Diabetes Remission and Hypoabsorptive Bariatric 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: Duodenal Switch, SADI-S, Minigastric Bypass.
- Who it may be relevant to
- Registry conditions: Severe Obesity, Diabetes Mellitus, Type 2, Bariatric Surgery Candidate. Basic parameters: 18 years — 60 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
- Spain
- Next step
- Save the trial, show it to the treating physician, and confirm current recruitment with the study center. Costs, documents and travel →
Unsure about the terms? Read our patient guide →
Official title
Prognostic Factors and Predictors of Diabetes Remission in Hypoabsorptive Bariatric Surgery Techniques. Randomized Comparative Study Between Duodenal Switch, Single-Anastomosis Duodenal Switch (SADI-S) and Mini-Gastric Bypass
Overview
Bariatric surgery is the most effective treatment to achieve type 2 Diabetes Mellitus (DM) remission in patients with severe obesity. However, there is little evidence of the effectiveness and pathophysiological mechanisms involved in metabolic improvement after hypoabsortive tecniques such as duodenal switch (DS), single anastomosis duodenal switch (SADI-S) or minigastric bypass (MGB). We have designed a randomized study to compare type 2 diabetes remission after the 3 bariatric procedures in patients with severe obesity (BMI \> 45kg/m2) and to study the implication of gastrointestinal hormones, bile acids and gut microbiota in metabolic improvement in each procedure.
Detailed description
Patients fulfilling inclusion criteria will be randomly assigned 1:1:1 to undergo DS, SADI-S or MGB. Allocation of patients will be assigned by simple randomization with stratification according to baseline levels of HbA1c (greater or lower/ equal to 7 %).
Protocol 0. Screening visit: All participants will be required to sign the informed consent, according to the regulations of the Committee of the center. Clinical, analytical, and general physical examination data will be collected and it will be checked the fulfillment of inclusion criteria.
1. Visit 1 (1 week after screening visit): Anthropometrical data will be collected, and general biochemical analytics including HbA1c, lipid profile and nutritional parameters and vitamins will be performed. Also a standard meal test (SMT) will be done with determination of GLP-1, PYY, GIP , and ghrelin, insulin, glucose and succinate concentrations before and during the SMT. A complete body composition study including DEXA, BIA and cardiac resonance to determine epicardia fat will be performed. Feces samples will be collected to determine gut microbiota. Quality of live questionnaire will be provided. 2. Visit2 (1 month after surgery): Glycaemia diaries will be checked. Anthropometrical, general biochemical analysis with determination of HbA1c, lipid profile and nutritional parameters and vitamins will be done. SMT will be performed with determination of GLP-1, PYY, GIP, ghrelin, insulin, glucose. A determination of bile acids will be done before starting the meal test. feces samples will be collected to determine gut microbiota. 3. Visit 3 (3 months after surgery): Glycaemia diaries will be checked. Anthropometrical, general biochemical analysis with determination of HbA1c, lipid profile and nutritional parameters and vitamins will be done. 4. Visit 4 (12 months after surgery): The same determinations of visit 1 will be performed 12 months after surgery.
Interventions
- Procedure Duodenal Switch
Classic Duodenal Switch - Procedure SADI-S
SADI-S with a 300cm common channel - Procedure Minigastric Bypass
Classic minigastric bypass
Primary outcome measures
- Type 2 Diabetes (T2D) remission. [Time frame: 12 months]
Secondary outcome measures (8)
- Weight loss [Time frame: 12 months]
- Entero-endocrine hormone GLP-1 [Time frame: 12 months]
- Entero-endocrine hormone PYY [Time frame: 12 months]
- Entero-endocrine hormone GIP [Time frame: 12 months]
- Entero-endocrine hormone Ghrelin [Time frame: 12 months]
- Bile salts [Time frame: 12 months]
- Intestinal microbiome [Time frame: 12 months]
- Epicardial fat [Time frame: 12 months]
Eligibility criteria
Inclusion criteria
- BMI>45 kg/m2
- T2D on treatment with hypoglycemic agents alone, insulin or both.
Exclusion criteria
- Type 1 diabetes
- Positivity for GAD auto-antibodies
- Secondary forms of diabetes
- Acute metabolic complications in the last 6 months
- Severe liver disease
- Renal dysfunction
- Patients under anticoagulant treatment
- Previous bariatric surgery
- Congenital or acquired abnormalities of the digestive tract
- Pregnancy
- Nursing or desired pregnancy in the 12 months following inclusion
- Corticoid use by oral or intravenous route for more than 14 consecutive days in the last three months.
Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.
Healthy volunteers: No
Study design
- Allocation
- Randomized
- Model
- Parallel assignment
- Masking
- Open label
- Primary purpose
- Treatment
Study locations
Spain · 1 center
- Hospital Universitari de Bellvitge — L'Hospitalet de Llobregat
Publications
- Finno P, Osorio J, Garcia-Ruiz-de-Gordejuela A, Casajoana A, Sorribas M, Admella V, Serrano M, Marchesini JB, Ramos AC, Pujol-Gebelli J. Single Versus Double-Anastomosis Duodenal Switch: Single-Site Comparative Cohort Study in 440 Consecutive Patients. Obes Surg. 2020 Sep;30(9):3309-3316. doi: 10.1007/s11695-020-04566-5. PMID 32240495
- Gebelli JP, Lazzara C, de Gordejuela AGR, Nora M, Pereira AM, Sanchez-Pernaute A, Osorio J, Sobrino L, Garcia AJT. Duodenal Switch vs. Single-Anastomosis Duodenal Switch (SADI-S) for the Treatment of Grade IV Obesity: 5-Year Outcomes of a Multicenter Prospective Cohort Comparative Study. Obes Surg. 2022 Dec;32(12):3839-3846. doi: 10.1007/s11695-022-06317-0. Epub 2022 Oct 25. PMID 36282430
Identifiers
NCT: NCT06043245 · PR015/23