CREON for the Treatment of Post-RYGB Hypoglycemia

Phase 1TerminatedNCT02733848

East Carolina University5 enrolled

Overview

Hypoglycemia is an increasingly recognized complication of Roux-en-Y gastric bypass (RYGB) that is poorly understood and difficult to treat. Investigators hypothesize that after RYGB some patients have incomplete carbohydrate absorption in the small intestine which leads to inconsistent glucose levels and hypoglycemia during oral consumption of a meal. Investigators further hypothesize that pancreatic enzyme supplementation with (Creon) during meals and snacks will improve carbohydrate absorption and lead to more stable glucose levels in patients with post-RYGB hypoglycemia.

Primary Objective: Evaluate the feasibility and safety of Creon in the treatment of post-RYGB hypoglycemia as add-on therapy to a diet higher in protein and lower in carbohydrate. Secondary Objective: Evaluate utility of continuous glucose monitoring (CGM) in monitoring hypoglycemia as an adjunct to standard venous blood testing using a glucometer in post-RYGB hypoglycemia.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Hypoglycemia

Interventions

CreonDRUG

Creon is a porcine derived pancreatic enzyme supplement that comes in in fixed dose combinations of lipase, protease, and amylase, respectively. Dosing is based on lipase per kilograms per meal (i.e. lipase units/kg/meal). Subjects will be started at a dose of 500 units of lipase/kg/meal and snacks at week 4 and continued until week 8. A follow-up visit at week 6 will assess patient for tolerance to Creon and need for dosage adjustment. Formulations come in different fixed dose combinations as follows: Creon: Lipase 3000 USP units, protease 9500 USP units, and amylase 15,000 USP units Creon: Lipase 6000 USP units, protease 19,000 USP units, and amylase 30,000 USP units Creon: Lipase 12,000 USP units, protease 38,000 USP units, and amylase 60,000 USP units Creon: Lipase 24,000 USP units, protease 76,000 USP units, and amylase 120,000 USP units Creon: Lipase 36,000 USP units, protease 114,000 USP units, and amylase 180,000 USP units

DietOTHER

A registered dietician will meet with the subject and take a thorough review of the patient's dietary history. The subject will then be counseled on a lower carbohydrate and higher protein diet. This diet will be continued for the entire 12 week of the study. The registered dietician will reinforce dietary recommendations by phone on week 2, 4 and 8, respectively.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Males and females 18 years and older * At least 6 months post-RYGB surgery * Clinical history of post-surgical hypoglycemia evident by subjective symptoms (i.e. tachycardia, sweating, hunger, confusion) and glucose monitoring demonstrating a venous blood sugars \< 70 mg/dL * Women must be postmenopausal, surgically sterile, not heterosexually active or heterosexually active using highly effective method of birth control * Women of childbearing potential must have negative pregnancy test * Subjects must have signed an informed consent document indicating they understand the purpose of and procedures required for the study and be willing to participate in the study * Willing and able to adhere to restrictions and follow instructions specific to this study * Adequate compliance in performing self-monitoring blood glucose (SMBG) testing at least three or more times per week and taking assigned medication dose as instructed Exclusion Criteria: * Current or past history of type 1 or type 2 diabetes * Known hypersensitivity to Creon * Known hypersensitivity to pork-derived products * Liver function studies 2 times the upper limit of normal (ALT \& AST) and/or a GFR \< 90 * History of fibrosing colonic strictures * History of gastroparesis, dysphagia, chronic abdominal pain, gastric outlet obstruction, chronic pancreatitis * History of stomach, small intestine or colon surgery other than Roux-en-Y gastric bypass * An active cancer of any type requiring concurrent treatment * History of gout or hyperuricemia * Current anemia requiring iron replacement * Any clinically significant condition that in the opinion of the investigator would make participation not in the best interest or safety of the subject or could prevent limit or confound the specific endpoints assessments * Not participating in any other research study * Known history of drug or alcohol abuse within 6 months of screening visit * Pregnancy or lactation (breastfeeding) * Informed consent withdrawal by subject

Outcomes

Primary Outcomes

Frequency of Hypoglycemia

The effect of DIET, CREON and PLACEBO on the number of hypoglycemic events (i.e. \<70 mg/dl) will be assessed using a standard blood glucose monitor that measures glucose in venous blood.

Time frame: 2 years

Secondary Outcomes

Continuous Glucose Monitoring using the Medtronic iPro 2

The effect of DIET, CREON and PLACEBO on the percent of time iPro 2 glucose values are less than 70 mg/dL will be measured.

Time frame: 2 years

Data from ClinicalTrials.gov

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