Comparison of Gastric By-Pass and Optimized Medical Treatment in Obese Diabetic Patients (DIABSURG)
Comparison of Gastric By-Pass and Optimized Medical Treatment in Obese Diabetic Patients in Terms of Mortality, Glycemic Control, and Cost Effectiveness - Prospective, Multicenter, Randomized Study
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Optimizing the management of type 2 diabetes (T2D) will remain a major public health concern for decades to come. T2DM has already affected 4% of the French population and generates each year over 12 billion euros of expenditure. By combining therapies, oral and/or injectable (insulin or analogues of GLP-1), the current management of T2DM provides two thirds of patients with a satisfactory metabolic control (HbA1c < 7%) and reduced incidence of cardiovascular complications. Its effect on mortality, however, remains more limited, presumably because of the persistence of other cardiovascular risk factors. A recent study has confirmed that French patients with T2DM present an overall mortality risk significantly higher than the general population. In France, this group registered a mortality of 32 deaths per 1000 persons.
Bariatric surgery is now a recognized method for the treatment of severe obesity. It allows for the permanent loss of at least 50% of initial excess weight. In obese patients, this surgery is also associated with a significant reduction in cardiovascular risk factors and particularly T2D. A recent meta-analysis of retrospective studies available suggests that surgery results in remission of T2DM in over 75% of cases. The only prospective randomized study showed that gastric restriction by placing a gastric band, provides better glycemic control than just medical treatment in obese patients with recently discovered T2DM. The gastric by-pass (GBP) which also includes an intestinal by-pass, seems to have an even higher metabolic efficiency than gastric bypass alone. In patients with T2DM, the GBP restores postprandial insulin secretion independently of weight loss. Despite the significant morbidity of the intervention, long-term results seem broadly supportive of the GBP. In a large case-control study, GBP was associated with a decrease of 90% of deaths related to diabetes. In a controlled study conducted in surgical candidates obese diabetics, the GBP decreased the overall world mortality by 75% after 6 years. Despite these very encouraging data, the GBP is now proposed to only a small proportion (< 1%) of patients likely to benefit from the procedure.
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 4
Contacts and Locations
Study Contact
Study Contact
- Name: Francois Pattou, Professor
- Phone Number: 00 33 3 20 44 42 73
- Email: fpattou@iv-lille2.fr
Study Locations
-
-
-
Angers, France
- Centre Hospitalier Regional D' Angers
-
Bois-Guillaume, France
- Hopital de Bois-Guillaume Chu Rouen
-
Boulogne-Billancourt, France
- Hu Ouest Site Ambroise Pare Aphp -
-
Dommartin-lès-Toul, France
- Hopital Jeanne D'Arc Chu Nancy
-
Lyon, France, 69008
- Hopital Lyon Sud - Hcl - Pierre Benite
-
Montpellier, France
- Hopital Lapeyronie Chu Montpellier
-
Paris, France
- Hu Pitie Salpetriere Aphp
-
Toulouse, France
- Hôpital Larrey CHU Toulouse
-
Valenciennes, France
- Ch Valenciennes
-
-
Nord
-
Lille, Nord, France, 59000
- University Hospital of Lille
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Type 2 diabetes mellitus with HbA1c > 7.5 %
- Body mass index > 35 and < 50 kg/m2
- Candidate for Gastric By-Pass
- Treatment with GLP1 (glucagon-like peptide) analogue or insulin
Exclusion Criteria:
- Contraindication to bariatric surgery
- Pregnancy
- Affiliation of health care assurance
- Psychiatric disorders
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Gastric By-Pass
group treated with Gastric By-Pass
|
Bariatric surgery laparoscopic Roux-en-Y Gastric Bypass (RYGBP)
Other Names:
|
|
Active Comparator: optimized medical management
group receiving an optimized medical management
|
group receiving an optimized medical management, among patients with obesity and poorly controlled type 2 diabetes
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
overall mortality
Time Frame: 5 years
|
to compare the results of the GBP to that of optimized medical therapy in patients with obesity and poorly controlled type 2 diabetes in terms of mortality
|
5 years
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
overall mortality
Time Frame: 7 years
|
The objectives are to compare the results of the GBP to that of optimized medical therapy in patients with obesity and poorly controlled type 2 diabetes in terms of mortality
|
7 years
|
|
overall mortality
Time Frame: 10 years
|
The objectives are to compare the results of the GBP to that of optimized medical therapy in patients with obesity and poorly controlled type 2 diabetes in terms of mortality
|
10 years
|
|
weight loss
Time Frame: 2 years
|
The objectives are to compare the results of the GBP to that of optimized medical therapy in patients with obesity and poorly controlled type 2 diabetes in terms of weight loss
|
2 years
|
|
glycemic control
Time Frame: 2 years
|
The objectives are to compare the results of the GBP to that of optimized medical therapy in patients with obesity and poorly controlled type 2 diabetes in terms of glycemic control
|
2 years
|
|
quality of life
Time Frame: 2 years
|
The objectives are to compare the results of the GBP to that of optimized medical therapy in patients with obesity and poorly controlled type 2 diabetes in terms of quality of life
|
2 years
|
|
cost, cost-effectiveness and cost utility
Time Frame: 2 years
|
The objectives are to compare the results of the GBP to that of optimized medical therapy in patients with obesity and poorly controlled type 2 diabetes in terms of cost, cost-effectiveness and cost utility of these two strategies.
|
2 years
|
Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Study Director: Francois Pattou, Professor, University Hospital of Lille
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimated)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- 2010_07/1019
- 2010-A01141-38. (Other Identifier: ID-RCB number, ANSM)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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