Normal-weight Diabetes: Adipocyte-directed Therapy With Pioglitazone or Tirzepatide

Overview

This study is to investigate how adipocyte (fat cell) function and fat distribution differ between individuals with normal-weight type 2 diabetes (NWD), those with overweight type 2 diabetes (OWD), and normal-weight controls without diabetes (NWC). The study will assess whether adipocyte-directed therapies, specifically pioglitazone and tirzepatide, can improve insulin resistance, adipocyte function, and fat distribution in individuals with NWD. By analyzing the biological mechanisms underlying adipocyte dysfunction, the study aims to provide insights into novel treatment strategies for improving metabolic health in normal-weight individuals with type 2 diabetes.

Detailed description

The investigators aim to learn how adipocyte dysfunction and disordered fat distribution contribute to the development of type 2 diabetes in normal-weight individuals. The investigators hope to determine whether adipocyte-directed therapies, such as pioglitazone and tirzepatide, can improve insulin sensitivity, fat distribution, and metabolic health in this population. This study is important because most diabetes research focuses on overweight or obese individuals, and very little is known about how diabetes affects those with normal body weight. Understanding the unique biology of normal-weight diabetes could lead to more personalized and effective treatment strategies, filling a gap in diabetes care for a group that can be overlooked in clinical research.

Interventions

• Procedure Insulin resistance testing
  Steady state Plasma Glucose test
• Procedure OGTT
  Will collect 5 blood draws during the test to measure insulin secretion
• Procedure Fat biopsy
  Needle biopsy to gather a sample of abdominal subcutaneous fat
• Radiation DXA scan
  Whole body DXA scan
• Procedure MRI
  Abdominal MRI
• Procedure 1H-MRS
  Spectroscopy of the abdominal region
• Drug Tirzepatide
  16 weeks started at 2.5mg/week and increased to 5mg/week dose
• Drug Pioglitazone
  16 weeks at a 45mg/day dose

Primary outcome measures

• Insulin resistance in normal weight women with diabetes compared to those with no diabetes [Time frame: Baseline measures comparison between the groups]
• Adipocyte function in women with normal weight diabetes as compared with those without diabetes [Time frame: Baseline comparisons]
• Fat storage in women with normal weight diabetes compared to those without diabetes [Time frame: Baseline comparisons between the groups]

Secondary outcome measures (6)

• Effect of adipose-directed therapy pioglitazone on HbA1c in both men and women with normal weight diabetes [Time frame: 16 weeks]
• Effect of pioglitazone in insulin resistance in both men and women. [Time frame: 16 weeks]
• Fat storage in men with normal weight diabetes (NWD) compared to those without diabetes (NWC). [Time frame: Baseline comparisons between the groups]
• Adipocyte function in men with normal weight diabetes as compared with those without diabetes [Time frame: Baseline comparisons]
• Insulin resistance in normal weight men with diabetes compared to those with no diabetes [Time frame: Baseline measures comparison between the groups]
• Insulin secretion in men and women with normal weight diabetes compared to those without diabetes [Time frame: Baseline measured compared between the groups]

Eligibility criteria

Inclusion criteria

Normal-Weight Diabetes (NWD) Group:

• Age: 30 to 70 years old.
• Diagnosis of Type 2 Diabetes (T2D): Based on a previous diagnosis or confirmed by laboratory testing at screening (A1c > 5.7% or fasting glucose > 100 mg/dL).
• HbA1c Range: Between 5.7% and 8%, with a stable medication or lifestyle regimen for at least 3 months.
• BMI: Between 19 and 24.9 kg/m².
• Diabetes Medications: All diabetes medications are allowed, except insulin and pioglitazone. GLP-1 receptor agonists are permitted if the dose has been stable for 3 months.
• Stable Body Weight: Body weight must have been stable (no more than 2 kg change) over the last 3 months.

Normal-Weight Control (NWC) Group:

• Age: 30 to 70 years old.
• No Diagnosis of Diabetes: Fasting plasma glucose < 100 mg/dL and A1c < 5.7%, with no history of glucose-lowering medications.
• BMI: Between 19 and 24.9 kg/m².
• Stable Body Weight: No more than 2 kg change over the past 3 months. -

Exclusion criteria

• Pregnancy or Lactation: Women who are pregnant, planning to become pregnant, or breastfeeding are excluded due to potential risks to the fetus or infant.
• Prior Use of Pioglitazone: Participants who have previously used pioglitazone are excluded to avoid confounding effects of prior drug exposure.
• Unstable Body Weight: Individuals with a body weight change of more than 2 kg in the last 3 months are excluded to ensure stable metabolic conditions.
• Liver or Kidney Disease: Participants with significant liver disease (ALT > 3x upper limit of normal) or renal disease (creatinine > 1.5 mg/dL) are excluded due to potential safety risks.
• Congestive Heart Failure or Fluid Overload History: These conditions are exclusionary due to the risk of fluid retention with pioglitazone.
• Uncontrolled Hypertension: Blood pressure > 160/90 mmHg excludes participants due to increased cardiovascular risk.
• Active Cancer: Individuals with a diagnosis of cancer in the past 3 years (except for skin cancer) are excluded.
• Chronic Inflammatory Diseases: Excluded due to potential effects on metabolic measurements.
• Use of Weight Loss Medications: Those currently taking weight loss medications are excluded to prevent confounding effects on body weight and metabolic function.
• Bariatric Surgery or Liposuction History: Participants who have had weight-loss surgeries or liposuction are excluded due to alterations in fat tissue and metabolic profiles.
• Insulin Use: Participants using insulin are excluded to focus on non-insulin-dependent diabetes.
• Active Psychiatric Disease or Eating Disorders: Individuals with these conditions are excluded due to potential impacts on study compliance and data integrity.
• Substance Abuse: Participants with a history of substance abuse are excluded for similar reasons.

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Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Crossover

Masking

Open label

Primary purpose

Treatment

Study locations

United States · 2 centers

• Stanford University — Palo Alto
• Stanford University, Clinical and Translational Research Unit (CTRU) — Stanford

Identifiers

NCT: NCT06657209 · 77199

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗