The Effect of Bariatric Surgery on Insulin Sensitivity and Energy Metabolism (Bariatrix)
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Purpose
The purpose of this study is:
- To explore to what extent insulin sensitivity, energy metabolism and ectopic lipid storage can be improved by bariatric surgery
- To explore to what extent hepatic and muscular disorders of energy metabolism occur in patients with obesity (degree 2-3)
- To explore whether the steato liver occurring in patients with obesity (degree 2-3) is associated with the degree of liver inflammation
| Condition | Intervention |
|---|---|
|
Obesity Diabetes Mellitus, Non-Insulin-Dependent |
Procedure: surgery |
| Study Type: | Interventional |
| Study Design: | Endpoint Classification: Efficacy Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Basic Science |
| Official Title: | Assessment of the Effect of Bariatric Surgery on Insulin Sensitivity and Energy Metabolism |
- Energy metabolism [ Time Frame: 4 years ] [ Designated as safety issue: No ]whole body substrate oxidation, ex vivo mitochondrial function via measurement of high resolution respirometry and in vivo mitochondrial function via measurement of ATP production
- weight loss [ Time Frame: four year ] [ Designated as safety issue: No ]body weight and body composition before and after bariatric surgery
- Insulin sensitivity [ Time Frame: four years ] [ Designated as safety issue: No ]Whole body glucose uptake and enfogenous glucose production as measure of skeletal muscle and hepatic insulin sensitivity
| Estimated Enrollment: | 50 |
| Study Start Date: | December 2011 |
| Estimated Study Completion Date: | December 2015 |
| Estimated Primary Completion Date: | December 2015 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Surgery
bariatric surgery
|
Procedure: surgery
biliopancreatic diversion, gastric banding, gastric sleeve resection
Other Name: bariatric surgery
|
Detailed Description:
Insulin resistance strongly relates to ectopic lipid deposition in skeletal muscle and the liver, which correlate with insulin resistance. Lipid metabolites accumulating in skeletal muscle and the liver are thought to impair insulin signalling and thereby reduce glucose uptake and glycogen storage. Insulin resistant humans frequently present with decreased mitochondrial function in skeletal muscle which might contribute to lipid accumulation and the development of insulin resistance. Non-alcoholic liver disease (NAFLD) comprise fatty liver, steatohepatitis and cirrhosis. NAFLD correlate with insulin resistance increased risk for cardiovascular diseases, type 2 diabetes and hepatocellular. The mechanisms leading from fatty liver to steatohepatitis and insulin resistance in the liver are yet unclear. Bariatric surgery relates to surgery for the reduction of body weight. Bariatric surgery frequently leads to normalization of glucose tolerance in previously diabetic humans even before the onset of body weight reduction. The underlying mechanisms are yet unclear. In this study we aim to explore the mechanisms underlying the onset of insulin resistance and steatohepatitis in patients with fatty liver and to identify the mechanisms leading to improved glucose tolerance in humans after bariatric surgery. We test the following hypotheses: increased lipid availability leads to (i) increased lipid oxidation and oxidative stress (ii) accumulation of lipid metabolites that impair insulin signalling (iii) bariatric surgery improves insulin sensitivity by increasing lipid oxidation.
This study will contribute to the understanding of NAFLD and will help to identify new targets for the therapy of diabetes.
Eligibility| Ages Eligible for Study: | 30 Years to 70 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
- Aged ≥ 30 years- ≤ 70 years
- Balanced sex (50: 50)
- BMI 20- 25 kg/m 2 normal- weight group
- BMI 35- 39,9 kg/m 2 (Obese type II)
- BMI >40 kg/m 2 (Obese type III)
Exclusion Criteria:
- Acute illness 2 weeks before start of examination
- Autoimmune or Immune disorder diseases (Leukozyten < 5000/µl
- Renal insufficiency (Kreatin > 1,5 mg/dl)
- Heart disease, condition after heart attack
- Anemia (Hb <12g/l, controlled before every day of examination) or blood donations 4weeks before examination.
- Participation in another trial within the last 2 weeks
- Pharmacological- immunotherapy (Cortisol, Antihistaminika, ASS)
- Thyroid disorders
- Glitazone or Insulin- Therapy
- Pregnancy, Lactation, Menstruation
- Smoking cigarettes, Alcohol- and drug abuse
- Psychiatric disorders
- Risk for/ or diagnosed HIV/ AIDS or Hepatitis B/C
- Liver disease, which are not caused by non- alcoholic steato- hepatitis
- Working on night shifts or irregular rhythm of night- day
- Impaired wound healing or clotting disorders
- Allergic reaction to local anesthetics
- Malignant cancer
Contacts and Locations| Germany | |
| DDZ (Deutsches Diabetes Zentrum) | Not yet recruiting |
| Düsseldorf, NRW, Germany, 40225 | |
| Contact: Michael Roden, Prof. med. 49(0) 2 11-33 82-201 roden@ddz.uni-duesseldorf.de | |
| Contact: Julia Szendrödi, Dr. med Ph.D 0211/3382-203 julia.Szendroedi@ddz.uni-duesseldorf.de | |
| Principal Investigator: | Julia Szendrödi, MD, PhD | German Diabetes Center |
More Information
Additional Information:
No publications provided
| Responsible Party: | julia szendrödi, Dr PhD, German Diabetes Center |
| ClinicalTrials.gov Identifier: | NCT01477957 History of Changes |
| Other Study ID Numbers: | Bariatrix |
| Study First Received: | November 13, 2011 |
| Last Updated: | November 22, 2011 |
| Health Authority: | Germany: Ethics Commission |
Keywords provided by German Diabetes Center:
|
weight loss after bariatric surgery Insulin sensitivity insulin resistance |
Additional relevant MeSH terms:
|
Diabetes Mellitus Diabetes Mellitus, Type 2 Obesity Insulin Resistance Glucose Metabolism Disorders Metabolic Diseases Endocrine System Diseases Overnutrition Nutrition Disorders |
Overweight Body Weight Signs and Symptoms Hyperinsulinism Insulin Hypoglycemic Agents Physiological Effects of Drugs Pharmacologic Actions |
ClinicalTrials.gov processed this record on May 16, 2013