Study of Fat Tissue's Ability to Take up Sugar in the Obese Population (ATGD)

Adipose Tissue Glucose Uptake in Obesity (ATGD)

People who are obese often have insulin resistance (inability of insulin to properly control blood sugar) and high blood sugar. However, not all people with obesity have this problem. About one-third of people with obesity have normal sugar metabolism (the way your body uses sugar). Similarly, not all people who are lean are also metabolically healthy and a subset of people who are lean are referred to as metabolically abnormal lean (MAL) or metabolically obese lean because they have the abnormalities in glucose metabolism typically associated with obesity. The reasons why some people with obesity have a problem with blood sugar control and others do not are not entirely clear. It is thought that impaired muscle sugar uptake is the main problem related to high blood sugar in people with obesity. However, adipose tissue (fat tissue) also consumes a substantial amount of blood sugar. Therefore, it is unclear whether muscle or adipose tissue (fat tissue) are primarily responsible for altered blood sugar concentrations in persons with metabolically abnormal obesity (MAO) (those with insulin resistance), compared to those with metabolically normal (healthy) obesity (MNO), or whether "healthy" adipose tissue (fat tissue) expansion in MNO people compared with lean people provides a vessel for blood sugar removal that helps maintain normal blood sugar concentration.

Accordingly, the investigators will determine the amount of sugar that is taken up by the body and in the cells of adipose tissue (fat tissue) and muscle by infusing labeled sugar into the blood and looking at its disappearance from blood and appearance in adipose tissue (fat tissue) and muscle. The investigators will also determine how well insulin, a hormone that controls blood sugar, turns on signals that stimulate sugar uptake in fat and muscle cells. These studies will be done after an overnight fast and during an infusion of sugar and insulin (hyperinsulinemic-euglycemic clamp), in sex- and age-matched people who are insulin resistant and insulin sensitive. People with obesity will also be invited to complete a ~10% diet-induced weight loss program and will be studied again after they have achieved the weight loss goal. A group of sex- and age-matched metabolically normal lean participants will serve as control group. An attempt will be made to also study a group of sex- and age-matched metabolically abnormal lean participants.

Study Overview

• Status: Active, not recruiting
• Conditions: Glucose Metabolism Disorders
• Intervention / Treatment: Other: Weight Loss

• Study Type: Observational
• Enrollment (Estimated): 90

Contacts and Locations

Study Locations

• United States
  • Missouri
    • Saint Louis, Missouri, United States, 63110
      • Washington University School of Medicine

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 64 years (Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

The investigators plan to study a total of 45 men and women of all races and ethnic groups: 15 MAO (metabolically abnormal obese, likely insulin resistant), 15 MNO (metabolically normal obese, likely insulin sensitive), and 15 lean. All three groups will be balanced with regards to sex and race/ethnicity distribution, and the two obese groups will also be matched on percent total body fat. They will also attempt to recruit 15 metabolically abnormal lean participants.

Description

Inclusion Criteria:

All subjects

• Age: greater than or equal to 18 years but <65 years
• Weight stable (i.e., ±2 kg for at least 3 months)
• Sedentary (less than 1 hour of structured exercise per week)
• No evidence of significant organ system dysfunction or disease (e.g., diabetes, impaired kidney function, cancer, etc.)

In addition, subjects must fulfill all of the following inclusion criteria.

Metabolically Normal Lean

• BMI greater than or equal to 18.5 but <25.0 kg/m2
• Fasting blood glucose: <100 mg/dl
• Blood glucose 2 h after an OGTT: <140 mg/dl
• HbA1c <5.7 %.

Metabolically Normal Obese, likely insulin sensitive

• BMI greater than or equal to 30.0 but <45.0 kg/m2
• Fasting blood glucose: <100 mg/dl
• Fasting insulin: <20 mU/l
• Blood glucose 2 h after an OGTT: <140 mg/dl
• HbA1c <5.7 %.

Metabolically Abnormal Obese, likely insulin resistant

• BMI greater than or equal to 30.0 but <45.0 kg/m2
• Fasting blood glucose ≥100 mg/dl or blood glucose 2 h after an OGTT ≥140 mg/dl or fasting insulin >20 µU/mL or HbA1c >5.7 %.

Metabolically Abnormal Lean

• BMI greater than or equal to 18.5 but <25.0 kg/m2
• Fasting blood glucose ≥100 mg/dl or blood glucose 2 h after an OGTT ≥140 mg/dl or fasting insulin >20 µU/mL or HbA1c >5.7 %.

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Metabolically Normal Obese (likely insulin sensitive); i) BMI ≥30.0 but <45.0 kg/m2; maximum body circumference <165 cm to ensure subjects fit into the PET/CT and MR scanners; iii) fasting blood glucose: <100 mg/dl; iv) blood glucose 2 h after an OGTT: <140 mg/dl; v) HbA1c <5.7 %; vi) fasting insulin: <20 µU/mL.	Other: Weight Loss; Diet-induced weight loss (obese only)
Metabolically Abnormal Obese (likely insulin resistant); i) BMI ≥30.0 but <45.0 kg/m2; maximum body circumference <165 cm to ensure subjects fit into the PET/CT and MR scanners; iii) fasting blood glucose: ≥100 mg/dl or blood glucose 2 h after an OGTT: ≥140 or fasting insulin: >20 µU/mL.	Other: Weight Loss; Diet-induced weight loss (obese only)
Metabolically Normal Lean; i) BMI ≥18.5 but <25.0 kg/m2; ii) maximum body circumference <165 cm to ensure subjects fit into the PET/CT and MR scanners; iii) fasting blood glucose: <100 mg/dl; iv) blood glucose 2 h after an OGTT: <140 mg/dl; v) HbA1c <5.7 %; vi) fasting insulin: <20 µU/mL.
Metabolically Abnormal Lean; i) BMI ≥18.5 but <25.0 kg/m2; ii) maximum body circumference <165 cm to ensure subjects fit into the PET/CT and MR scanners; iii) iii) fasting blood glucose: ≥100 mg/dl or blood glucose 2 h after an OGTT: ≥140 or fasting insulin: >20 µU/mL.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Contribution of subcutaneous adipose tissue glucose uptake to whole-body glucose disposal in people who are insulin sensitive or insulin resistant (defined as insulin-mediated glucose disposal rate)	Comparison of whole body and total adipose tissue glucose disposal rate assessed by using stable isotope labeled glucose tracer infusion in conjunction with dynamic PET imaging	Baseline

Collaborators and Investigators

• Sponsor: University of Missouri-Columbia
• Investigators: Principal Investigator: Bettina Mittendorfer, PhD, Washington University School of Medicine

Publications and helpful links

General Publications

• Cao C, Koh HE, Van Vliet S, Patterson BW, Reeds DN, Laforest R, Gropler RJ, Mittendorfer B. Increased plasma fatty acid clearance, not fatty acid concentration, is associated with muscle insulin resistance in people with obesity. Metabolism. 2022 Jul;132:155216. doi: 10.1016/j.metabol.2022.155216. Epub 2022 May 13.
• van Vliet S, Koh HE, Patterson BW, Yoshino M, LaForest R, Gropler RJ, Klein S, Mittendorfer B. Obesity Is Associated With Increased Basal and Postprandial beta-Cell Insulin Secretion Even in the Absence of Insulin Resistance. Diabetes. 2020 Oct;69(10):2112-2119. doi: 10.2337/db20-0377. Epub 2020 Jul 10.

Study record dates

Study Major Dates

• Study Start (Actual): July 1, 2017
• Primary Completion (Estimated): January 1, 2027
• Study Completion (Estimated): January 1, 2027

Study Registration Dates

• First Submitted: December 9, 2016
• First Submitted That Met QC Criteria: December 12, 2016
• First Posted (Estimated): December 15, 2016

Study Record Updates

• Last Update Posted (Actual): March 18, 2024
• Last Update Submitted That Met QC Criteria: March 14, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Metabolic Diseases; Glucose Metabolism Disorders
• Other Study ID Numbers: 201610005

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The investigators do not currently anticipate to share IPD, but will do so upon request.