PrediabetesNCT07546409
Effects of Exogenous Ketones on Cognitive Function in Older Adults With Prediabetes?
A study testing Ketone Monoester (KE) in people with Prediabetes and Healthy (Controls), run by University of Alabama at Birmingham at 2 sites in United States.
Trial summary
Brief Summary The goal of this clinical trial is to learn whether older adults with prediabetes, but no diagnosed cognitive impairment, show early changes in brain energy use and thinking speed compared to older adults with normal blood sugar levels. Read more about this study
- Who is it for?
- Ages 60 to 75 yearsHealthy volunteers can take part
- Conditions the study is for
- Prediabetes, Healthy (Controls)
- What is being tested?
- Ketone Monoester (KE)
- Type of treatment
- Pill or oral medicine
- Could I receive a placebo?
- Yes, some participants may receive a placebo
- How many people
- 20 participants
- Where
- 2 sitesUnited States
- Study dates
- 20 May 2025to 31 May 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 60 to 75 years
- All sexes
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Age 60 to 75 years
- Able to provide written informed consent
- Fluent in English
- No diagnosed cognitive impairment or dementia
- Classified as either:
- Prediabetes (based on American Diabetes Association criteria), or Normal glucose regulation (control group)
- Medically stable and cleared to undergo positron emission tomography and magnetic resonance imaging
- Willing to comply with study procedures, including metabolic testing, supplement ingestion, and neuroimaging
Who cannot join
- Diagnosis of mild cognitive impairment, dementia, or other neurodegenerative disorder
- Diagnosis of type 1 diabetes or type 2 diabetes
- Use of glucose-lowering medications (e.g., insulin, metformin, glucagon-like peptide-1 receptor agonists)
- History of major neurological disorder (e.g., stroke, traumatic brain injury with loss of consciousness >30 minutes, epilepsy, multiple sclerosis)
- Major psychiatric disorder not stable on treatment
- Uncontrolled hypertension or significant cardiovascular disease
- Severe renal, hepatic, or gastrointestinal disease that may affect supplement metabolism
- Contraindications to magnetic resonance imaging (e.g., non-compatible implanted devices, severe claustrophobia)
Trial locations and contacts
2 sites in 1 country. Contact the study team or a site near you to ask about taking part.
United States2 sites, 2 recruiting
- Recruiting
UAB Comprehensive Cancer Center
Birmingham, Alabama, 35205
Sarah K Sweatt, PhD, 205-975-5398, sksweatt@uab.edu
- Recruiting
Webb Nutrition Sciences Building
Birmingham, Alabama, 35205
Sarah K Sweatt, PhD, 205-975-5398, sksweatt@uab.edu
Sarah K Sweatt, PhD
About this study
Official title: Can Exogenous Ketone Supplementation Compensate for Glucose Hypometabolism and Improve Cognitive Processing Speed in Veterans With Prediabetes?
Brief Summary
The goal of this clinical trial is to learn whether older adults with prediabetes, but no diagnosed cognitive impairment, show early changes in brain energy use and thinking speed compared to older adults with normal blood sugar levels. The study will also test whether a single dose of an exogenous ketone supplement can improve brain energy use and cognitive processing speed.
Read more
The main questions it aims to answer are:
Do older adults with prediabetes have lower brain glucose uptake and slower cognitive processing speed compared to those with normal glucose levels?
Does a single dose of an exogenous ketone monoester supplement improve cognitive processing speed and brain glucose uptake?
Researchers will compare older adults with prediabetes to older adults with normal glucose levels to determine whether differences exist in brain glucose metabolism and cognitive performance. In a subset of participants, researchers will also compare brain and cognitive outcomes before and after consuming a ketone monoester supplement (DeltaG, Oxford, England).
Participants will:
Complete metabolic testing to determine glucose status
Undergo brain imaging using fluorodeoxyglucose positron emission tomography combined with magnetic resonance imaging (18FDG-PET/MRI) while performing a cognitive processing speed task
Consume a single dose of a commercially available ketone monoester supplement during one study visit
Complete cognitive testing during imaging to measure processing speed and brain activity
The results of this study will help determine whether early metabolic dysfunction is linked to reduced brain energy use and whether ketones can temporarily support brain function in individuals at risk for dementia.
Read the detailed description
Metabolic dysfunction and impaired brain energy metabolism are increasingly recognized as early contributors to cognitive decline and dementia risk. Type 2 diabetes is a well-established risk factor for cognitive impairment; however, less is known about whether cerebral metabolic alterations are already present during the prediabetes stage, prior to clinically apparent cognitive symptoms. Prediabetes is characterized by impaired glucose regulation and early insulin resistance, both of which may reduce the efficiency of glucose transport and utilization in the brain. Because glucose is the brain's primary fuel under usual dietary conditions, even subtle reductions in cerebral glucose uptake may create a relative energy deficit that affects neural efficiency and cognitive performance.
Reductions in cerebral glucose metabolism have been observed years before the onset of dementia symptoms. These changes are particularly evident in frontal and temporoparietal regions that support higher-order cognitive functions, including processing speed. Cognitive processing speed is one of the earliest cognitive domains to decline in both metabolic disease and neurodegenerative conditions and is closely linked to functional independence in older adults. Identifying early metabolic and neural alterations in individuals with prediabetes may therefore provide insight into mechanisms linking metabolic dysfunction to later dementia risk.
This study uses hybrid fluorodeoxyglucose positron emission tomography combined with magnetic resonance imaging (18F-FDG PET/MRI) to quantify regional brain glucose uptake while participants perform a cognitive processing speed task during the imaging session. Fluorodeoxyglucose (FDG) is a radiolabeled glucose analog that allows measurement of tissue glucose uptake as an index of metabolic activity. Simultaneous magnetic resonance imaging (MRI), including functional MRI (fMRI), provides complementary measures of neural activation and network engagement during task performance. This multimodal approach allows assessment of neural efficiency, defined as cognitive task performance relative to regional glucose uptake and blood oxygen level-dependent (BOLD) signal changes.
The first objective of the study is to determine whether older adults with prediabetes exhibit reduced regional brain glucose uptake and slower cognitive processing speed compared to metabolically normal older adults. Metabolic status will be characterized using standardized clinical testing to define glycemic phenotype. The primary neural outcome is regional FDG uptake during task performance, and the primary cognitive outcome is processing speed performance acquired during the scan.
The second objective is to determine whether acute elevation of circulating ketone bodies through ingestion of an exogenous ketone monoester (DeltaG, Oxford, England) modifies cognitive performance and cerebral glucose uptake. Ketone bodies, including beta-hydroxybutyrate, serve as an alternative fuel for the brain and can be utilized even when glucose metabolism is impaired. Acute ketone supplementation increases circulating ketone concentrations without requiring prolonged dietary modification. This study evaluates whether providing an alternative metabolic substrate acutely influences neural efficiency and cognitive processing speed in individuals at risk for metabolic-related cognitive decline.
Together, these aims will clarify whether early metabolic dysregulation is associated with measurable alterations in brain glucose metabolism and cognitive function, and whether short-term metabolic substrate supplementation can modulate these relationships. Findings will inform future mechanistic and interventional studies targeting metabolic pathways to preserve brain health in at-risk aging populations.
- Conditions
- Prediabetes, Healthy (Controls)
- Being tested
- Ketone Monoester (KE), Placebo
- Keywords
- Prediabetic State, Insulin Resistance, Brain Glucose Metabolism, Cerebral Glucose Uptake, Fluorodeoxyglucose F18, Positron-Emission Tomography, Magnetic Resonance Imaging, Functional Magnetic Resonance Imaging, Cognitive Dysfunction, Dementia, Aging, Processing Speed, Ketone Bodies, beta-Hydroxybutyrate, Neuroimaging, Brain Energy Metabolism
- Medical subject headings
- Prediabetic State, Insulin Resistance, Cognitive Dysfunction, Dementia
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Ketone Monoester (KE)Dietary supplement
The intervention is a single acute oral dose of a commercially available ketone monoester supplement (DeltaG®, Oxford, England). The active ingredient, (R)-3-hydroxybutyl (R)-3-hydroxybutyrate, is rapidly metabolized after ingestion to raise circulating beta-hydroxybutyrate concentrations without requiring dietary carbohydrate restriction or fasting. The supplement is administered under supervised conditions during a study visit. Brain imaging with fluorodeoxyglucose F18 positron emission tomography combined with magnetic resonance imaging is performed during the post-ingestion period while participants complete a cognitive processing speed task. This protocol evaluates the immediate metabolic and neurocognitive effects of exogenous ketone administration within a single session.
PlaceboDietary supplement
The placebo consists of a taste-, color-, and volume-matched beverage formulated to mimic the sensory characteristics of the ketone monoester supplement but containing no active ketone ingredient. The placebo does not contain (R)-3-hydroxybutyl (R)-3-hydroxybutyrate) and does not elevate circulating beta-hydroxybutyrate concentrations.
The placebo beverage will be administered orally under supervised research conditions during a study visit using procedures identical to the active supplement condition. Brain imaging with fluorodeoxyglucose F18 positron emission tomography combined with magnetic resonance imaging will be performed during the post-ingestion period while participants complete a cognitive processing speed task. This control condition allows isolation of the metabolic effects of ketone elevation from expectancy or beverage-related effects.
| Study group | Role | What they receive |
|---|---|---|
| Ketone | Experimental | Not described Receives: Dietary Supplement: Ketone Monoester (KE) |
| Placebo | Placebo comparator | Not described Receives: Dietary Supplement: Placebo |
What is being measured
The primary outcome is the main question the study is designed to answer.
Regional brain glucose uptake
Regional brain glucose uptake measured by fluorodeoxyglucose F18 positron emission tomography.
The primary outcome is regional cerebral glucose uptake quantified using fluorodeoxyglucose F18 positron emission tomography integrated with magnetic resonance imaging. Glucose uptake will be assessed in prespecified frontal and temporoparietal regions implicated in early metabolic and cognitive decline. Uptake values will be expressed as standardized uptake value ratios to allow regional comparison across participants.
This outcome is used to determine (1) whether older adults with prediabetes exhibit reduced task-related brain glucose uptake compared to metabolically normal older adults, and (2) whether acute ketone monoester ingestion alters regional glucose uptake during cognitive task performance.
Measured: Two visits (placebo and ketone condition in random order) will take place within 4 weeks of enrollment. Main outcome is change in cerebral glucose uptake between placebo and ketone conditions.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted22 Apr 2026
- Study start20 May 2025
- Primary completion31 May 2027 (estimated)
- Study completion31 May 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for PrediabetesStudies of the same condition, open and under way.
- More trials run by University of Alabama at BirminghamThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Triple blind
- Who is masked
- Participant, Care provider, Investigator
- Enrolment
- 20 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University of Alabama at Birmingham
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Katherine Sweatt, University of Alabama at Birmingham
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07546409
- Sponsor's protocol ID
- IRB-300013058
- Other IDs
- UAB NORC
- Status last verified
- Jun 2026
- First submitted
- 10 Apr 2026
- Last updated
- 2 Jul 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: Plan Description: Individual participant data (IPD) will not be publicly shared due to the sensitive nature of the data collected, which includes neuroimaging scans, metabolic testing results, and cognitive performance measures. Although all data will be de-identified, neuroimaging data carry a potential risk of re-identification. Additionally, the small sample size and mechanistic design of this pilot study increase the likelihood of indirect participant identification. Access Criteria: De-identified data may be made available to qualified researchers upon reasonable request. Access will require institutional review board (IRB) approval or exemption, execution of a data use agreement, and confirmation that the proposed use is consistent with participant consent and applicable institutional policies. Data sharing will occur through secure, controlled-access mechanisms rather than public repositories.
Study at a glance
From the registry record, last updated by the sponsor on 2 Jul 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Can Exogenous Ketone Supplementation Compensate for Glucose Hypometabolism and Improve Cognitive Processing Speed in Veterans With Prediabetes?
- ClinicalTrials.gov ID
- NCT07546409
- Acronym / sponsor ID
- IRB-300013058
- Conditions
- Prediabetes, Healthy (Controls)
- Keywords
- Prediabetic State, Insulin Resistance, Brain Glucose Metabolism, Cerebral Glucose Uptake, Fluorodeoxyglucose F18, Positron-Emission Tomography, Magnetic Resonance Imaging, Functional Magnetic Resonance Imaging
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 20 participants (estimated)
- Lead sponsor
- University of Alabama at BirminghamUniversity, hospital or other
- Study start
- 20 May 2025 (actual)
- Primary completion
- 31 May 2027 (estimated)
- Study completion
- 31 May 2027 (estimated)
- First posted
- 22 Apr 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Brief Summary
The goal of this clinical trial is to learn whether older adults with prediabetes, but no diagnosed cognitive impairment, show early changes in brain energy use and thinking speed compared to older adults with normal blood sugar levels. The study will also test whether a single dose of an exogenous ketone supplement can improve brain energy use and cognitive processing speed.
The main questions it aims to answer are:
Do older adults with prediabetes have lower brain glucose uptake and slower cognitive processing speed compared to those with normal glucose levels?
Does a single dose of an exogenous ketone monoester supplement improve cognitive processing speed and brain glucose uptake?
Researchers will compare older adults with prediabetes to older adults with normal glucose levels to determine whether differences exist in brain glucose metabolism and cognitive performance. In a subset of participants, researchers will also compare brain and cognitive outcomes before and after consuming a ketone monoester supplement (DeltaG, Oxford, England).
Participants will:
Complete metabolic testing to determine glucose status
Undergo brain imaging using fluorodeoxyglucose positron emission tomography combined with magnetic resonance imaging (18FDG-PET/MRI) while performing a cognitive processing speed task
Consume a single dose of a commercially available ketone monoester supplement during one study visit
Complete cognitive testing during imaging to measure processing speed and brain activity
The results of this study will help determine whether early metabolic dysfunction is linked to reduced brain energy use and whether ketones can temporarily support brain function in individuals at risk for dementia.
Detailed description
Metabolic dysfunction and impaired brain energy metabolism are increasingly recognized as early contributors to cognitive decline and dementia risk. Type 2 diabetes is a well-established risk factor for cognitive impairment; however, less is known about whether cerebral metabolic alterations are already present during the prediabetes stage, prior to clinically apparent cognitive symptoms. Prediabetes is characterized by impaired glucose regulation and early insulin resistance, both of which may reduce the efficiency of glucose transport and utilization in the brain. Because glucose is the brain's primary fuel under usual dietary conditions, even subtle reductions in cerebral glucose uptake may create a relative energy deficit that affects neural efficiency and cognitive performance.
Reductions in cerebral glucose metabolism have been observed years before the onset of dementia symptoms. These changes are particularly evident in frontal and temporoparietal regions that support higher-order cognitive functions, including processing speed. Cognitive processing speed is one of the earliest cognitive domains to decline in both metabolic disease and neurodegenerative conditions and is closely linked to functional independence in older adults. Identifying early metabolic and neural alterations in individuals with prediabetes may therefore provide insight into mechanisms linking metabolic dysfunction to later dementia risk.
This study uses hybrid fluorodeoxyglucose positron emission tomography combined with magnetic resonance imaging (18F-FDG PET/MRI) to quantify regional brain glucose uptake while participants perform a cognitive processing speed task during the imaging session. Fluorodeoxyglucose (FDG) is a radiolabeled glucose analog that allows measurement of tissue glucose uptake as an index of metabolic activity. Simultaneous magnetic resonance imaging (MRI), including functional MRI (fMRI), provides complementary measures of neural activation and network engagement during task performance. This multimodal approach allows assessment of neural efficiency, defined as cognitive task performance relative to regional glucose uptake and blood oxygen level-dependent (BOLD) signal changes.
The first objective of the study is to determine whether older adults with prediabetes exhibit reduced regional brain glucose uptake and slower cognitive processing speed compared to metabolically normal older adults. Metabolic status will be characterized using standardized clinical testing to define glycemic phenotype. The primary neural outcome is regional FDG uptake during task performance, and the primary cognitive outcome is processing speed performance acquired during the scan.
The second objective is to determine whether acute elevation of circulating ketone bodies through ingestion of an exogenous ketone monoester (DeltaG, Oxford, England) modifies cognitive performance and cerebral glucose uptake. Ketone bodies, including beta-hydroxybutyrate, serve as an alternative fuel for the brain and can be utilized even when glucose metabolism is impaired. Acute ketone supplementation increases circulating ketone concentrations without requiring prolonged dietary modification. This study evaluates whether providing an alternative metabolic substrate acutely influences neural efficiency and cognitive processing speed in individuals at risk for metabolic-related cognitive decline.
Together, these aims will clarify whether early metabolic dysregulation is associated with measurable alterations in brain glucose metabolism and cognitive function, and whether short-term metabolic substrate supplementation can modulate these relationships. Findings will inform future mechanistic and interventional studies targeting metabolic pathways to preserve brain health in at-risk aging populations.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Crossover
- Masking
- Triple blind (participant, care provider, investigator)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Ketone | Experimental | Dietary Supplement: Ketone Monoester (KE) |
| Placebo | Placebo comparator | Dietary Supplement: Placebo |
Who may qualify
- Ages
- 60 to 75 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (8 listed)
- Age 60 to 75 years
- Able to provide written informed consent
- Fluent in English
- No diagnosed cognitive impairment or dementia
- Prediabetes (based on American Diabetes Association criteria), or Normal glucose regulation (control group)
Key exclusion criteria (8 listed)
- Diagnosis of mild cognitive impairment, dementia, or other neurodegenerative disorder
- Diagnosis of type 1 diabetes or type 2 diabetes
- Use of glucose-lowering medications (e.g., insulin, metformin, glucagon-like peptide-1 receptor agonists)
- History of major neurological disorder (e.g., stroke, traumatic brain injury with loss of consciousness >30 minutes, epilepsy, multiple sclerosis)
- Major psychiatric disorder not stable on treatment
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Ketone Monoester (KE)The intervention is a single acute oral dose of a commercially available ketone monoester supplement (DeltaG®, Oxford, England). The active ingredient, (R)-3-hydroxybutyl (R)-3-hydroxybutyrate, is rapidly metabolized after ingestion to raise circulating beta-hydroxybutyrate concentrations without requiring dietary carbohydrate restriction or fasting. The supplement is administered under supervised conditions during a study visit. Brain imaging with fluorodeoxyglucose F18 positron emission tomography combined with magnetic resonance imaging is performed during the post-ingestion period while participants complete a cognitive processing speed task. This protocol evaluates the immediate metabolic and neurocognitive effects of exogenous ketone administration within a single session. | Dietary supplement | Ketone |
| PlaceboThe placebo consists of a taste-, color-, and volume-matched beverage formulated to mimic the sensory characteristics of the ketone monoester supplement but containing no active ketone ingredient. The placebo does not contain (R)-3-hydroxybutyl (R)-3-hydroxybutyrate) and does not elevate circulating beta-hydroxybutyrate concentrations. The placebo beverage will be administered orally under supervised research conditions during a study visit using procedures identical to the active supplement condition. Brain imaging with fluorodeoxyglucose F18 positron emission tomography combined with magnetic resonance imaging will be performed during the post-ingestion period while participants complete a cognitive processing speed task. This control condition allows isolation of the metabolic effects of ketone elevation from expectancy or beverage-related effects. | Dietary supplement | Placebo |
Primary outcome
Regional brain glucose uptake
Time frame: Two visits (placebo and ketone condition in random order) will take place within 4 weeks of enrollment. Main outcome is change in cerebral glucose uptake between placebo and ketone conditions.
Regional brain glucose uptake measured by fluorodeoxyglucose F18 positron emission tomography. The primary outcome is regional cerebral glucose uptake quantified using fluorodeoxyglucose F18 positron emission tomography integrated with magnetic resonance imaging. Glucose uptake will be assessed in prespecified frontal and temporoparietal regions implicated in early metabolic and cognitive decline. Uptake values will be expressed as standardized uptake value ratios to allow regional comparison across participants. This outcome is used to determine (1) whether older adults with prediabetes exhibit reduced task-related brain glucose uptake compared to metabolically normal older adults, and (2) whether acute ketone monoester ingestion alters regional glucose uptake during cognitive task performance.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 2 Jul 2026.
- Individual participant dataSharing planned: No. Plan Description: Individual participant data (IPD) will not be publicly shared due to the sensitive nature of the data collected, which includes neuroimaging scans, metabolic testing results, and cognitive performance measures. Although all data will be de-identified, neuroimaging data carry a potential risk of re-identification. Additionally, the small sample size and mechanistic design of this pilot study increase the likelihood of indirect participant identification. Access Criteria: De-identified data may be made available to qualified researchers upon reasonable request. Access will require institutional review board (IRB) approval or exemption, execution of a data use agreement, and confirmation that the proposed use is consistent with participant consent and applicable institutional policies. Data sharing will occur through secure, controlled-access mechanisms rather than public repositories.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Ketone Monoester (KE) in people with Prediabetes and Healthy (Controls), run by University of Alabama at Birmingham at 2 sites in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 8 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 2 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Katherine Sweatt, PhD (205-975-5398, sksweatt@uab.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Regional brain glucose uptake (time frame: Two visits (placebo and ketone condition in random order) will take place within 4 weeks of enrollment. Main outcome is change in cerebral glucose uptake between placebo and ketone conditions.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 2 Jul 2026.