The Role of Islet GLP-1 in the Pathogenesis of Prediabetes

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

PHASE2

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-11-01

Study Completion Date

2028-03-31

Brief Summary

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We recently demonstrated that blockade of Glucagon-Like Peptide-1's (GLP-1) receptor (GLP1R) results in changes in islet function without changes in circulating GLP-1. These effects are more pronounced in people with early type 2 diabetes (T2DM) in keeping with increased expression of PC-1/3 and GLP-1 that is observed in diabetic islets. However, its regulation is at present unknown. At present it is unknown if these abnormalities develop in prediabetes and whether they contribute to the phenotypes observed. In this experiment we will use blockade of GLP1R to probe the contribution of endogenous GLP-1 secretion to the regulation of fasting glucose and islet function in prediabetes.

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Detailed Description

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We recently demonstrated that blockade of Glucagon-Like Peptide-1's (GLP-1) receptor (GLP1R) results in changes in islet function without changes in circulating GLP-1. This supports other evidence (rodents and humans) that through the (inducible) expression of a prohormone convertase (PC-1/3), the α-cell can process proglucagon to intact GLP-1. 'Islet' or 'pancreatic' GLP-1 acts in a paracrine fashion to regulate insulin and glucagon secretion. These effects are more pronounced in people with early type 2 diabetes (T2DM). Although pancreatic GLP-1 adapts to support islet function in T2DM, it is unclear if this mechanism is upregulated in prediabetes and whether it contributes to the phenotype(s) observed. Abnormal α-cell responsivity to glucose, measured using G50, is associated with Impaired Fasting Glucose (IFG); β-cell dysfunction is associated with Impaired Glucose Tolerance (IGT). Does IGT (or IFG) represent selective failure of intra-islet GLP-1 to support islet function? In this experiment we will use blockade of GLP1R to probe the contribution of endogenous GLP-1 secretion to the regulation of fasting glucose and islet function in prediabetes

Conditions

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PreDiabetes

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

we will study people with normal glucose tolerance with or without impaired fasting glucose together with people with impaired fasting glucose with or without impaired glucose tolerance. All subjects will be studied on 2 occasions - on one they will receive exendin 9-39 and on the other saline

Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

NONE

Study Groups

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Exendin 9-39

Subjects will receive exendin 9-39 during the study

Group Type ACTIVE_COMPARATOR

Exendin 9-39

Intervention Type BIOLOGICAL

Exendin 9-39 is a competitive antagonist of the GLP-1 receptor

Saline

Subjects will receive saline during the study

Group Type PLACEBO_COMPARATOR

Saline

Intervention Type BIOLOGICAL

Saline

Interventions

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Exendin 9-39

Exendin 9-39 is a competitive antagonist of the GLP-1 receptor

Intervention Type BIOLOGICAL

Saline

Intervention Type BIOLOGICAL

Eligibility Criteria

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Inclusion Criteria

* People with stable weight and no history of diabetes.
* Fasting glucose \< 126 mg/dL
* 2hr glucose after 75g OGTT \< 200 mg/dL

Exclusion Criteria

* Age \< 25 or \> 70 years (to avoid studying subjects who could have latent type 1 diabetes, or the effects of age extremes in subjects with normal or impaired fasting glucose).
* HbA1c \> 6.5%
* Use of any glucose-lowering agents including metformin or sulfonylureas.
* For female subjects: positive pregnancy test at the time of enrollment or study
* History of prior upper abdominal surgery such as adjustable gastric banding, pyloroplasty and vagotomy.
* Active systemic illness or malignancy.
* Symptomatic macrovascular or microvascular disease.

Minimum Eligible Age

25 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes