Effect of Bile Acid Sequestration on Postprandial GLP-1 Secretion, Glucose Homeostasis and Gut Microbiota

NCT02061124 | Completed

• 1 other identifier: H-2-2013-148
• Study Type: interventional
• Target: 50
• Locations: 1 country
• Sites: 1

Brief Summary

Accumulating evidence suggests that bile acids and bacteria in our intestines may constitute essential components in the complex mechanisms regulating gut hormone secretion and glucose homeostasis. At the same time, bile acids and gut bacteria are interdependent. Thus, it is likely that modification of the enterohepatic circulation of bile acids can lead to changes in gut hormone secretion or gut bacteria composition and consequently affect glucose homeostasis. The current study is a human interventional study with 7-day ingestion of a bile acid sequestrant or placebo, preceded and followed by meal tests and faecal sampling. The aim is to examine how (and if) bile acid sequestration can influence postprandial glucagon-like peptide-1 (GLP-1) secretion, gut microbiota and glucose homeostasis in patients with type 2 diabetes and healthy individuals. As a tool to sequester bile acids we will use sevelamer, a phosphate binding resin used in the treatment of hyperphosphataemia in adult patients with chronic kidney disease. Surprisingly, sevelamer was recently shown to improve glycaemic control in patients with chronic kidney disease and type 2 diabetes. The investigators hypothesize that higher luminal concentrations of bile acids in the distal gut will elicit changes in the postprandial gut hormone secretion and gut bacteria composition. The current study will help to clarify this hypothesis and improve our general understanding of the association between bile acid circulation and signalling, gut hormone secretion, gut bacteria and glucose metabolism.

Conditions

Type 2 Diabetes

Outcome Measures

Primary Outcomes (1)

• Incremental and total area under the Concentration-Time Curve (AUC 0-240 min)

  Postprandial responses of glucagon-like peptide-1 (GLP-1)

  -30, -15, 0, 10, 20, 30, 45, 60, 90, 120, 180, 240 min on study days 1 and 7 (meal tests start at 0 min)

Secondary Outcomes (1)

• Incremental and total area under the Concentration-Time Curve (AUC 0-240 min)

  -30, -15, 0, 10, 20, 30, 45, 60, 90, 120, 180, 240 min on study days 1 and 7 (meal tests start at 0 min)

Other Outcomes (8)

• Blood analysis

  Fasting status on study days 1 and 7

• Blood analysis

  Fasting status on study days 1 and 7

• Faecal samples

  Prior to study days 1 and 7

Study Arms (4)

T2DM, sevelamer

ACTIVE COMPARATOR

Patients with type 2 diabetes treated with sevelamer

Drug: Sevelamer 1600 mg TID for 7 days

T2DM, placebo

PLACEBO COMPARATOR

Patients with type 2 diabetes treated with placebo

Drug: Placebo 1600 mg TID for 7 days

Healthy subjects, sevelamer

ACTIVE COMPARATOR

Healthy subjects treated with sevelamer

Drug: Sevelamer 1600 mg TID for 7 days

Healthy subjects, placebo

PLACEBO COMPARATOR

Healthy subjects treated with placebo

Drug: Placebo 1600 mg TID for 7 days

Interventions

Sevelamer 1600 mg TID for 7 days DRUG

Healthy subjects, sevelamer; T2DM, sevelamer

Placebo 1600 mg TID for 7 days DRUG

Healthy subjects, placebo; T2DM, placebo

Eligibility Criteria

• Age: 35 Years - 80 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Both groups
• Caucasian ethnicity
• Normal haemoglobin
• Age above 35 years and below 80 years
• Informed and written consent
• BMI \> 23 kg/m2 and \<35 kg/m2
• Patients with type 2 diabetes
• Type 2 diabetes for at least 3 months
• Diagnosed according to the criteria of the World Health Organization (WHO)
• Healthy Subjects
• Normal fasting plasma glucose (FPG) \<6.5 mM and
• Normal glycated haemoglobin (HbA1c) \<6.0 %

You may not qualify if:

• Both groups
• Liver disease (alanine aminotransferase (ALAT) and/or serum aspartate aminotransferase (ASAT) \>2 times normal values) or history of hepatobiliary disorder
• Gastrointestinal disease, previous intestinal resection, cholecystectomy or any major intra-abdominal surgery
• Hypo- or hyperphosphataemia
• Nephropathy (serum creatinine \>150 µM and/or albuminuria
• Treatment with medicine that cannot be paused for 12 hours
• Intake of antibiotics six months prior to study
• Hypo- or hypercalcaemia
• Hypo- and hyperthyroidism
• Treatment with oral anticoagulants
• Active or recent malignant disease
• Any treatment or condition requiring acute or sub-acute medical or surgical intervention
• Lack of effective birth control in premenopausal women
• Positive pregnancy test on study days in premenopausal women
• Tobacco smoking

Sponsors & Collaborators

• University Hospital, Gentofte, Copenhagen: lead
• Sanofi: collaborator

Study Sites (1)

Diabetes Research Division, Gentofte Hospital, Copenhagen

Hellerup, 2900, Denmark

Location

MeSH Terms

Conditions

Diabetes Mellitus, Type 2

Interventions

Sevelamer

Condition Hierarchy (Ancestors)

Diabetes Mellitus; Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases

Intervention Hierarchy (Ancestors)

Polyamines; Amines; Organic Chemicals

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, INVESTIGATOR
• Purpose: BASIC SCIENCE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: MD

Study Record Dates

• First Submitted: February 6, 2014
• First Posted: February 12, 2014
• Study Start: February 1, 2014
• Primary Completion: October 1, 2015
• Study Completion: October 1, 2015
• Last Updated: November 23, 2015

Record last verified: 2015-11

Locations

DK (1)