Comparison of Gastric By-Pass and Optimized Medical Treatment in Obese Diabetic Patients

NCT ID: NCT01501201

Last Updated: 2023-02-08

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

PHASE4

Total Enrollment

490 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-08-08

Study Completion Date

2029-09-30

Brief Summary

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The objectives are to compare the results of the Gastric By-Pass (GBP) to that of optimized medical therapy in patients with obesity and poorly controlled type 2 diabetes in terms of mortality, weight loss, glycemic control, quality of life, cost, cost-effectiveness and cost utility of these two strategies.

Detailed Description

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Optimizing the management of type 2 diabetes (T2D) will remain a major public health concern for decades to come. T2DM has already affected 4% of the French population and generates each year over 12 billion euros of expenditure. By combining therapies, oral and/or injectable (insulin or analogues of GLP-1), the current management of T2DM provides two thirds of patients with a satisfactory metabolic control (HbA1c \< 7%) and reduced incidence of cardiovascular complications. Its effect on mortality, however, remains more limited, presumably because of the persistence of other cardiovascular risk factors. A recent study has confirmed that French patients with T2DM present an overall mortality risk significantly higher than the general population. In France, this group registered a mortality of 32 deaths per 1000 persons.

Bariatric surgery is now a recognized method for the treatment of severe obesity. It allows for the permanent loss of at least 50% of initial excess weight. In obese patients, this surgery is also associated with a significant reduction in cardiovascular risk factors and particularly T2D. A recent meta-analysis of retrospective studies available suggests that surgery results in remission of T2DM in over 75% of cases. The only prospective randomized study showed that gastric restriction by placing a gastric band, provides better glycemic control than just medical treatment in obese patients with recently discovered T2DM. The gastric by-pass (GBP) which also includes an intestinal by-pass, seems to have an even higher metabolic efficiency than gastric bypass alone. In patients with T2DM, the GBP restores postprandial insulin secretion independently of weight loss. Despite the significant morbidity of the intervention, long-term results seem broadly supportive of the GBP. In a large case-control study, GBP was associated with a decrease of 90% of deaths related to diabetes. In a controlled study conducted in surgical candidates obese diabetics, the GBP decreased the overall world mortality by 75% after 6 years. Despite these very encouraging data, the GBP is now proposed to only a small proportion (\< 1%) of patients likely to benefit from the procedure.

Conditions

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Obesity Diabetes

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Gastric By-Pass

group treated with Gastric By-Pass

Group Type EXPERIMENTAL

Gastric By-Pass

Intervention Type PROCEDURE

Bariatric surgery laparoscopic Roux-en-Y Gastric Bypass (RYGBP)

optimized medical management

group receiving an optimized medical management

Group Type ACTIVE_COMPARATOR

optimized medical management

Intervention Type DRUG

group receiving an optimized medical management, among patients with obesity and poorly controlled type 2 diabetes

Interventions

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Gastric By-Pass

Bariatric surgery laparoscopic Roux-en-Y Gastric Bypass (RYGBP)

Intervention Type PROCEDURE

optimized medical management

group receiving an optimized medical management, among patients with obesity and poorly controlled type 2 diabetes

Intervention Type DRUG

Other Intervention Names

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RYGBP

Eligibility Criteria

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Inclusion Criteria

* Type 2 diabetes mellitus with HbA1c \> 7.5 %
* Body mass index \> 35 and \< 50 kg/m2
* Candidate for Gastric By-Pass
* Treatment with GLP1 (glucagon-like peptide) analogue or insulin

Exclusion Criteria

* Contraindication to bariatric surgery
* Pregnancy
* Affiliation of health care assurance
* Psychiatric disorders
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Hospital, Lille

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Francois Pattou, Professor

Role: STUDY_DIRECTOR

University Hospital of Lille

Locations

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University Hospital of Lille

Lille, Nord, France

Site Status RECRUITING

Centre Hospitalier Regional D' Angers

Angers, , France

Site Status RECRUITING

Hopital de Bois-Guillaume Chu Rouen

Bois-Guillaume, , France

Site Status RECRUITING

Hu Ouest Site Ambroise Pare Aphp -

Boulogne-Billancourt, , France

Site Status RECRUITING

Hopital Jeanne D'Arc Chu Nancy

Dommartin-lès-Toul, , France

Site Status RECRUITING

Hopital Lyon Sud - Hcl - Pierre Benite

Lyon, , France

Site Status RECRUITING

Hopital Lapeyronie Chu Montpellier

Montpellier, , France

Site Status RECRUITING

Hu Pitie Salpetriere Aphp

Paris, , France

Site Status RECRUITING

Hopital Larrey Chu Toulouse

Toulouse, , France

Site Status RECRUITING

Ch Valenciennes

Valenciennes, , France

Site Status RECRUITING

Countries

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France

Central Contacts

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Francois Pattou, Professor

Role: CONTACT

00 33 3 20 44 42 73

Facility Contacts

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Violeta Raverdy, MD

Role: primary

00 33 3 20 44 59 62

Other Identifiers

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2010-A01141-38.

Identifier Type: OTHER

Identifier Source: secondary_id

2010_07/1019

Identifier Type: -

Identifier Source: org_study_id

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