The Effect of Gastric Bypass Surgery on Diabetes

Study Overview
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Brief Summary
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This study will investigate the effects of gastric bypass surgery on type II diabetes. The study will recruit patients with type II diabetes having Roux-en-Y gastric bypass, patients without type II diabetes having Roux-en-Y gastric bypass, and control subjects (patients having gastroscopy, but no surgery). Targeted enrollment is 30 patients per group. Samples of intestine are taken prior to surgery in gastroscopy, during surgery, and 6 months after surgery during gastroscopy. Meal test with incretin measurements, and feces and blood samplings are performed before and after surgery Hypotheses are: The pathogenesis of type II diabetes is linked to changes in the expression of intestinal endocrine cells The changes in the incretine excretion after the gastric bypass surgery partly explain the amelioration of type II diabetes The oxidation of lipoprotein is diminished after the gastric bypass surgery slowing the development of atherosclerosis The immunologic functions of the intestine are changed by the gastric bypass surgery attenuating systemic inflammation The gastric bypass surgery changes cholesterol and bile acid metabolism The gastric bypass surgery changes the fecal microbiota Primary end points are: Changes in the amounts of endocrine cells in ventricle, duodenum and jejunum Changes in the incretine secretion studied with liquid meal test Changes in the oxidation of lipoproteins Changes in the immunologic markers in ventricle, duodenum and jejunum Changes in the amounts of phytosterols, cholesterol metabolites and bile acids Changes in fecal microbiota

Official Title
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Laihdutusleikkauksen Vaikutus Diabetekseen

Conditions
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Type II Diabetes

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria (patients with surgery): Patients having Roux-en-Y gastric bypass (according to clinical guidelines) Age: 18-65 years Inclusion Criteria (control patients without surgery): Patients having gastroscopy (for various clinical reasons) Exclusion Criteria: Diabetes (applies for control patients) BMI over 30 (applies for control patients) Insulin treatment Oral corticosteroid treatment Chronic inflammatory disease Coeliac disease Malignant disease

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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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients with diabetes having Roux-en-Y gastric bypass<br> | |
| Patients without diabetes having Roux-en-Y gastric bypass<br> | |
| Control subjects (patients having gastroscopy, no surgery)<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in the amounts of endocrine cells in ventricle, duodenum and jejunum | Samples of intestine are taken prior to surgery in gastroscopy, during surgery, and 6 months after surgery during gastroscopy | baseline to 6 months | 
| Changes in the incretine secretion studied with liquid meal test | Samples of intestine are taken prior to surgery in gastroscopy, during surgery, and 6 months after surgery during gastroscopy | baseline to 6 months | 
| Changes in the oxidation of lipoproteins | Samples of intestine are taken prior to surgery in gastroscopy, during surgery, and 6 months after surgery during gastroscopy | baseline to 6 months | 
| Changes in the immunologic markers in ventricle, duodenum and jejunum | Samples of intestine are taken prior to surgery in gastroscopy, during surgery, and 6 months after surgery during gastroscopy | baseline to 6 months | 
| Changes in the amounts of phytosterols, cholesterol metabolites and bile acids | Samples of intestine are taken prior to surgery in gastroscopy, during surgery, and 6 months after surgery during gastroscopy | baseline to 6 months | 
| Changes in fecal microbiota | Samples of intestine are taken prior to surgery in gastroscopy, during surgery, and 6 months after surgery during gastroscopy | baseline to 6 months |