Metabolic Associated Fatty Liver Disease, Type 2 Diabetes (T2DM)
Conditions
Keywords
MASLD, Glucagon, Glucagon Resistance
Brief summary
The goal of this clinical trial is to investigate the sensitivity to glucagon in patients with type 2 diabetes mellitus (T2DM), with and without metabolic associated fatty liver disease (MASLD). The main questions it aims to answer are: 1. Is the sensitivity to glucagon with respect to hepatic FA oxidation and suppression of VLDL-TG secretion impaired in humans with T2DM and MASLD? 2. Is glucagon resistance and MASLD reflected in an aberrated lipidomic/metabolomic profile in blood and adipose tissue? Researchers will compare patients with T2DM with and without MASLD to see if the response to basal and high levels of glucagon differs between the groups. Participants will attend 2 short visits and 1 full-day visit, including: * Body scan (DXA) to check fat and bone composition * MRI to measure liver fat. * Blood tests. * Ultrasound to check liver stiffness and scarring. * Fat biopsies * 8-hour hormone (including glucagon) and tracer infusion * PET-CT scans
Interventions
OTHERGlugagon
Infusion of low dose glucagon and high dose glucagon during simultaneous somatostatin infusion and replacement doses of insulin and growth hormone. Infusion of palmitate, VLDL-triglyceride and glucose tracers. \[11C\]palmitate PET during low and high dose glucagon.
Sponsors
University of Aarhus
Novo Nordisk A/S
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
BASIC_SCIENCE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
30 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* BMI \> 26 kg/m² * confirmed diagnosis of Type 2 Diabetes Mellitus (T2DM) min. 6 months prior enrollment * steatosis FF% \> 5,6% on MR spectroscopy for MAFLD group
Exclusion criteria
* Alcohol abuse (\>10 units per week for both sexes) or other substance abuse * Smoking * Current or previous malignant disease * Blood donation within the last 3 months prior to the study day * Participation in studies involving radioactive isotopes within the past 3 months * Pregnancy * Severely dysregulated type 2 diabetes mellitus (haemoglobin A1c ≥ 100 mmol/mol) * C-peptide \< 200 pmol/L * Previous acute myocardial infarction (AMI) * Clinical symptoms of heart failure * Current or previous malignant disease * Known ongoing systemic disease, except for dyslipidaemia and hypertension * Regular use of medication that may affect lipid and glucose metabolism, including insulin treatment, regular use of over-the-counter medications, and hormonal contraception. Exceptions: 1. Participants treated with statins may be included following a 2-week washout period prior to the experimental study day. 2. Participants receiving oral glucose-lowering therapy for T2DM and antihypertensive medication may be included provided that medication is withheld on the study day only. 3. Participants receiving weekly injectable glucagon-like peptide-1 receptor agonists (GLP-1 analogues) may be included following a 1-week washout period prior to the study day.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hepatic FFA oxidation rate (µmol/100Ml/min) | 30 minutes at steady-state | Measured using \[11C\]palmitate positron-emission tomography (PET) |
| Blood and adipose tissue proteomic and lipidomic profiles | 30 minutes after steady-state | Mass spectrometry-based lipidomic/proteomic profiles of paired adipose and plasma samples. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Endogen glucose production (mmol/kg/min) | 30 minutes at steady-state | 3-3H glucose tracer technique |
| Fatty acid turnover (µmol/min) | 30 minutesat steady-state | Infusion af \[9,10-3H\] palmitate and measurement of specific activity |
| VLDL-triglyceride kinetics (appearance rate (µmol/min) and oxidation (µmol/min)) | 30 minutes at steady-state | Ex vivo labeled VLDL \[14C\]-triolein tracer technique. Oxidation is measured by specific activity in exhaled air. |
Countries
Denmark
Contacts
CONTACTKia E. Fonfara, Medical Doctor
Outcome results
None listed