- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02421055
Longitudinal Phenotyping of Bariatric Surgery Patients
Recent studies have shown that bacteria within the gut play an important role in diabetes improvement after bariatric (weight-loss) surgery. Bariatric surgery fundamentally changes the environment within the gut, which results in changes to the makeup of the trillions of bacteria living within it. These changes in the gut bacteria can affect the body in a number of complex ways, which we are only just beginning to understand. For example, gut bacteria breakdown food we are unable to absorb ourselves, leading to altered sugar levels and can release molecules that act to reduce appetite.
In this study we aim to find out how bariatric surgery changes the gut bacteria and how this leads to weight loss and improvement of diabetes. With this understanding we hope to discover potential targets for future treatments, such as identifying beneficial bacteria that could be supplemented with probiotics in patients.
Additionally, although highly successful, up to 30% of obese patients do not undergo improvement of their diabetes after bariatric surgery. We aim to identify molecules within the patient's blood or urine that are able to predict the likely chance a patient will undergo improvement in their diabetes after bariatric surgery to help clinicians select patients most likely to benefit.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This study aims to assess how the gut microbiome affects the host phenotype following bariatric surgery through altered gut microbiome-host co-metabolism. The secondary objective is to identify novel biomarkers for the preoperative prognostication of T2DM remission following bariatric surgery.
The study will longitudinally phenotype obese diabetics and non-diabetics undergoing Roux-en-Y Gastric Bypass or Sleeve Gastrectomy surgery. Patients will be assessed preoperatively and at 3 months and 1 year postoperatively. Clinical measures recorded will include; 1) anthropometric & physiological measurements, 2) demographic details, 3) biochemical parameters including HbA1c, 4) anti-hyperglycaemic and other medication use, 5) co-morbidity status and 6) dietary choices through 24hr dietary recall questionnaires.
Blood, urine and stool samples will be collected at the above time points. Changes to the microbiome will be assessed using metagenomic sequencing. Global metabonomic profiles of serum, urine and faecal water will be generated using 1H-NMR. Further targeted analyses of bile acid and short-chain fatty acid profiles will be performed using LC-MS / GC-MS.
The study will utilise multivariate statistical analysis techniques to identify metabolic pathways altered following intervention, and novel host-microbiome co-metabolism pathways that impact upon phenotype. A supervised multivariate analysis, mapping T2DM outcomes to metagenomic and metabonomic data will be performed with the aim of identifying novel preoperative biomarkers that are able to prognosticate T2DM resolution following bariatric surgery.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
-
-
-
London, United Kingdom, W2 1NY
- Imperial Weight Centre
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Obese (BMI>30kg/m2)
- Type 2 Diabetes Mellitus and non-diabetic
- Failure of efforts at lifestyle modification and dieting
- Fitness for anaesthesia and procedure
- Willingness to comply with the trial protocol
Exclusion Criteria:
- Previous bariatric surgery
- Pregnancy or intention to become pregnant during trial period
- Lack of capacity to consent
- Previous major abdominal surgery (Small or large bowel resection, stomach, liver, pancreatic or splenic surgery. Does not include patients who have previously had an appendicectomy, cholecystectomy or hernia repair).
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
Group 1
Roux-en-Y Gastric Bypass
|
|
Group 2
Sleeve Gastrectomy
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Participants With Complete Diabetes Remission at 3 Months
Time Frame: 3 months
|
Participants with HbA1c <6% (42mmol/mol), off anti-diabetic medication, at 3 months
|
3 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Partial Diabetes Remission
Time Frame: 3 months
|
HbA1c <6.5% (48mmol/mol), off anti-diabetic medication, at 3 months.
(Includes participants with complete remission).
|
3 months
|
HbA1c Improvement
Time Frame: 3 months
|
Reduction in HbA1c at 3 months
|
3 months
|
Weight Loss
Time Frame: 3 months
|
Weight loss at 3 months
|
3 months
|
BMI Reduction
Time Frame: 3 months
|
BMI reduction at 3 months
|
3 months
|
Complete Diabetes Remission
Time Frame: 1 year
|
HbA1c <6% (42mmol/mol), off anti-diabetic medication, at 1 year
|
1 year
|
Partial Diabetes Remission
Time Frame: 1 year
|
HbA1c <6.5% (48mmol/mol), off anti-diabetic medication, at 1 year.
(Includes participants with complete diabetes remission).
|
1 year
|
HbA1c Improvement
Time Frame: 1 year
|
Reduction in HbA1c at 1 year
|
1 year
|
Weight Loss
Time Frame: 1 year
|
Weight loss at 1 year
|
1 year
|
BMI Reduction
Time Frame: 1 year
|
BMI reduction at 1 year
|
1 year
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Ara Darzi, MB, BCh, MD, Imperial College London
Study record dates
Study Major Dates
Study Start (Actual)
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 (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 15SM2479
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.
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