Beta Cell Restoration Through Fat Mitigation
Overview
- Phase
- Not Applicable
- Intervention
- Metformin
- Conditions
- Prediabetes
- Sponsor
- University of Southern California
- Enrollment
- 88
- Locations
- 1
- Primary Endpoint
- Steady State Beta Cell Compensation
- Status
- Completed
- Last Updated
- 6 years ago
Overview
Brief Summary
Weight loss achieved through gastric banding will be superior to treatment with metformin in preserving or restoring pancreatic beta cell function in people with prediabetes or mild type 2 diabetes.
Detailed Description
BetaFat is a 2-arm, unblinded study to compare gastric banding to treatment with metformin over a 24-month period in moderately obese adults with pre- or mild type 2 diabetes. The primary outcome will be change in β-cell compensation for insulin resistance, which the investigators will compare between groups. Secondary analyses will include other potential markers of β-cell health and potential mediators of treatment-specific effects. The main focus will be on mediators related to obesity. Clinically, the project will serve as a test of concept for use of gastric banding relatively early in the spectrum of obesity and β-cell disease. Biologically, the results will provide crucial information on potential mediators of β-cell failure and its arrest or reversal in the context of obesity. Those mediators will guide the development of more effective treatment and monitoring for the β-cell disease that causes type 2 diabetes.
Investigators
Thomas Buchanan
Professor
University of Southern California
Eligibility Criteria
Inclusion Criteria
- •Prior completion of at least two months in a diet, exercise and lifestyle intervention program within the past two years
- •Fasting plasma glucose \>90 mg/dl plus 2-hour glucose ≥140 mg/dl on 75 gm OGTT plus HbA1C ≤7.0%. There is no lower limit for the A1C and no upper limit for the OGTT 2-hour glucose based on prior studies that allow us to identify people with falling β-cell function
- •Age 22-65 years
- •Body mass index (BMI) 30-40 kg/m2
- •For participants with diabetes, known duration \<1 year
- •No history of use of antidiabetic medications except during pregnancy
Exclusion Criteria
- •Contraindications to LapBand(see Appendix 1)
- •Contraindication to MRI (claustrophobia; permanent metal objects such as pacemakers, prostheses, aneurysm clips)
- •Underlying disease(s) likely to (a) limit life span to less than study duration and/or (b) increase risk of intervention outside of the study and/or (c) limit ability to participate in outcomes assessment and/or (d) limit participation
- •An underlying disease known to have important effects on glucose metabolism
- •Active infections
- •Renal disease (serum creatinine ≥1.4 mg/dl for men; ≥1.3 mg/dl for women) or serum potassium abnormality (\<3.4 or \>5.5 mmol/l)
- •Anemia (hemoglobin \<11g/dl in women, \<12 g/dl in men) or known coagulopathy
- •Cardiovascular disease, including uncontrolled hypertension and symptomatic congestive heart failure. Participants must be able to safely tolerate administration of fluid/volume challenges during clamp studies.
- •Serum AST \>3 times upper limit of normal in local clinical lab
- •Excessive alcohol intake
Arms & Interventions
metformin
subjects receiving metformin
Intervention: Metformin
gastric banding
subjects receiving LAP-BAND
Intervention: gastric banding
Outcomes
Primary Outcomes
Steady State Beta Cell Compensation
Time Frame: 24 months
mean plasma C-peptide concentration during clamp steady state, adjusted for mean clamp insulin sensitivity