Glucolipotoxicity and Type 2 Diabetes

Study Overview
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Brief Summary
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Elevations of blood glucose and lipid are thought to be deleterious to the insulin secretory function of the pancreas. This is known as glucolipotoxicity. However, few studies have examined this in detail. This investigation will examine pancreatic insulin secretory function in physiological models of glucolipotoxicity such as obese and type 2 diabetic individuals. Furthermore, healthy subjects will undergo 24 hour infusion of glucose or Intralipid to induce experimental models of glucolipotoxicity. Insulin secretion in response to intravenous infusions of glucose, GLP-1, GIP, and arginine and in response to meal ingestion, will be examined. the investigators hypothesize that experimental glucolipotoxicity will impairs pancreatic insulin secretory function to levels akin to that seen in type 2 diabetics.

Official Title
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The Effects of Experimental Elevation of Plasma Glucose and Lipid on Pancreatic Beta-cell Function in Humans

Conditions
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Type 2 Diabetes Mellitus

Intervention / Treatment
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* Procedure: Glucotoxicity
* Procedure: Lipotoxicity


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: normal glucose tolerance based on screening OGTT or diagnosed type 2 diabetic (confirmed with OGTT) Exclusion Criteria: insulin dependent diabetes age <18 or >65 years BMI <20 or > 35 kg/m2 evidence of hematological, pulmonary, hepatic, renal, or cardiovascular disease actively undergoing weight-loss (>2kg change in last 6 months) bariatric surgery (gastric by-pass or banding) pregnancy smoking

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Glucotoxicity Trial<br>Insulin secretion will be assessed using a hyperglycemic clamp combined with GLP-1, GIP, and arginine infusions. The clamp will be performed before and after 24 hours of bed rest, isocaloric meal feeding, and experimental elevation of blood glucose. | Procedure: Glucotoxicity<br>* Glucose will be infused intravenously for a 24 hour period to raise blood glucose concentrations 5 mM above basal.<br>|
| No Intervention: Control Trial<br>Insulin secretion will be assessed using a hyperglycemic clamp combined with GLP-1, GIP, and arginine infusions. The clamp will be performed before and after 24 hours of bed rest and isocaloric meal feeding. | |
| Experimental: Lipotoxicity Trial<br>Insulin secretion will be assessed using a hyperglycemic clamp combined with GLP-1, GIP, and arginine infusions. The clamp will be performed before and after 24 hours of bed rest, isocaloric meal feeding, and experimental elevation of blood free fatty acids. | Procedure: Lipotoxicity<br>* Intralipid and heparin will be infused intravenously for a 24 hour period to raise blood free fatty acid concentrations to approximately 1 mM.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Insulin Secretion | Insulin secretion will be assessed in response to intravenous infusions of glucose, GLP-1, GIP, and arginine, and in response to meal ingestion. | 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Insulin Sensitivity | Glucose kinetics will be assesed using [6,6-2H2]glucose. Rate of glucose disappearance during glucose infusion will be quantified per unit of plasma insulin to derive an estimate of insulin sensitivity. | 24 hours | 
| Plasma Cytokines (IL-6, TNF, IL-1beta, IL-1ra) | Cytokines will be measured in plasma: IL-6, TNF-alpha, IL-1beta, IL-1 receptor antagonist, IL-8, IL-10, Interferon gamma. Peripheral blood mononuclear cells will be isolated. | 24 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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diabetes, incretin, beta-cell function, glucolipotoxicity, glucagon-like peptide 1, glucose-dependent insulinotropic polypeptide