Role of Neural and Hormonal Regulation Factors on Insulin Secretion After Gastric Bypass Surgery

Study Overview
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Brief Summary
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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.

Detailed Description
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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

Official Title
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Hormonal and Neural Control of Insulin Secretion Following Gastric Bypass Surgery

Conditions
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Post Bariatricsurgery, Hypoglycemia

Intervention / Treatment
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* Drug: Exendin-(9-39)
* Drug: Atropine
* Drug: GLP-1 and GIP


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Non-Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Exendin-(9-39)<br>To evaluate the role of GLP-1 signaling in glucose tolerance and insulin secretion | Drug: Exendin-(9-39)<br>* A physiological study to evaluate the role of GLP-1 signaling in glucose tolerance and insulin secretion<br>* Other names: No other name for Exendin-(9-39);|
| Experimental: atropine<br>To evaluate the effect of neural activation on insulin secretion and glucose metabolism | Drug: Atropine<br>* A physiological study to evaluate the effect of neural activation on insulin secretion and glucose metabolism<br>* Other names: Atropine sulfate;|
| Experimental: GLP-1 and GIP<br>to evaluate the beta-cell sensitivity to different doses of exogenous gut hormones | Drug: GLP-1 and GIP<br>* A physiological study to evaluate the beta-cell sensitivity to different doses of exogenous gut hormones<br>* Other names: No other names for GLP-1 and GIP.;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Gut hormones and neural signaling contribution to insulin secretion rate and glucose tolerance |  | Each study of the protocol is conducted up to seven hours with data collected at intervals specific to the individual study procedure. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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gastric bypass surgery, glucose tolerance, Insulin response to meal ingestion, Gut hormone and neural response to meal ingestion