Mechanisms of Diabetes Relapse After Bariatric Surgery
Condition: Type 2 Diabetes
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 2
Study type: Interventional

Summary: 
      The objective of this study is to investigate the different mechanisms by which Gastric
      Bypass (GBP), laparoscopic adjustable gastric banding (LAGB) and vertical sleeve gastrectomy
      (VSG) affect glucose control. We wish to understand the role of weight loss versus changes in
      gut peptides in the short and long term in morbidly obese patients with Type 2 Diabetes
      Mellitus after GBP, LAGB or VSG. The 2 surgical groups will be compared at 10% equivalent
      weight loss and at after surgery in terms of gut hormones levels, insulin secretion and
      glucose control.
    

Detailed description: 
      The mechanisms of type 2 diabetes (T2DM) remission after gastric bypass surgery (GBP) are
      unclear. The levels of the gut hormones incretins and their effect on insulin secretion,
      which is impaired in T2DM, markedly increase after GBP. The anatomical changes of GBP, rather
      than weight loss, seem to be responsible for the changes of incretins. The objective of this
      proposal is to investigate the different mechanisms by which GBP, laparoscopic adjustable
      gastric banding (LAGB) and vertical sleeve gastrectomy (VSG) affect glucose control. We wish
      to understand the role of weight loss versus changes in gut peptides in the short and long
      term in morbidly patients with T2DM after GBP, LAGB or VSG.

      AIM 1: Will study the short term changes of incretins levels and effect in obese individuals
      with T2DM after GBP, LAGB or VSG, before and 1 month after GBP or before and after equivalent
      weight loss after LAGB or VSG.

      AIM 2: Will study the long-term (12 and 24 months after surgery) changes in the incretin
      effect on insulin secretion, in patients with T2DM after GBP, LAGB or VSG.

      AIM 3: Will study the changes of insulin secretion to IV glucose (AIRg) and insulin
      sensitivity (Si), measured by the minimal model, in patients with T2DM after GBP, VSG or
      LAGB, before and at 24 months after the surgery, at weight stability under condition of
      controlled diet.
    

Intervention name(s): Roux-en-Y Gastric Bypass; Laparoscopic adjustable gastric banding; Vertical Sleeve Gastrectomy
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): A surgical technique in which the stomach is stapled into a smaller pouch and then attached directly to the small intestine, bypassing the rest of the original stomach. The goal of the surgery is weight loss.; A surgical technique in which an inflatable silicone device placed around the top portion of the stomach, creating a smaller gastric pouch. The goal of the surgery is weight loss.; A surgical technique in which a large portion of the stomach is removed, leaving only a smaller gastric pouch. The goal of the surgery is weight loss.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: Type 2 Diabetes; Gastric Bypass; Laparoscopic Banding; Vertical Sleeve Gastrectomy