males/1.4 mg/dl females) will be excluded.
18. Subjects with a history of orthostatic hypotension (\>15/10 mmHg) will be excluded.
19. Subjects with liver enzymes (ALT, AST) \>3-fold above upper normal limit will be excluded.
20. Subjects with a history of hypersensitivity to pioglitazone, dapagliflozin, or Saxagliptin will be excluded.
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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American Diabetes Association

OTHER

Sponsor Role collaborator

AstraZeneca

INDUSTRY

Sponsor Role collaborator

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

NIH

Sponsor Role collaborator

The University of Texas Health Science Center at San Antonio

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Ralph A DeFronzo, MD

Role: PRINCIPAL_INVESTIGATOR

The University of Texas Health Science Center at San Antonio

Locations

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The University of Texas Health Science Center at San Antonio

San Antonio, Texas, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Ralph A DeFronzo, MD

Role: CONTACT

210-567-6691

Monica Palomo, BS

Role: CONTACT

210-567-6710

Facility Contacts

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Ralph A DeFronzo, MD

Role: primary

210-567-6691

Monica Palomo, BS

Role: backup

210-567-6710

Other Identifiers

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R01DK024092-34

Identifier Type: NIH

Identifier Source: secondary_id

View Link

HSC20130414H

Identifier Type: -

Identifier Source: org_study_id

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