Purpose The project investigates how bariatric surgery affects the metabolism of
cortisol. Additionally, it examines whether changes in cortisol contribute to the
development of reactive hypoglycemia, a serious complication observed after bariatric
surgery.
Study Visits
Visit 1:
At the first visit, participants sign an informed consent form, complete a medical
history questionnaire, undergo measurements (height, weight), and have blood samples
taken. They also undergo an adrenal stimulation test (ACTH test), receive a continuous
glucose monitor (CGM), and complete a questionnaire about hypoglycemia symptoms.
The CGM is a small device that continuously measures blood glucose levels via a tiny
sensor placed on the skin, typically on the arm or abdomen.
The ACTH test is performed after the participant has rested for at least 15 minutes. A
synthetic hormone (Synacthen) is injected to stimulate the adrenal glands to produce
cortisol. Blood samples are collected immediately before the injection and again 30
minutes afterward. The visit is expected to last approximately 1 hour.
Participants wear the CGM until the second visit and are instructed to collect 24-hour
urine samples. If they experience hypoglycemia symptoms between visits, they take a
saliva sample for cortisol measurement 5 minutes after symptom onset and another exactly
24 hours later.
Visit 2:
Ten days after the first visit, participants return for the second visit, where they
submit their 24-hour urine and saliva samples. They then undergo a three-hour extended
meal test.
This test consists of consuming a standardized liquid meal (200 ml Nutridrink, containing
per 100 ml: 150 kcal, 5.8 g fat, 18.4 g carbohydrates, and 5.9 g protein). While
undergoing the meal test, participants continue wearing the CGM, have blood samples taken
at 30-minute intervals, and complete another questionnaire on hypoglycemia. This visit is
expected to last 4 hours, bringing the total expected study time to 5 hours.
Monitoring and Reporting To ensure participant safety throughout the study, the following
procedures will be implemented to manage potential complications.
Participants will be closely monitored during all procedures, including blood sampling,
the ACTH test, and the meal test. Any side effects or complications will be documented
and reported to the principal investigator.
Emergency Preparedness Emergency medical equipment, allergy management supplies, and
trained nurses will be available during all visits. The nurses are trained to handle
cases of post-bariatric hypoglycemia. In the event of severe allergic reactions or other
acute complications, immediate medical treatment will be provided, and the principal
investigator will be contacted immediately.
Informed Consent Participants will receive detailed information about potential risks and
side effects before the study begins. They will be encouraged to report any discomfort or
side effects immediately.
Follow-up Participants will have the opportunity to contact the principal investigator
between and after visits if they experience any issues or have questions.
Protocol for Study Discontinuation If a participant experiences severe complications,
their participation in the study will be discontinued, and they will receive appropriate
medical care as outlined above, along with follow-up observation until they are in stable
condition. The principal investigator will assess the situation and adjust the study
protocol if necessary to prevent further complications.
Financial Aspects The project is funded through research grants from the Region of
Southern Denmark. No financial compensation is provided to participants, except for
reimbursement of transportation costs.