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Surgical or Medical Treatment (ST2OMP)

Primary Purpose

Diabetes Mellitus, Type 2, Pediatric Obesity, Bariatric Surgery Candidate

Status
Recruiting
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Advanced Medical Therapy and Bariatric Surgery
Advanced Medical Therapy
Bariatric Surgery
Sponsored by
Children's Hospital Medical Center, Cincinnati
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Diabetes Mellitus, Type 2

Eligibility Criteria

13 Years - 19 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria for the medical or surgical type 2 diabetes groups

  • Age 13-19.9 years of age at time of consent
  • Type 2 diabetes by the American Diabetes Association criteria
  • Negative diabetes-associated antibodies
  • BMI greater than or equal to 30
  • Willingness to take oral medications and/or diabetes subcutaneous medications as medically indicated

Exclusion Criteria for the medical or surgical type 2 diabetes groups

  • Known type 1 diabetes of maturity onset diabetes on the young (MODY) or secondary diabetes
  • Chronic kidney or liver disease (except NAFLD or DKD)
  • Pregnancy or breast-feeding
  • Genetic cause of obesity or hypothalamic obesity
  • Prior bariatric surgery
  • History of malignancy
  • Current participating in another clinical trial affecting study outcomes

Inclusion criteria for the comparison group without type 2 diabetes

  • Age 13-19.9 years of age at time of consent
  • BMI greater than or equal to 30

Exclusion Criteria for the comparison group without type 2 diabetes

  • Known diabetes
  • Chronic kidney or liver disease (except NAFLD or DKD)
  • Pregnancy or breast-feeding
  • Genetic cause of obesity or hypothalamic obesity
  • Prior bariatric surgery
  • History of malignancy
  • Current participating in another clinical trial affecting study outcomes

Sites / Locations

  • Children's Hospital ColoradoRecruiting
  • Lurie Children's Hospital
  • Cincinnati ChildrensRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Active Comparator

Active Comparator

Arm Label

Medical Therapy and Bariatric Surgery in Youth with Type 2 Diabetes

Medical Therapy in Youth with Type 2 Diabetesin Youth with Type 2 Diabetes

Bariatric Surgery in Youth with Obesity

Arm Description

Youth with type 2 diabetes undergoing bariatric surgery, n=45

Youth with type 2 diabetes receiving medical management, n=45

Youth with no obesity undergoing bariatric surgery, n=10

Outcomes

Primary Outcome Measures

Glycemic Control
Hemoglobin A1c of <6.5%

Secondary Outcome Measures

Glycemic Control
Hemoglobin A1c <6.5% at 2 years
Glycemic Variability
Time In Range by Continuous Glucose Monitoring
Beta Cell Function
Oral disposition index= Insulin secretion [insulinogenic index] * insulin sensitivity [1/fasting insulin]
Alpha cell function
Glucagon area under the curve from mixed meal tolerance testing
Incretin Response
GLP-1 area under the curve from mixed meal tolerance testing
Fatty Liver Disease
Hepatic Fat (<5% )by Magnetic Resonance imaging
Dyslipidemia
LDL <130mg/dL
Hypertension
Blood pressure <130/80 mmHg
Diabetic Kidney Disease
Urinary albumin excretion <30μg/mg

Full Information

First Posted
October 11, 2019
Last Updated
August 28, 2023
Sponsor
Children's Hospital Medical Center, Cincinnati
Collaborators
Children's Hospital Colorado
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1. Study Identification

Unique Protocol Identification Number
NCT04128995
Brief Title
Surgical or Medical Treatment
Acronym
ST2OMP
Official Title
Surgical or Medical Treatment for Pediatric Type 2 Diabetes
Study Type
Interventional

2. Study Status

Record Verification Date
August 2023
Overall Recruitment Status
Recruiting
Study Start Date
December 15, 2019 (Actual)
Primary Completion Date
September 1, 2024 (Anticipated)
Study Completion Date
December 1, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Children's Hospital Medical Center, Cincinnati
Collaborators
Children's Hospital Colorado

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will test the hypothesis that metabolic bariatric surgery will be more effective at providing durable glycemic control and reduce co-morbidities than intensive medical therapy in youth with type 2 diabetes.
Detailed Description
Youth-onset type 2 diabetes (T2D) leads to early dependence on exogenous insulin and progression of T2D co-morbidities, including dyslipidemia, hypertension, non-alcoholic fatty liver disease and diabetic kidney disease. The pathophysiology of T2D in youth differs considerably from adults and current treatment approaches are in-adequate for youth. Thus, exploration of innovative approaches to reduce co-morbidities is critical. Metabolic bariatric surgery (MBS) significantly improves multiple outcomes in adults with T2D. Initial small, uncontrolled studies of Roux-en-Y gastric bypass also suggest beneficial effects in youth with T2D, but definitive studies and understanding of mechanisms in youth-onset T2D are lacking, especially with the now more common form of MBS, vertical sleeve gastrectomy (VSG). We will test the hypothesis that VSG will be more effective in reducing glycemia and comorbidities than the best currently available medical treatment: advanced medical therapy (AMT), via pancreatic, enterohepatic and/or metabolic changes. To test this hypothesis, 90 adolescents with T2D will be studied to compare the effects of VSG vs. AMT on glycemic control and T2D-associated comorbidities, as well as underlying mechanisms.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Diabetes Mellitus, Type 2, Pediatric Obesity, Bariatric Surgery Candidate

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Model Description
Open label prospective clinical trial. Primary comparison is medical (n=45) vs surgical (n=45) groups. Patients with obesity and no diabetes (n=10) are a comparator group.
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
100 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Medical Therapy and Bariatric Surgery in Youth with Type 2 Diabetes
Arm Type
Active Comparator
Arm Description
Youth with type 2 diabetes undergoing bariatric surgery, n=45
Arm Title
Medical Therapy in Youth with Type 2 Diabetesin Youth with Type 2 Diabetes
Arm Type
Active Comparator
Arm Description
Youth with type 2 diabetes receiving medical management, n=45
Arm Title
Bariatric Surgery in Youth with Obesity
Arm Type
Active Comparator
Arm Description
Youth with no obesity undergoing bariatric surgery, n=10
Intervention Type
Procedure
Intervention Name(s)
Advanced Medical Therapy and Bariatric Surgery
Intervention Description
Vertical Sleeve Gastrectomy and Advanced Medical Therapy that could include metformin, GLP-1 agonist, SGLT-2 inhibitor, or basal insulin for youth with type 2 diabetes
Intervention Type
Drug
Intervention Name(s)
Advanced Medical Therapy
Intervention Description
Advanced Medical Therapy that could include metformin, GLP-1 agonist, SGLT-2 inhibitor, or basal insulin for youth with type 2 diabetes
Intervention Type
Procedure
Intervention Name(s)
Bariatric Surgery
Other Intervention Name(s)
Vertical Sleeve Gastrectomy
Intervention Description
Vertical Sleeve Gastrectomy for youth without type 2 diabetes
Primary Outcome Measure Information:
Title
Glycemic Control
Description
Hemoglobin A1c of <6.5%
Time Frame
At one year
Secondary Outcome Measure Information:
Title
Glycemic Control
Description
Hemoglobin A1c <6.5% at 2 years
Time Frame
At two years
Title
Glycemic Variability
Description
Time In Range by Continuous Glucose Monitoring
Time Frame
At one year
Title
Beta Cell Function
Description
Oral disposition index= Insulin secretion [insulinogenic index] * insulin sensitivity [1/fasting insulin]
Time Frame
at 1 and 2 years
Title
Alpha cell function
Description
Glucagon area under the curve from mixed meal tolerance testing
Time Frame
at 1 and 2 years
Title
Incretin Response
Description
GLP-1 area under the curve from mixed meal tolerance testing
Time Frame
at 1 and 2 years
Title
Fatty Liver Disease
Description
Hepatic Fat (<5% )by Magnetic Resonance imaging
Time Frame
at 1 and 2 years
Title
Dyslipidemia
Description
LDL <130mg/dL
Time Frame
at 1 and 2 years
Title
Hypertension
Description
Blood pressure <130/80 mmHg
Time Frame
at 1 and 2 years
Title
Diabetic Kidney Disease
Description
Urinary albumin excretion <30μg/mg
Time Frame
At 1 and 2 years

10. Eligibility

Sex
All
Minimum Age & Unit of Time
13 Years
Maximum Age & Unit of Time
19 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria for the medical or surgical type 2 diabetes groups Age 13-19.9 years of age at time of signing the consent Type 2 diabetes by the American Diabetes Association criteria Negative diabetes-associated antibodies Exclusion Criteria for the medical or surgical type 2 diabetes groups Known type 1 diabetes, maturity onset diabetes of the young (MODY), or secondary diabetes Any chronic oral steroids use within 60 days of enrollment Current pancreatotoxic drugs Chronic kidney or liver disease (except NAFLD or DKD) Pregnancy, breast-feeding or intension of becoming pregnant Prior bariatric surgery History of malignancy Current participation in another clinical trial that may affect study outcomes Other conditions, that in the determination of the study investigator, may interfere with study participation Inclusion Criteria for the Obese control group Age 13-19.9 years of age at time of signing the consent Clinical indication to receive bariatric surgery Exclusion Criteria for the obese control group Known diabetes Any chronic oral steroids use within 60 days of enrollment Current pancreatotoxic drugs Chronic kidney or liver disease (except NAFLD or DKD) Pregnancy, breast-feeding or intension of becoming pregnant Prior bariatric surgery History of malignancy Current participation in another clinical trial that may affect study outcomes Other conditions, that in the determination of the study investigator, may interfere with study participation
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Amy S Shah, MD
Phone
513-636-4744
Email
amy.shah@cchmc.org
First Name & Middle Initial & Last Name or Official Title & Degree
Kristen J Nadeau, MD
Phone
(720) 777-6128
Email
Kristen.Nadeau@childrenscolorado.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Amy S Shah, MD MS
Organizational Affiliation
Cincinnati Childrens Hospital Medical Center
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Kristen J Nadeau, MD MS
Organizational Affiliation
Children's Hospital Colorado
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Michael A Helmrath, MD MS
Organizational Affiliation
Children's Hospital Medical Center, Cincinnati
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Thomas H Inge, MD PhD
Organizational Affiliation
Lurie Children's Hospital
Official's Role
Principal Investigator
Facility Information:
Facility Name
Children's Hospital Colorado
City
Aurora
State/Province
Colorado
ZIP/Postal Code
80045
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Amy Baumgartner
Phone
720-777-6143
Email
amy.baumgartner@childrenscolorado.org
First Name & Middle Initial & Last Name & Degree
Kristen J Nadeau, MD
First Name & Middle Initial & Last Name & Degree
Megan M Kelsey, MD
First Name & Middle Initial & Last Name & Degree
Sarkis Derderian, MD
Facility Name
Lurie Children's Hospital
City
Chicago
State/Province
Illinois
ZIP/Postal Code
60611
Country
United States
Individual Site Status
Active, not recruiting
Facility Name
Cincinnati Childrens
City
Cincinnati
State/Province
Ohio
ZIP/Postal Code
45229
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Allen Riegler
Phone
513-636-4744
Email
jenni.sizemore@cchmc.org
First Name & Middle Initial & Last Name & Degree
Michael A Helmrath, MD
First Name & Middle Initial & Last Name & Degree
Amy S Shah, MD
First Name & Middle Initial & Last Name & Degree
Stavra Xanthakos, MD

12. IPD Sharing Statement

Plan to Share IPD
No
IPD Sharing Plan Description
The PI's will also report a of summary results information (including adverse events) after completion of the study. All data from the study including any negative findings will be published in peer reviewed manuscripts.
Citations:
PubMed Identifier
34389568
Citation
Shah AS, Helmrath MA, Inge TH, Xanthakos SA, Kelsey MM, Jenkins T, Trout AT, Browne L, Nadeau KJ. Study protocol: a prospective controlled clinical trial to assess surgical or medical treatment for paediatric type 2 diabetes (ST2OMP). BMJ Open. 2021 Aug 13;11(8):e047766. doi: 10.1136/bmjopen-2020-047766.
Results Reference
derived

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Surgical or Medical Treatment

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