Improvement of Insulin Resistance After Bariatric Surgery
Mechanisms Underlying the Improvement of Insulin Resistance in Response to Bariatric Surgery
調査の概要
状態
詳細な説明
Bariatric and weight loss surgery is an effective treatment for severe obesity. Bariatric surgery also decreases insulin resistance and improves diabetes. Our study enrolled individuals approved for bariatric surgery to collect data on modifiable predictors and laboratory outcomes. These data would allow us to systematically assess clinical outcomes over one year post bariatric surgery and elucidate how insulin resistance is decreased and diabetes is improved.
The type of surgery was selected by the subjects between Roux-en-Y gastric bypass or a laparoscopic adjustable gastric banding. Participation in the study involved having a small sample of tissue obtained from the abdomen and subjects were also given the option to have a biopsy performed in the thigh area during their elective surgical procedure (optional adipose and muscle tissue biopsies).
Subjects were examined prior to surgery and at 2, 3, 6 months after intervention. Anthropometric and body composition measurements were performed using the Bioelectrical Impendence Analysis (BIA) before surgery and 6 months post operatively. Morning blood was collected after overnight fasting during each visit. Some of the non-diabetic subjects completed a mixed nutrient stimulation study during the baseline and 6-month visit. Blood samples were collected immediately prior to drinking the liquid drink, and every 30 minutes after the meal ingestion for 2 hours.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
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Massachusetts
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Boston、Massachusetts、アメリカ、02215
- Beth Israel Deaconess Medical Center
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- males and females
- 18-65 years old
- approved for bariatric surgery as per BIDMC Bariatric Clinic guidelines
- English-speaking
- willing and able to take part in a multi year study involving telephone interviews and enrolled prior to bariatric surgery
Exclusion Criteria:
Any condition that would exclude a patient from bariatric surgery as listed below:
- patients with untreated major depression or psychosis
- binge eating disorders
- current drug and alcohol abuse
- severe cardiac disease with prohibitive anesthetic risks
- severe coagulopathy
- inability to comply with nutritional requirements including life-long vitamin replacement.
- pregnancy
- Any additional condition not in accordance with standard of care as per Bariatric Clinic at BIDMC.
- Any condition which in the opinion of the investigators rendered the candidate unsuitable for participation in this study.
Exclusion Criteria for Optional Biopsy:
- history of any illness, other than obesity, that may affect insulin sensitivity (diabetes anemia, infectious diseases, renal or hepatic failure, uncontrolled hypertension, cancer or lymphoma)
- subjects who required special diet prior to surgery
- chronic inflammatory conditions such as inflammatory bowel disease and rheumatoid arthritis
- states of cortisol or growth hormone excess
- any medications that are known to influence glucose metabolism such as glucocorticoids
- a known history of anaphylaxis or anaphylactoid-like reactions or who have a known hypersensitivity to anesthetic agents such as Lidocaine or Novocaine
- a known history of bleeding dyscrasia or poor wound healing
- any medical condition precluding supine position
研究計画
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：基礎科学
- 割り当て：非ランダム化
- 介入モデル：並列代入
- マスキング：なし（オープンラベル）
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
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アクティブコンパレータ：Laparoscopic Adjustable Gastric Band
Subjects who elected to undergo Laparoscopic Adjustable Gastric Band intervention were examined prior to surgery and at 2, 3, 6 months after operation.
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Placement of a soft silicone ring with an expandable balloon in the center, around the top part of the stomach to create a two-compartment stomach, with a much smaller top part above the band.
The subject will eat enough food only to fill the top part of the stomach decreasing caloric consumption.
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実験的：Roux-en-Y gastric bypass surgery
Subjects who elected to undergo Roux-en-Y gastric bypass surgery were examined prior to surgery and at 2, 3, 6 months after operation.
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Creation of a small pouch from the stomach and connection of the newly created pouch directly to the small intestine so that swallowed food bypasses most of the stomach and the first section of the small intestine.
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この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
fasting insulin
時間枠：Change from Baseline insulin at 6 months post-surgery
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circulating levels of fasting insulin measured in pmol/L
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Change from Baseline insulin at 6 months post-surgery
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fasting glucose
時間枠：Change from Baseline insulin at 6 months post-surgery
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circulating levels of fasting glucose measured in mg/dl
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Change from Baseline insulin at 6 months post-surgery
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Boost Challenge Test
時間枠：Change from Baseline insulin at 6 months post-surgery
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serum insulin and glucose levels after a mixed meal challenge (Boost Protein shake)
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Change from Baseline insulin at 6 months post-surgery
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協力者と研究者
捜査官
- 主任研究者：Christos Mantzoros, MD, PhD、Beth Israel Deaconess Medical Center
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
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