Obesity Clinical Trial
Official title:
Changes in Insulin Sensitivity After Weight Loss Induced by Diet or Bariatric Surgery
This study is designed to compare the changes in insulin sensitivity as well as gastrointestinal hormone levels in diabetic and non-diabetic obese individuals who are undergoing weight loss procedures. The main hypothesis of this study is that weight loss induced by gastric bypass will induce a greater improvement in insulin sensitivity compared with gastric banding or low calorie diet. Subjects will be studied before and after weight loss. Studies consist of intravenous glucose tolerance test, body composition analysis, meal test, and energy expenditure.
Patients who are scheduled for gastric bypass (GBP), sleeve gastrectomy (SG), or simple
caloric restriction with gastric banding (BND) or a very low calorie diet (VLCD) will be
examined at baseline weight, and when 6-10% total body weight has been lost. We will measure
insulin sensitivity with an intravenous glucose tolerance test, and fasting levels of
hormones that regulate food intake and insulin sensitivity, such as ghrelin, peptide YY
(PYY), glucagon-like peptide 1 (GLP1) and leptin. Fat mass and skeletal muscle mass will be
measured by dual photon absorptiometry (DXA). We will also measure the hormonal and thermic
response to food with a liquid test meal and energy expenditure by indirect calorimetry. This
measures how many calories are burned at rest and the in response to food. Subjects with
diabetes will continue to be studied with the same protocol on an annual basis out to 5 years
in order to determine the rate of remission of diabetes and the durability of this effect as
subjects tend to regain some body weight over time.
Subjects with diabetes will also be followed every three months for the first year after the
initial weight loss for HbA1c and fasting glucose levels. The results of this study may lead
to new understanding about changes in insulin sensitivity, body composition and hormonal
profile, as well as changes in energy expenditure with weight loss after bariatric surgery or
with simple caloric restriction. With this greater understanding, new treatments for obesity
and diabetes, that do not require surgery, may be developed.
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