News & Research

    Cleveland Clinic, Cleveland, Ohio

Metabolic Determinants of Remission vs. Non-Remission of Type 2 Diabetes Following Bariatric Surgery from a Randomized Controlled Trial

General Research Subject: Type 2 Diabetes

Focus: Integrated Physiology\Insulin Resistance, Integrated Physiology\Insulin Secretion and Islet Hormones, Obesity\Clinical Treatment

Type of Grant: Clinical Translational Research

Project Start Date: January 1, 2011

Project End Date: December 31, 2013

Diabetes Type: Type 2 diabetes

Research Description

The treatment of obesity and diabetes is a major medical problem. Obesity (bariatric) surgery is becoming popular for the treatment of severe obesity and also seems to dramatically improve diabetes. However, it is unclear if bariatric surgery is effective in treating diabetes in patients with less severe obesity, and controlled studies comparing its benefits to medical therapy for diabetes are lacking. To address these issues, we are conducting a five year clinical trial to determine the efficacy of two bariatric surgical procedures vs. medical therapy for treating diabetes in modestly obese individuals. This proposal will determine the clinical and metabolic factors that associate with post-surgical remission of diabetes (defined as normal glucose control without the need for diabetic medications) vs. non-remission (abnormal glucose control requiring medications) following the two types of bariatric procedures in patients enrolled in this trial. We believe that patients who do not achieve remission 1 and 2 years following surgery will have specific defects in a) intestinal hormones that control insulin secretion and b) insulin's ability to control glucose levels caused by weight regain following surgery. We will therefore measure key intestinal and fat hormones in the blood of patients enrolled in this trial  and relate these measures to glucose regulation and remission status following surgery. Determining the specific metabolic adaptations to various bariatric procedures and their relationships to  diabetes remission vs. non-remission will better enable us to evaluate the therapeutic potential of surgery for the treatment of diabetes in patients with modest obesity.

Research Profile

What area of diabetes research does your project cover?  What role will this particular project play in preventing, treating and/or curing diabetes?

The treatment of obesity is a major medical problem that directly impacts diabetes development and progression. Obesity (i.e. bariatric) surgery is becoming popular for the treatment of severe obesity and also seems to dramatically improve diabetes. However, it is unclear how effective bariatric surgery is in treating diabetes in patients with less severe obesity and controlled studies comparing its risk/benefits to current medical therapy for diabetes are lacking. To address these issues, we are conducting a five year clinical trial to determine the efficacy of two bariatric surgical procedures vs. medical therapy for treating diabetes in modestly obese individuals.

Our study will determine the clinical and metabolic factors that associate with post-surgical remission of diabetes (defined as normal glucose control without the need for diabetic medications) vs. non-remission (abnormal glucose control requiring medications) following the two types of bariatric procedures in patients enrolled in this trial. We believe that patients who do not achieve remission 1 and 2 years following surgery will have specific defects in a) intestinal hormones that control insulin secretion and b) insulin's ability to control glucose levels caused by weight regain following surgery. We will therefore measure key intestinal and fat hormones in the blood of patients enrolled in this trial and relate these measurements to glucose regulation and remission status following surgery. Determining the specific metabolic adaptations to various bariatric procedures and their relationships to diabetes remission status will better enable us to evaluate the therapeutic potential of surgery for the treatment of diabetes in patients with modest obesity. Given that this phenotype is common in the clinical setting and constitutes the majority of diabetes in our population, the potential significance of the study results is substantial.

If a person with diabetes were to ask you how your project will help them in the future, how would you respond?

Weight loss is critical for the improvement of diabetes and novel strategies for weight loss are clearly needed. Bariatric surgery is highly effective in inducing dramatic weight loss and may potentially reverse diabetes in some patients. We are interested in learning about gut factors related to pancreatic function that are associated with remission versus non-remission of diabetes following various bariatric surgical procedures. Our study will provide insight into the clinical and metabolic profile of those that are most responsive to bariatric surgery and potential treatment strategies to alter the metabolic profile for those patients who only partially respond.

Why is it important for you, personally, to become involved in diabetes research?  What role will this award play in your research efforts?

In medical school, I lost my father to complications from type 2 diabetes and realized thru my education and training that diabetes is a preventable and treatable disease that impacts close to 24 million people in our country. Over 50% of people with diabetes are overweight or obese, and obesity is the leading risk factor for diabetes development across various age and ethnic categories. Clearly, targeting weight loss is important for the well being of our patients and being involved with research that provides effective solutions for weight loss will reduce morbidity and mortality related to diabetes. I am grateful for the opportunity given by the American Diabetes Association for furthering my research goals to understand the effects of surgical and non-surgical weight loss strategies for the treatment of diabetes. Results from this study will be applied to the generation of larger multi-center studies examining the risks and benefits of bariatric surgery for diabetes.

In what direction do you see the future of diabetes research going?

We are in the beginning phase in the 'march of science' to understand the impact of bariatric and intestinal procedures for the treatment of diabetes. The future of diabetes research will involve examining surgical and non-surgical manipulation of gut biology to treat diabetes and its complications.