Mechanisms Underlying Postoperative Insulin Resistance and Inflammation
Investigating Whether the Magnitude of Postoperative Inflammatory and Insulin Resistant Responses is Related to Body Composition and Physiological Function of Skeletal Muscle & Adipose Tissue
Having an operation places an enormous burden on the body, leading to the development of inflammation and so called 'insulin resistance'. Insulin resistance means the body is unable to respond to important hormones that control use of energy. Recent studies have shown that patients who develop 'higher' insulin resistance and inflammation have more serious complications and take longer to recover after surgery. The investigators do not know what controls the development of insulin resistance and inflammation after surgery. Similarly, the investigators do not know why certain patients develop much more insulin resistance and inflammation than others, even though they have the same operation.
The main purpose of the study is to try to find out which patients are prone to developing greater 'amounts' of insulin resistance and inflammation. The investigators also want to find out whether the investigators can reduce the 'amount' of insulin resistance and inflammation in these patients (for example by giving them carbohydrate [sugar-based] drinks before surgery - these have been shown to reduce insulin resistance in some patient groups).
Information from this study should improve the way the investigators prepare patients before surgery and this should help to improve patient outcomes following surgery (by reducing complications and speeding recovery after major surgery).
Studieoversigt
Status
Betingelser
Intervention / Behandling
Detaljeret beskrivelse
Interested participants who are undergoing abdominal (tummy) surgery will be recruited from surgical clinics. They will be asked to attend the Greenfield Human Physiology Laboratory where they will be asked to complete two questionnaires. In addition, a sample of blood, and a small sample of muscle and fat from their thigh will be taken. They will undergo a low dose X-ray (DXA scan) and an insulin clamp. The insulin clamp involves being connected to an insulin and glucose drip for around four hours during which their blood pressure and pulse is monitored and regular blood samples are taken.
Participants will be allocated randomly to one of two groups. One group will receive a carbohydrate (sugar) drink before surgery and the other group will receive a dummy (placebo) drink.
On the day of surgery, pre-operative checks and assessment will proceed as normal. After the participant is asleep under anaesthetic, a blood sample and tummy muscle and fat samples will be taken by the surgeon through the surgical incision. At the end of surgery, another blood sample and muscle and fat samples from the tummy and thigh will be taken while the participant is still under anaesthetic.
On the day after surgery, a further blood test and tummy and thigh muscle and fat sample will be taken. Participants will also undergo another insulin clamp.
The research team will follow participants' progress after surgery, but the decision to allow them home will be made by the medical team responsible for their care.
Undersøgelsestype
Tilmelding (Forventet)
Fase
- Fase 4
Kontakter og lokationer
Studiesteder
-
-
-
Nottingham, Det Forenede Kongerige, NG7 2UH
- Rekruttering
- University of Nottingham
-
Kontakt:
- Dileep Lobo
- E-mail: dileep.lobo@nottingham.ac.uk
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Ledende efterforsker:
- Dileep Lodo
-
-
Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria:
- Age 18-75 yrs
- Correct BMI and waist circumference criteria : Obese group - BMI ≥30 AND waist circumference ≥94 cm in men and ≥ 80 cm in women, Non obese group - BMI 18.5-25 AND waist circumference ≤94cm in men and ≤80 cm in women Due to undergo elective major abdominal surgery ASA I-III Caucasian patients Able to give informed consent and comply with study protocol
Exclusion Criteria:
History of significant preoperative weight loss (>10% over preceding 3 weeks)
- Clinical history of pulmonary aspiration
- Known gastro-oesophageal reflux disease (GORD) or hiatus hernia
- History of difficult intubation or conditions leading to the latter such as: previous neck radiotherapy/rheumatoid arthritis/presence of thyroid goitre
- Metabolic disorders (e.g. diabetes mellitus, thyroid disease, Cushing's Syndrome)
- Simultaneous participation in another clinical study or involvement in a clinical study within the preceding 3 months,
- Patients with suspicion of alcohol/drug abuse
- Pregnancy
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Grundvidenskab
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Dobbelt
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
|---|---|
|
Eksperimentel: Overvægtige
|
carbohydrate drink
Open muscle biopsy
Venopuncture
|
|
Eksperimentel: Normal body weight
|
carbohydrate drink
Open muscle biopsy
Venopuncture
|
|
Placebo komparator: Normal Body Weight placebo
Participants of mormal body weight given placebo
|
Open muscle biopsy
Venopuncture
|
|
Placebo komparator: Obese placebo
Participants who are obese given placebo
|
Open muscle biopsy
Venopuncture
|
Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Tidsramme |
|---|---|
|
Within subject differences in perioperative insulin sensitivity (M-value, corrected for insulin concentrations) amongst obese, non-obese, carbohydrate loaded and non-carbohydrate loaded patients.
Tidsramme: 2 weeks
|
2 weeks
|
Sekundære resultatmål
Resultatmål |
Tidsramme |
|---|---|
|
Correlation between body composition and changes in perioperative insulin sensitivity
Tidsramme: 2 weeks
|
2 weeks
|
|
Differences in inflammatory cytokine gene expression
Tidsramme: 2 months
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2 months
|
|
Differences in muscle and fat genes and proteins controlling carbohydrate/fat oxidation and insulin signalling
Tidsramme: 3 months
|
3 months
|
|
Differences activities of muscle and fat enzymes involved in carbohydrate/fat/carnitine metabolism
Tidsramme: 2 months
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2 months
|
|
Differences in the aforementioned between peripheral and central fat and muscle
Tidsramme: 2 months
|
2 months
|
|
The incidence of post-operative infectious and non-infectious complications
Tidsramme: 30 days
|
30 days
|
|
Length of hospital stay (difference between groups)
Tidsramme: 6 weeks
|
6 weeks
|
Samarbejdspartnere og efterforskere
Sponsor
Datoer for undersøgelser
Studer store datoer
Studiestart
Primær færdiggørelse (Forventet)
Studieafslutning (Forventet)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Skøn)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Skøn)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- 11040 (DAIDS ES Registry Number)
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