The Importance of Ghrelin for Glucose Metabolism After Sleeve Gastrectomy

NCT ID: NCT05189353

Last Updated: 2023-11-01

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

COMPLETED

Clinical Phase

NA

Total Enrollment

22 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-01-14

Study Completion Date

2023-06-26

Brief Summary

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The overall aim is to delineate the contribution of ghrelin to glucose tolerance after sleeve gastrectomy. The hypothesis is that decreased concentration of ghrelin after SG is of importance for improved insulin secretion and glucose tolerance seen after SG. The expectation is therefore that infusion of ghrelin will impair insulin secretion and glucose tolerance compared with a control day without ghrelin infusion.

Detailed Description

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Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are bariatric procedures. Overwhelming evidence support bariatric surgery as the most effective treatment for severe obesity and related metabolic comorbidities, particularly type 2 diabetes mellitus.

The mechanisms of improved glycaemic control after SG are not fully understood and differ from those of RYGB. Interestingly, there is demonstrated a markedly lower secretion of the orexigenic hormone ghrelin after SG compared with both RYGB and unoperated obese controls. Hence, the decreased level of ghrelin could be of major importance in relation to the improved glucose tolerance after SG.

Ghrelin is secreted from the gastric mucosa in the fasting state and decreases in response to food intake. Administration of exogenous ghrelin reduces insulin sensitivity and glucose tolerance in healthy humans and contributes to hyperglycaemia. In accordance, ghrelin receptor knockout in mice improves glucose sensitivity and enhances glucose-stimulated insulin secretion.

On this background the investigators hypothesize that the markedly reduced secretion of ghrelin after SG could therefore be of particularly importance for the improved glucose tolerance after this procedure.

This present study is complementary to an on-going study in SG operated subjects, where the role of ghrelin for appetite and insulin secretion during a mixed meal followed by an ad libitum meal are investigated. In the present study the effect of ghrelin on insulin secretion and insulin sensitivity is thoroughly investigated using methods eliminating the effect of other hormones on glucose metabolism.

Ghrelin will be infused in physiological doses aiming for plasma concentration after SG resembling the pre-operative plasma concentrations.

Specific aim is to evaluate the effect of ghrelin on both alpha and beta cell function as well as on liver and peripheral insulin sensitivity in individuals with SG using matched controls. The subjects will be investigated with both glucose and glycerol tracers, IVGTT and a hyperinsulinemic euglycaemic clamp.

Conditions

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Bariatric Surgery Candidate Glucose Metabolism Disorders

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

SINGLE

Participants
Single randomized clinical trial

Study Groups

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Gastric sleeve operated

12 subjects with normal glucose tolerance (NGT) operated with SG minimum 12 month earlier

Group Type EXPERIMENTAL

Ghrelin

Intervention Type OTHER

Ghrelin infusion

Placebo

Intervention Type OTHER

Saline infusion

Matched control group

12 weight-matched unoperated subjects with NGT

Group Type PLACEBO_COMPARATOR

Ghrelin

Intervention Type OTHER

Ghrelin infusion

Placebo

Intervention Type OTHER

Saline infusion

Interventions

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Ghrelin

Ghrelin infusion

Intervention Type OTHER

Placebo

Saline infusion

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Sleeve gastrectomy-operated \> 12 months prior to inclusion
* Weight stable (+/- 3 kg during the last 3 months)
* Fasting glucose \< 7,0 mmol/l / HbA1c \< 48 mmol/mol pre- and postoperative
* Signed written informed consent

Exclusion Criteria

* Pregnancy or breastfeeding.
* Haemoglobin \< 6,5 mM.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Institute of Biomedical Sciences, SUND, University of Copenhagen

UNKNOWN

Sponsor Role collaborator

Hvidovre University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Marie-Louise Dichman

MD, Ph.d.-student

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Hvidovre Universitets Hospital

Hvidovre, , Denmark

Site Status

Countries

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Denmark

Other Identifiers

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H-21037442

Identifier Type: -

Identifier Source: org_study_id

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