Protocol for a randomised clinical study comparing the effect of Roux-en-Y gastric bypass and sleeve gastrectomy on reactive hypoglycaemia in morbidly obese subjects

Geltrude Mingrone, Simona Panunzi, Andrea De Gaetano, Caterina Guidone, Marco Raffaelli, Cosimo Callari, Pio Celestino Lombardi, Rocco Bellantone, Geltrude Mingrone, Simona Panunzi, Andrea De Gaetano, Caterina Guidone, Marco Raffaelli, Cosimo Callari, Pio Celestino Lombardi, Rocco Bellantone

Abstract

Introduction: Roux-en-Y gastric bypass (RYGB) is the most performed bariatric operation. Reactive hypoglycaemia is a frequent late complication occurring in about 72% of RYGB patients, which can present with various intensities up to the serious form of neuroglycopaenia. However, it seems to occur also after sleeve gastrectomy (SG) although much more rarely.

Methods and analysis: A single centre, open, 1-year randomised trial to compare the incidence of hypoglycaemia after RYGB or SG. A secondary objective is the assessment of the comparative ability of the two surgical procedures in determining the improvement or normalisation of insulin sensitivity, given the established relevance of insulin resistance in the cardiometabolic syndrome of obesity.

Ethics and dissemination: The study will be published and presented to international meetings and, due to the safety issue, it will represent a relevant information for national healthcare systems. The protocol was approved by the Catholic University Ethical Committee (A1534/CE/2012). Clinicaltrials.gov Registration n. NCT01581801.

References

    1. Flegal KM, Carroll MD, Kit BK, et al. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA 2012;307:491–7
    1. Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009;360:859–73
    1. Gastrointestinal Surgery for Severe Obesity NIH Consens Statement 1991;9:1–20
    1. Steinbrook R. Surgery for severe obesity. N Engl J Med 2004;350:1075–9
    1. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med 2012;366:1577–85
    1. Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 2012;366:1567–76
    1. Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004;351:2683–93
    1. Livingston EH. The incidence of bariatric surgery has plateaued in the U.S. Am J Surg 2010;200:378–85
    1. Regan JP, INabnet WB, Gagner M, et al. Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg 2003;13:861–4
    1. Deitel M, Crosby RD, Gagner M. The first international consensus summit for sleeve gastrectomy (SG), New York City, 25–27 October 2007. Obes Surg 2008;18:487–96
    1. Lee CM, Cirangle PT, Jossart GH. Vertical gastrectomy for morbid obesity in 216 patients: report of two-year results. Surg Endosc 2007;21:1810–16
    1. Himpens J, Dapri G, Cadiere GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg 2006;16:1450–6
    1. Langer FB, Hoda Reza MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg 2005;15:1024–9
    1. Salinari S, Bertuzzi A, Guidone C, et al. Insulin sensitivity and secretion changes after gastric bypass in normotolerant and diabetic obese subjects. Ann Surg (in press)
    1. Laferrère B, Heshka S, Wang K, et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgeryin obese patients with type 2 diabetes. Diabetes Care 2007;30:1709–16
    1. Laferrère B, Teixeira J, McGinty J, et al. Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab 2008;93:2479–85
    1. Service GJ, Thompson GB, Service FJ, et al. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med 2005;353:249–54
    1. Patti ME, McMahon G, Mun EC, et al. Severe hypoglycaemia post-gastric bypass requiring partial pancreatectomy: evidence for inappropriate insulin secretion and pancreatic islet hyperplasia (see comment). Diabetologia 2005;48:2236–40
    1. Engstrom Eden B, Burman P, Holdstock C, et al. Effects of gastric bypass on the GH/IGF-I axis in severe obesity—and a comparison with GH deficiency. Eur J Endocrinol 2006;154:53–9
    1. Carpenter T, Trautmann ME, Baron AD. Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery. N Engl J Med 2005;353:2192–4
    1. Roslin M, Damani T, Oren J, et al. Abnormal glucose tolerance testing following gastric bypass demonstrates reactive hypoglycemia. Surg Endosc 2011;25:1926–32
    1. Tzovaras G, Papamargaritis D, Sioka E, et al. Symptoms suggestive of dumping syndrome after provocation in patients after laparoscopic sleeve gastrectomy. Obes Surg 2012;22:23–8
    1. Marsk R, Jonas E, Rasmussen F, et al. Nationwide cohort study of post-gastric bypass hypoglycaemia including 5040 patients undergoing surgery for obesity in 1986–2006 in Sweden. Diabetologia 2010;53:2307–11
    1. Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing. Diabetes Care 1999;22:1462–70

Source: PubMed

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