Hormonal and Neural Control of Insulin Secretion Following Gastric Bypass Surgery

  • STATUS
    Recruiting
  • End date
    Aug 20, 2024
  • participants needed
    160
  • sponsor
    The University of Texas Health Science Center at San Antonio
Updated on 20 August 2022
diabetes
insulin
glucagon
bariatric surgery
type 1 diabetes mellitus
antihyperglycemic
gastric bypass
glucagon-like peptide-1
glucagon-like peptide 1
glucagon like peptide
hyperinsulinemic hypoglycemia
Accepts healthy volunteers

Summary

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.

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

Details
Condition Post Bariatricsurgery, Hypoglycemia
Treatment atropine, exendin-(9-39), GLP-1 and GIP
Clinical Study IdentifierNCT00992901
SponsorThe University of Texas Health Science Center at San Antonio
Last Modified on20 August 2022

Eligibility

Yes No Not Sure

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
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