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The Effects of Glycemic Optimization Before Gastric Bypass Surgery (GLUCOSURG2)

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ClinicalTrials.gov Identifier: NCT01353118
Recruitment Status : Completed
First Posted : May 12, 2011
Last Update Posted : August 11, 2017
Sponsor:
Information provided by (Responsible Party):
Carel Le Roux, Imperial College London

Study Description
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Brief Summary:

Metabolic surgery such as gastric bypass, gastric banding or sleeve gastrectomy operations can cause rapid and uncontrolled reductions in blood glucose. There is limited information on whether:

  • metabolic surgery is superior to modern medical care for glycaemic control and type 2 diabetes remission.
  • metabolic surgery is safe for microvascular complications of Type 2 diabetes
  • good glycaemic control pre surgery has any effects on the long term glycaemia and complications of type 2 diabetes.

This study aims to assess:

  1. whether metabolic surgery is better for diabetes control compared to medical treatment.
  2. whether metabolic surgery is safe for eye, nerve and kidney complications.
  3. whether good sugar control before metabolic surgery improves the long term effects of sugar control and microvascular complications.

Condition or disease Intervention/treatment Phase
Type 2 Diabetes Biological: gastric bypass Not Applicable

Detailed Description:

This is a prospective study involving 150 patients with type 2 diabetes mellitus (T2DM) and obesity. One hundred patients will undergo gastric bypass surgery whilst 50 will be treated with best medical care. The surgical patient group will be randomised to either immediate surgery or 3 months of medical glycaemic optimisation followed by surgery (n=50 group).

Intervention Group A: Patients will undergo gastric bypass surgery within 3 months after randomisation without any pre operative optimisation of glycaemic control.

Group B: Patients will undergo gastric bypass 3-6 months after randomisation. During this period the group will receive modern best medical care based on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) guidelines. Glycaemic optimisation will be achieved with particular attention to the avoidance of hypoglycaemia.

Group C: Obese patients with T2DM (who choose not to have surgery) will be treated with best medical care based on the ADA/EASD guidelines including anti-diabetes/obesity pharmacotherapy, access to a trained dietician and exercise programme.


Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 50 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Participant)
Primary Purpose: Treatment
Official Title: Investigation of the Effects of Glycaemic Optimisation Before Gastric Bypass Surgery on the Glycaemic Remission and Microvascular Complication Rates of Type 2 Diabetes Mellitus
Study Start Date : May 2011
Actual Primary Completion Date : July 2017
Actual Study Completion Date : August 2017

Resource links provided by the National Library of Medicine


Arms and Interventions
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Arm Intervention/treatment
No Intervention: gastric bypass
Group A: Patients will undergo gastric bypass surgery within 3 months after randomisation without any pre operative optimisation of glycaemic control.
Active Comparator: Gastric bypass 2
Gastric bypass 2 (Group B):Patients will undergo gastric bypass 3-6 months after randomisation. During this period the group will receive modern best medical care based on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) guidelines. Glycaemic optimisation will be achieved in a gradual manner with particular attention to the avoidance of hypoglycaemia
 Biological: gastric bypass
Optimise glucose control within 3 months before operation
Other Names:
  • Type 2 diabetes
  • glucose optimisation
  • microvascular complications
  • retinopathy
  • neuropathy
  • nephropathy
  • Gastric bypass with
No Intervention: Best medical care
Group C: Obese patients with T2DM (who choose not to have surgery) will be treated with best medical care based on the ADA/EASD guidelines including anti-diabetes/obesity pharmacotherapy, access to a trained dietician and exercise programme.


Outcome Measures
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Primary Outcome Measures :
  1. Composite of fasting glucose, glycosylated haemoglobin c and rates of Type 2 Diabetes mellitus remission. [ Time Frame: 1 year ]
    Fasting glucose and HbA1c 1 year after intervention / metabolic surgery. Remission of diabetes will be based on the American Diabetes Association definition.


Secondary Outcome Measures :
  1. A composite of microvascular complications [ Time Frame: 1 year ]
    A composite of microvascular complications. Microvascular events will be defined as new or worsening nephropathy, retinopathy or neuropathy.


Eligibility Criteria
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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Adult patients with T2DM and BMI above 35kg/m2
  2. HbA1c ≥ 8.5% and/or the presence of at least one microvascular complication.

Exclusion Criteria:

  • End stage retinopathy, nephropathy or neuropathy.
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01353118


Locations
United Kingdom
Imperial Weight Centre, Charing Cross Hospital,
London, United Kingdom, W6 8FR
Charing Cross Hospital
London, United Kingdom, W6 8RF
Sponsors and Collaborators
Imperial College London
Investigators
Principal Investigator: Carel Le Roux, MBChB, PhD Imperial College London
More Information
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Responsible Party: Carel Le Roux, Consultant metabolic medicine, Imperial College London
ClinicalTrials.gov Identifier: NCT01353118     History of Changes
Other Study ID Numbers: GLUCOSURG 2
First Posted: May 12, 2011    Key Record Dates
Last Update Posted: August 11, 2017
Last Verified: August 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes

Keywords provided by Carel Le Roux, Imperial College London:
diabetes
bariatric surgery
Roux-en-y gastric bypass
 retinopathy
neuropathy
nephropathy

Additional relevant MeSH terms:
Diabetes Mellitus, Type 2
Diabetes Mellitus
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases