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Gastrectomy, Eating Behaviour and GLP-1

Primary Purpose

Gastric Cancer, Dumping Syndrome

Status
Completed
Phase
Not Applicable
Locations
United Kingdom
Study Type
Interventional
Intervention
Exendin 9-39
Placebo
Sponsored by
Cambridge University Hospitals NHS Foundation Trust
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional basic science trial for Gastric Cancer focused on measuring Dumping syndrome, Gastrectomy, GLP-1, Insulin

Eligibility Criteria

18 Years - 100 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • • At least 3 months post completion of treatment for gastric cancer, or prophylactic gastrectomy

    • Aged at least 18 years
    • Able to tolerate an oral glucose tolerance test
    • Able to understand and retain all information regarding the study and give informed consent.
    • Willing to receive an infusion of human albumin solution

Exclusion Criteria:

  • • Have a diagnosis of diabetes

    • Have a history of untreated anaemia in the last 3 months
    • Be aged under 18 years
    • Have active gastric cancer
    • Be pregnant or attempting to conceive

Sites / Locations

  • Cambridge University Hospitals NHS Foundation Trust

Arms of the Study

Arm 1

Arm 2

Arm Type

Placebo Comparator

Experimental

Arm Label

Placebo

Exendin

Arm Description

Infusion of 1% human albumin in normal saline.

Infusion of Exendin 9-39 in 1% human albumin in normal saline

Outcomes

Primary Outcome Measures

Nadir Blood Glucose
Lowest blood sugar reading during an oral glucose tolerance test while receiving infusion of GLP-1 antagonist. Please note participants will receive infusion of active compound for a maximum of four hours, with no expected effect of compound persisting for more than 30 minutes post-infusion.

Secondary Outcome Measures

Total Insulin Secretion
60 minute incremental area under the curve (i.e. total) insulin secretion during 50g oral glucose tolerance test while receiving infusion of GLP-1 antagonist. Please note participants will receive infusion of active compound for a maximum of four hours, with no expected effect of compound persisting for more than 30 minutes post-infusion.
Eating Rate During ad Libitum Meal
As measured by universal eating monitor, total weight of a standardised meal consumed over a measured time in grams per minute.
Decreased Hunger and Satiety Ratings During and After ad Libitum Meal
Will be measured on visual analogue scale and reported as a score out of 100. Higher value indicated more hunger and more satiety.
Altered Food Attention.
Food motivation can be measured by response rates to visual cues while being distracted by food related images. Will be measured with and without GLP-1 blockade to investigate effects of GLP-1 on food attention behaviour. Measure is of difference in response time when visual cue is colocated with a food related image vs a non-food related image, indicating degree of bias in attention to food images. Measure is undertaken during infusion at four timepoints - baseline (i.e. fasting), post oral glucose tolerance test (post-OGTT), before a standard meal (pre-meal) and after the meal (post-meal).
Altered Food Motivation
Participant motivation to view particular food based cues is assessed by grip strength exerted to maintain those cues. Measure is undertaken during infusion at four timepoints - baseline (i.e. fasting), post oral glucose tolerance test (post-OGTT), before a standard meal (pre-meal) and after the meal (post-meal).
Number of Participants With Infusion Related Adverse Events as Assessed by CTCAE v4
Total Meal Consumption
Total consumption amount of a standard meal during study intervention, measured in grams using a universal eating monitor.

Full Information

First Posted
November 17, 2016
Last Updated
August 27, 2019
Sponsor
Cambridge University Hospitals NHS Foundation Trust
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1. Study Identification

Unique Protocol Identification Number
NCT02971631
Brief Title
Gastrectomy, Eating Behaviour and GLP-1
Official Title
The Effect of Glucagon Like Peptide-1 (GLP-1) on Glycaemic Profile and Eating Behaviour Following Gastrectomy
Study Type
Interventional

2. Study Status

Record Verification Date
August 2019
Overall Recruitment Status
Completed
Study Start Date
August 10, 2017 (Actual)
Primary Completion Date
September 16, 2018 (Actual)
Study Completion Date
September 16, 2018 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Cambridge University Hospitals NHS Foundation Trust

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Patients who have undergone gastrectomy (removal of the stomach) to treat or prevent cancer are known to have a significantly reduced quality of life. To date, there is very little information on the physiological causes of this. The investigators suspect that overproduction of a hormone (chemical) called glucagon like peptide-1 (GLP-1) released by the lining of the gut may play a role in the reduced appetite, weight loss and low blood sugar symptoms seen in this group. To investigate this, the investigators will study the response of 16 patients who have previously had a gastrectomy to a glucose drink, and a meal, while receiving an infusion of a specific blocker of GLP-1 or placebo. The investigators will examine the levels of sugar and associated hormones in the blood, food consumption and food reward behaviour using standard tools. Participants will be invited to attend the Clinical Research Facility at Addenbrooke's Hospital for a screening visit, and two whole day study visits. The study has been designed to assess the role of overproduction of GLP-1 by completely blocking its actions, rather than assess the use of the blocking compound as a medication, and is therefore regarded as a physiological study, not a clinical trial. The goal of this study is to demonstrate the magnitude of effect of GLP-1 on blood sugar and appetite derangement in patients who have had a gastrectomy. This will guide future work on the development of novel treatment paradigms for the post-gastrectomy patient group.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Gastric Cancer, Dumping Syndrome
Keywords
Dumping syndrome, Gastrectomy, GLP-1, Insulin

7. Study Design

Primary Purpose
Basic Science
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
5 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Infusion of 1% human albumin in normal saline.
Arm Title
Exendin
Arm Type
Experimental
Arm Description
Infusion of Exendin 9-39 in 1% human albumin in normal saline
Intervention Type
Other
Intervention Name(s)
Exendin 9-39
Intervention Description
Complete blockade of action of endogenous GLP-1 by Exendin 9-39. Defined as a physiological study, not a clinical trial as such (as advised by the UK MHRA).
Intervention Type
Other
Intervention Name(s)
Placebo
Intervention Description
Infusion of 1% human albumin in normal saline
Primary Outcome Measure Information:
Title
Nadir Blood Glucose
Description
Lowest blood sugar reading during an oral glucose tolerance test while receiving infusion of GLP-1 antagonist. Please note participants will receive infusion of active compound for a maximum of four hours, with no expected effect of compound persisting for more than 30 minutes post-infusion.
Time Frame
As assessed during a 50g glucose tolerance test while receiving infusion of GLP-1 antagonist. At time 30-120 minutes of infusion of Exendin 9-39.
Secondary Outcome Measure Information:
Title
Total Insulin Secretion
Description
60 minute incremental area under the curve (i.e. total) insulin secretion during 50g oral glucose tolerance test while receiving infusion of GLP-1 antagonist. Please note participants will receive infusion of active compound for a maximum of four hours, with no expected effect of compound persisting for more than 30 minutes post-infusion.
Time Frame
Samples collected at 0, 15, 30, 45 and 60 minutes post oral glucose tolerance test.
Title
Eating Rate During ad Libitum Meal
Description
As measured by universal eating monitor, total weight of a standardised meal consumed over a measured time in grams per minute.
Time Frame
150-210 minutes during infusion of Exendin 9-39 or placebo.
Title
Decreased Hunger and Satiety Ratings During and After ad Libitum Meal
Description
Will be measured on visual analogue scale and reported as a score out of 100. Higher value indicated more hunger and more satiety.
Time Frame
150-240 minutes during infusion of Exendin 9-39 or placebo and for 4 hours post-cessation of infusion.
Title
Altered Food Attention.
Description
Food motivation can be measured by response rates to visual cues while being distracted by food related images. Will be measured with and without GLP-1 blockade to investigate effects of GLP-1 on food attention behaviour. Measure is of difference in response time when visual cue is colocated with a food related image vs a non-food related image, indicating degree of bias in attention to food images. Measure is undertaken during infusion at four timepoints - baseline (i.e. fasting), post oral glucose tolerance test (post-OGTT), before a standard meal (pre-meal) and after the meal (post-meal).
Time Frame
0-240 minutes during infusion of Exendin 9-39 or placebo, assessed on four occasions (baseline or T0, post-OGTT, pre-meal, post-meal) using a validated dot-probe visual response tool and reported in response time (milliseconds).
Title
Altered Food Motivation
Description
Participant motivation to view particular food based cues is assessed by grip strength exerted to maintain those cues. Measure is undertaken during infusion at four timepoints - baseline (i.e. fasting), post oral glucose tolerance test (post-OGTT), before a standard meal (pre-meal) and after the meal (post-meal).
Time Frame
0-240 minutes during infusion of Exendin 9-39 or placebo (baseline or T0, post-OGTT, pre-m, assessed on four occasions using a validated grip strength surrogate of food motivation and measured as the area under the curve of a grip force monitoring curve.
Title
Number of Participants With Infusion Related Adverse Events as Assessed by CTCAE v4
Time Frame
24 hours from onset of infusion.
Title
Total Meal Consumption
Description
Total consumption amount of a standard meal during study intervention, measured in grams using a universal eating monitor.
Time Frame
150-210 minutes during infusion of Exendin 9-39 or placebo

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
100 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: • At least 3 months post completion of treatment for gastric cancer, or prophylactic gastrectomy Aged at least 18 years Able to tolerate an oral glucose tolerance test Able to understand and retain all information regarding the study and give informed consent. Willing to receive an infusion of human albumin solution Exclusion Criteria: • Have a diagnosis of diabetes Have a history of untreated anaemia in the last 3 months Be aged under 18 years Have active gastric cancer Be pregnant or attempting to conceive
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Geoffrey Roberts, MA BM BCh
Organizational Affiliation
University of Cambridge
Official's Role
Principal Investigator
Facility Information:
Facility Name
Cambridge University Hospitals NHS Foundation Trust
City
Cambridge
State/Province
Cambridgeshire
ZIP/Postal Code
CB2 0QQ
Country
United Kingdom

12. IPD Sharing Statement

Plan to Share IPD
No

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Gastrectomy, Eating Behaviour and GLP-1

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