- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01117311
Vagal Nerve Stimulation and Glucose Metabolism
The Effect of Vagal Nerve Stimulation on Enteroendocrine Secretion and Glucose Metabolism
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
The overall aim of this application is to determine the mechanism(s) by which common bariatric surgical procedures alter carbohydrate metabolism. Very often, resolution of diabetes occurs in the early post-operative period prior to the development of significant weight loss. It has been suggested that bariatric surgery alters insulin action but few studies have examined insulin secretion or postprandial glucose fluxes in such patients. At the present time, little is known about how the various bariatric surgical procedures alter glucose homeostasis. It is essential that the effect of bariatric surgery and meal size on these parameters be understood and accurately measured. Enteroendocrine secretion is affected by the rate of intestinal delivery of calories and may also be modulated by the enteric nervous system and the rate of direct delivery of nutrients to enteroendocrine cells. Direct measurement of intestinal transit is also an important part of understanding how bariatric surgery alters intestinal secretion of hormones that may alter glucose metabolism. The Oral and C-peptide Minimal Models when applied to C-peptide, glucose and insulin concentrations after ingestion of a standard labeled mixed meal can accurately measure insulin secretion and action. Subsequently, the disposition index provides a measurement of the appropriateness of insulin secretion for the prevailing insulin action. When coupled with established triple-tracer methodology, a mixed meal can be used to measure fasting and postprandial glucose fluxes. Though the vagal trunks are preserved during bariatric surgery, gastric transection during the formation of a gastric pouch for Roux-en-Y gastric bypass (RYGB), or during the sleeve gastrectomy for the duodenal switch procedure, may denervate post-gastric organs including the pancreas and intestine. Reversible vagal block results in weight loss, decreased caloric intake, earlier satiation and reduced hunger. The effect of this form of vagal denervation on glycemic control is unclear. There is evidence that hepatic parasympathetic input regulates insulin action in rodents. Vagal afferents are also important in hepatoportal glucose sensing.
Subjects enrolled into the study would be on stable Vagal Nerve Stimulation Blocker (VNB) intervention in excess of 12 months, having taken part in prior observational study examining the long-term effects of vagal inhibition. All subjects will be studied three times after using a mixed meal. Participants will be admitted to the Mayo Clinic Clinical Research Unit at 17.00 hours the evening before the study. Following ingestion of a standardized low calorie mixed meal (400 Kcal: 55% carbohydrate, 30% fat, and 15% protein) subjects will fast overnight. During the experiment subjects will undergo a mixed meal study as outlined below (Lead-in Mixed Meal 1). On the day after study, subjects will be randomized to one of 2 interventions: either discontinue use of the VNB or continue its use. Subjects will then be restudied (Mixed Meal 2) the day after admission to the Clinical Research Unit at 17.00 hours on the 13th day after randomization. To determine the metabolic effects, if any, of starting VNB therapy, on the day after study, VNB use will be resumed or discontinued depending on prior activation or inactivation. Subjects will then be restudied (Mixed Meal 3) the day after admission to the Clinical Research Unit at 17.00 hours on the 13th day after completion of Mixed Meal 2. Following completion of the study, VNB use will be resumed in all subjects.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
Minnesota
-
Rochester, Minnesota, United States, 55905
- Mayo Clinic in Rochester
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Quadruple
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: VNB off first, then VNB on
Subjects assigned to this reporting group had the vagal nerve blocker (VNB) on for the lead in period (Mixed Meal 1), then VNB off first for the first intervention (Mixed Meal 2), then VNB on for the second intervention (Mixed Meal 3).
|
The implanted Vagal Nerve Blocker will be on at the time of study.
The implanted Vagal Nerve Blocker will be off at the time of study.
|
Experimental: VNB on first, then VNB off
Subjects assigned to this reporting group had the vagal nerve blocker (VNB) on for the lead in period (Mixed Meal 1), then VNB on first for the first intervention (Mixed Meal 2), then VNB off for the second intervention (Mixed Meal 3).
|
The implanted Vagal Nerve Blocker will be on at the time of study.
The implanted Vagal Nerve Blocker will be off at the time of study.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Disposition Index
Time Frame: baseline, 2 weeks
|
Total Disposition Index (DI) is a calculated value which represents the ability of a person's pancreas to lower blood glucose.
A higher number means the pancreas is better able to lower blood glucose and a lower number means the pancreas is less able to lower blood glucose.
|
baseline, 2 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Gastric Emptying Half-time
Time Frame: approximately 2 hours after radiolabeled meal is ingested
|
Gastric emptying half time is the time for half of the ingested solids or liquids to leave the stomach.
|
approximately 2 hours after radiolabeled meal is ingested
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 09-008825
- UL1RR024150 (U.S. NIH Grant/Contract)
- R01DK082396 (U.S. NIH Grant/Contract)
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Obesity
-
Central Hospital, Nancy, FranceNot yet recruiting
-
University of MinnesotaNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)Active, not recruitingAdolescent ObesityUnited States
-
Helsinki University Central HospitalKarolinska Institutet; Folkhälsan Researech CenterEnrolling by invitation
-
Istanbul Medipol University HospitalMedipol UniversityCompletedObesity, Morbid | Obesity, Adolescent | Obesity, Abdominal | Weight, Body | Obesity, VisceralTurkey
-
Queen Fabiola Children's University HospitalNot yet recruitingMorbid Obesity | Adolescent Obesity | Bariatric SurgeryBelgium
-
Azienda Ospedaliero-Universitaria Consorziale Policlinico...Institute of Biomembranes, Bioenergetics and Molecular Biotechnologies; Istituti... and other collaboratorsCompletedMorbid Obesity | Metabolically Healthy ObesityItaly
-
Washington University School of MedicinePatient-Centered Outcomes Research Institute; Pennington Biomedical Research... and other collaboratorsActive, not recruitingOvernutrition | Nutrition Disorders | Overweight | Body Weight | Pediatric Obesity | Body Weight Changes | Childhood Obesity | Weight Gain | Adolescent Obesity | Obesity, Childhood | Overweight and Obesity | Overweight or Obesity | Overweight AdolescentsUnited States
-
Fundació Sant Joan de DéuRecruitingObesity, Childhood | Obesity, AdolescentSpain
-
Consorcio Centro de Investigación Biomédica en...Maimónides Biomedical Research Institute of Córdoba; Instituto de Salud Carlos... and other collaboratorsActive, not recruiting
-
University of HoustonBaylor College of MedicineCompleted
Clinical Trials on VNB on
-
University of California, San FranciscoNational Heart, Lung, and Blood Institute (NHLBI); National Institutes of Health...WithdrawnAsthma | Mucus; Plug, TracheobronchialUnited States
-
Sinocelltech Ltd.Not yet recruiting
-
University of Sao PauloCompleted
-
University of Sao PauloCompletedDuchenne Muscular DystrophyBrazil
-
Universidade Federal de PernambucoUnknown
-
The University of Hong KongSino Group; NG TENG FONG Charitable FoundationNot yet recruiting
-
SeqirusDepartment of Health and Human ServicesActive, not recruitingInfections | Virus Diseases | Respiratory Tract Infections | Influenza, Human | Infection ViralUnited States
-
University of NebraskaCompleted
-
Zimmer BiometActive, not recruitingOsteoarthritisFinland, United Kingdom
-
First Affiliated Hospital of Zhejiang UniversityRecruiting