Role of Neural and Hormonal Regulation Factors on Insulin Secretion After Gastric Bypass Surgery
For patients and families
In plain language
An automatic summary of structured registry data. It is an orientation aid, not a substitute for the official protocol or a physician assessment.
- What is being studied
- The protocol lists: Exendin-(9-39), Atropine, GLP-1 and GIP.
- Who it may be relevant to
- Registry conditions: Post Bariatricsurgery, Hypoglycemia. Basic parameters: 18 years — 65 years · All.
- What needs checking
- Age, condition and sex are only basic indicators. Prior treatment, laboratory values and other mandatory requirements appear in the eligibility criteria below.
- Where it takes place
- United States
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
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Official title
Hormonal and Neural Control of Insulin Secretion Following Gastric Bypass Surgery
Overview
RYGB (roux-en-y gastric bypass) has been reported to reverse type 2 diabetes (T2DM) immediately after surgery before any significant weight loss. In addition, a growing number of patients have been recognized with life-threatening hyperinsulinemic hypoglycemia several years following their surgery. While the mechanisms by which RYGB improves glucose metabolism or alters islet cell function in patients after RYGB are not understood, recent studies suggest that increased secretion of GI hormones, primarily glucagon-like peptide 1 (GLP-1), as well as alteration in neural activity may contribute to enhanced insulin secretion in general, and to a greater extent in patients with hypoglycemia. The proposed research is designed to address the role of RYGB on insulin secretion by evaluating the contribution of stimulatory factors (neural and GI hormone) on islet cell function and the islet cell responsiveness to the physiologic stimulatory factors, in RYGB patients with and without hypoglycemia and non-operated controls.
Detailed description
RYGB (roux-en-y gastric bypass) has been reported to reverse type 2 diabetes (T2DM) immediately after surgery before any significant weight loss. In addition, a growing number of patients have been recognized with life-threatening hyperinsulinemic hypoglycemia several years following their surgery. While the mechanisms by which RYGB improves glucose metabolism or alters islet cell function in patients after RYGB are not understood, recent studies suggest that increased secretion of GI hormones, primarily glucagon-like peptide 1 (GLP-1), as well as alteration in neural activity may contribute to enhanced insulin secretion in general, and to a greater extent in patients with hypoglycemia. The proposed research is designed to address the role of RYGB on insulin secretion by evaluating the contribution of stimulatory factors (neural and GI hormone) on islet cell function and the islet cell responsiveness to the physiologic stimulatory factors, in RYGB patients with and without hypoglycemia and non-operated controls
Interventions
- Drug Exendin-(9-39)
A physiological study to evaluate the role of GLP-1 signaling in glucose tolerance and insulin secretion - Drug Atropine
A physiological study to evaluate the effect of neural activation on insulin secretion and glucose metabolism - Drug GLP-1 and GIP
A physiological study to evaluate the beta-cell sensitivity to different doses of exogenous gut hormones
Primary outcome measures
- Gut hormones and neural signaling contribution to insulin secretion rate and glucose tolerance [Time frame: Each study of the protocol is conducted up to seven hours with data collected at intervals specific to the individual study procedure.]
Eligibility criteria
Inclusion criteria
- Hypoglycemic RYGB patients with documented blood glucose level <50 mg/dl
- Asymptomatic individuals with bariatric surgery
- Healthy non-surgical patients with no personal history of diabetes
- Subjects must physically be able to come to our clinical research center at Cedars-Sinai Medical Center
Exclusion criteria
- Active heart, lung, liver, gastrointestinal or kidney disease; unable to give informed consent; pregnancy; uncontrolled high blood pressure or high cholesterol; significant anemia (hemoglobin <11g/dL); prisoners or institutionalized individuals; type 2 diabetes melitis; development of any serious medical or psychiatric illness during recruitment or studies;
- RYGB patients will also be disqualified if they have gastric outlet obstruction or severe diarrhea
- Healthy non-surgical patients with personal history of diabetes
For administration of atropine, the following exclusions also apply:
- History of glaucoma
- Uncontrolled hypertension (any subjects with BP>140/90 and history of dyslipidemia
- Taking any medication that might interact with atropine and cannot be stopped will be excluded from the study)
- Myasthenia gravis
- Brain pathology
- Enlarged prostate in men
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: Yes
Study design
- Allocation
- Non-randomized
- Model
- Crossover
- Masking
- Open label
- Primary purpose
- Other
Study locations
United States · 2 centers
- Texas Diabetes Institute - University Health System — San Antonio
- South Texas Veterans Health Care System — San Antonio
Identifiers
NCT: NCT00992901 · 18-070H · DK083554