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The Effects of Glycemic Optimization Before Gastric Bypass Surgery (GLUCOSURG2)
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Purpose
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:
- whether metabolic surgery is better for diabetes control compared to medical treatment.
- whether metabolic surgery is safe for eye, nerve and kidney complications.
- whether good sugar control before metabolic surgery improves the long term effects of sugar control and microvascular complications.
| Condition | Intervention |
|---|---|
| Type 2 Diabetes | Biological: gastric bypass |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Intervention Model: Parallel Assignment Masking: Open Label 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 |
- 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.
- 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.
| Estimated Enrollment: | 150 |
| Study Start Date: | May 2011 |
| Estimated Study Completion Date: | October 2018 |
| Estimated Primary Completion Date: | October 2018 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
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.
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|
|
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:
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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.
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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.
Eligibility| Ages Eligible for Study: | 18 Years to 70 Years (Adult, Senior) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Adult patients with T2DM and BMI above 35kg/m2
- HbA1c ≥ 8.5% and/or the presence of at least one microvascular complication.
Exclusion Criteria:
- End stage retinopathy, nephropathy or neuropathy.
Contacts and LocationsPlease refer to this study by its ClinicalTrials.gov identifier: NCT01353118
| United Kingdom | |
| Imperial Weight Centre, Charing Cross Hospital, | |
| London, United Kingdom, W6 8FR | |
| Charing Cross Hospital | |
| London, United Kingdom, W6 8RF | |
| Principal Investigator: | Carel Le Roux, MBChB, PhD | Imperial College London |
More Information
| Responsible Party: | Carel Le Roux, Consultant metabolic medicine, Imperial College London |
| ClinicalTrials.gov Identifier: | NCT01353118 History of Changes |
| Other Study ID Numbers: |
GLUCOSURG 2 |
| Study First Received: | May 11, 2011 |
| Last Updated: | February 25, 2016 |
| 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 |
ClinicalTrials.gov processed this record on July 27, 2017