Mechanisms Underlying Postoperative Insulin Resistance and Inflammation
Primary Purpose
Obesity
Status
Unknown status
Phase
Phase 4
Locations
United Kingdom
Study Type
Interventional
Intervention
carbohydrate drink
Muscle biopsy
Blood sampling
Placebo
Sponsored by
About this trial
This is an interventional basic science trial for Obesity focused on measuring Dietary supplement, Carbohydrate loading, Insulin resistance, Surgery
Eligibility Criteria
Inclusion Criteria:
- Age 18-75 yrs
- Correct BMI and waist circumference criteria : Obese group - BMI ≥30 AND waist circumference ≥94 cm in men and ≥ 80 cm in women, Non obese group - BMI 18.5-25 AND waist circumference ≤94cm in men and ≤80 cm in women Due to undergo elective major abdominal surgery ASA I-III Caucasian patients Able to give informed consent and comply with study protocol
Exclusion Criteria:
History of significant preoperative weight loss (>10% over preceding 3 weeks)
- Clinical history of pulmonary aspiration
- Known gastro-oesophageal reflux disease (GORD) or hiatus hernia
- History of difficult intubation or conditions leading to the latter such as: previous neck radiotherapy/rheumatoid arthritis/presence of thyroid goitre
- Metabolic disorders (e.g. diabetes mellitus, thyroid disease, Cushing's Syndrome)
- Simultaneous participation in another clinical study or involvement in a clinical study within the preceding 3 months,
- Patients with suspicion of alcohol/drug abuse
- Pregnancy
Sites / Locations
- University of NottinghamRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Arm Type
Experimental
Experimental
Placebo Comparator
Placebo Comparator
Arm Label
Normal body weight
Obese
Normal Body Weight placebo
Obese placebo
Arm Description
Participants of mormal body weight given placebo
Participants who are obese given placebo
Outcomes
Primary Outcome Measures
Within subject differences in perioperative insulin sensitivity (M-value, corrected for insulin concentrations) amongst obese, non-obese, carbohydrate loaded and non-carbohydrate loaded patients.
Secondary Outcome Measures
Correlation between body composition and changes in perioperative insulin sensitivity
Differences in inflammatory cytokine gene expression
Differences in muscle and fat genes and proteins controlling carbohydrate/fat oxidation and insulin signalling
Differences activities of muscle and fat enzymes involved in carbohydrate/fat/carnitine metabolism
Differences in the aforementioned between peripheral and central fat and muscle
The incidence of post-operative infectious and non-infectious complications
Length of hospital stay (difference between groups)
Full Information
NCT ID
NCT01470534
First Posted
November 9, 2011
Last Updated
October 4, 2012
Sponsor
University of Nottingham
1. Study Identification
Unique Protocol Identification Number
NCT01470534
Brief Title
Mechanisms Underlying Postoperative Insulin Resistance and Inflammation
Official Title
Investigating Whether the Magnitude of Postoperative Inflammatory and Insulin Resistant Responses is Related to Body Composition and Physiological Function of Skeletal Muscle & Adipose Tissue
Study Type
Interventional
2. Study Status
Record Verification Date
October 2012
Overall Recruitment Status
Unknown status
Study Start Date
November 2011 (undefined)
Primary Completion Date
November 2012 (Anticipated)
Study Completion Date
November 2012 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University of Nottingham
4. Oversight
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
Having an operation places an enormous burden on the body, leading to the development of inflammation and so called 'insulin resistance'. Insulin resistance means the body is unable to respond to important hormones that control use of energy. Recent studies have shown that patients who develop 'higher' insulin resistance and inflammation have more serious complications and take longer to recover after surgery. The investigators do not know what controls the development of insulin resistance and inflammation after surgery. Similarly, the investigators do not know why certain patients develop much more insulin resistance and inflammation than others, even though they have the same operation.
The main purpose of the study is to try to find out which patients are prone to developing greater 'amounts' of insulin resistance and inflammation. The investigators also want to find out whether the investigators can reduce the 'amount' of insulin resistance and inflammation in these patients (for example by giving them carbohydrate [sugar-based] drinks before surgery - these have been shown to reduce insulin resistance in some patient groups).
Information from this study should improve the way the investigators prepare patients before surgery and this should help to improve patient outcomes following surgery (by reducing complications and speeding recovery after major surgery).
Detailed Description
Interested participants who are undergoing abdominal (tummy) surgery will be recruited from surgical clinics. They will be asked to attend the Greenfield Human Physiology Laboratory where they will be asked to complete two questionnaires. In addition, a sample of blood, and a small sample of muscle and fat from their thigh will be taken. They will undergo a low dose X-ray (DXA scan) and an insulin clamp. The insulin clamp involves being connected to an insulin and glucose drip for around four hours during which their blood pressure and pulse is monitored and regular blood samples are taken.
Participants will be allocated randomly to one of two groups. One group will receive a carbohydrate (sugar) drink before surgery and the other group will receive a dummy (placebo) drink.
On the day of surgery, pre-operative checks and assessment will proceed as normal. After the participant is asleep under anaesthetic, a blood sample and tummy muscle and fat samples will be taken by the surgeon through the surgical incision. At the end of surgery, another blood sample and muscle and fat samples from the tummy and thigh will be taken while the participant is still under anaesthetic.
On the day after surgery, a further blood test and tummy and thigh muscle and fat sample will be taken. Participants will also undergo another insulin clamp.
The research team will follow participants' progress after surgery, but the decision to allow them home will be made by the medical team responsible for their care.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Obesity
Keywords
Dietary supplement, Carbohydrate loading, Insulin resistance, Surgery
7. Study Design
Primary Purpose
Basic Science
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantInvestigator
Allocation
Randomized
Enrollment
32 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
Normal body weight
Arm Type
Experimental
Arm Title
Obese
Arm Type
Experimental
Arm Title
Normal Body Weight placebo
Arm Type
Placebo Comparator
Arm Description
Participants of mormal body weight given placebo
Arm Title
Obese placebo
Arm Type
Placebo Comparator
Arm Description
Participants who are obese given placebo
Intervention Type
Dietary Supplement
Intervention Name(s)
carbohydrate drink
Intervention Description
carbohydrate drink
Intervention Type
Procedure
Intervention Name(s)
Muscle biopsy
Intervention Description
Open muscle biopsy
Intervention Type
Procedure
Intervention Name(s)
Blood sampling
Intervention Description
Venopuncture
Intervention Type
Dietary Supplement
Intervention Name(s)
Placebo
Primary Outcome Measure Information:
Title
Within subject differences in perioperative insulin sensitivity (M-value, corrected for insulin concentrations) amongst obese, non-obese, carbohydrate loaded and non-carbohydrate loaded patients.
Time Frame
2 weeks
Secondary Outcome Measure Information:
Title
Correlation between body composition and changes in perioperative insulin sensitivity
Time Frame
2 weeks
Title
Differences in inflammatory cytokine gene expression
Time Frame
2 months
Title
Differences in muscle and fat genes and proteins controlling carbohydrate/fat oxidation and insulin signalling
Time Frame
3 months
Title
Differences activities of muscle and fat enzymes involved in carbohydrate/fat/carnitine metabolism
Time Frame
2 months
Title
Differences in the aforementioned between peripheral and central fat and muscle
Time Frame
2 months
Title
The incidence of post-operative infectious and non-infectious complications
Time Frame
30 days
Title
Length of hospital stay (difference between groups)
Time Frame
6 weeks
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Age 18-75 yrs
Correct BMI and waist circumference criteria : Obese group - BMI ≥30 AND waist circumference ≥94 cm in men and ≥ 80 cm in women, Non obese group - BMI 18.5-25 AND waist circumference ≤94cm in men and ≤80 cm in women Due to undergo elective major abdominal surgery ASA I-III Caucasian patients Able to give informed consent and comply with study protocol
Exclusion Criteria:
History of significant preoperative weight loss (>10% over preceding 3 weeks)
Clinical history of pulmonary aspiration
Known gastro-oesophageal reflux disease (GORD) or hiatus hernia
History of difficult intubation or conditions leading to the latter such as: previous neck radiotherapy/rheumatoid arthritis/presence of thyroid goitre
Metabolic disorders (e.g. diabetes mellitus, thyroid disease, Cushing's Syndrome)
Simultaneous participation in another clinical study or involvement in a clinical study within the preceding 3 months,
Patients with suspicion of alcohol/drug abuse
Pregnancy
Facility Information:
Facility Name
University of Nottingham
City
Nottingham
ZIP/Postal Code
NG7 2UH
Country
United Kingdom
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Dileep Lobo
Email
dileep.lobo@nottingham.ac.uk
First Name & Middle Initial & Last Name & Degree
Dileep Lodo
12. IPD Sharing Statement
Learn more about this trial
Mechanisms Underlying Postoperative Insulin Resistance and Inflammation
We'll reach out to this number within 24 hrs