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Hormone infusion

Infusion of three hormones aids weight loss in patients with obesity

Researchers wanted to see if infusing patients with GOP to mimic the high levels seen after surgery, could aid weight loss and reduce high glucose levels

A small study examining the effects of subcutaneous infusion of three hormones - glucagon-like peptide 1 (GLP-1), oxyntomodulin (OXM) and peptide YY (PYY) collectively known as ‘GOP’ - on glycaemia and body weight has report that patients lost on average 4.4kg and the treatment led to substantial improvements to their blood glucose, with some patients' reducing to near-normal levels.

The paper, ‘Combined GLP-1, Oxyntomodulin, and Peptide YY Improves Body Weight and Glycemia in Obesity and Prediabetes/Type 2 Diabetes: A Randomized, Single-Blinded, Placebo-Controlled Study’, was published in Diabetes Care by researchers from Imperial College London. The study, presented at the American Diabetes Association 79th Scientific Sessions meeting at San Francisco, was in collaboration with University of Copenhagen and University College Dublin. The treatment was trialled on patients at the National Institute for Health Research Imperial Clinical Research Facility at Hammersmith Hospital, part of Imperial College Healthcare NHS Trust.

Tricia Tan

Previous research by the same group suggested that one of the reasons why gastric bypass surgery works so well is because these three specific hormones originating from the bowels are released in higher levels. This hormone combination reduces appetite, causes weight loss and improves the body's ability to use the sugar absorbed from eating.

"Obesity and type 2 diabetes can lead to very serious and potentially life-threatening conditions such as cancer, stroke and heart disease. There is a real need to find new medicines so we can improve and save the lives of many patients,” said Professor Tricia Tan, Professor of Practice (Metabolic Medicine & Endocrinology) at Imperial College London and lead author of the study. “Although this is a small study our new combination hormone treatment is promising and has shown significant improvements in patients' health in only four weeks. Compared to other methods the treatment is non-invasive and reduced glucose levels to near-normal levels in our patients."

Researchers wanted to see if infusing patients with GOP to mimic the high levels seen after surgery, could aid weight loss and reduce high glucose levels. In the study, 15 patients were given the GOP treatment for four weeks using a pump that slowly injects the GOP mixture under the skin for 12 hours a day, beginning one hour before breakfast and disconnecting after their last meal of the day. Patients also received dietetic advice on healthy eating and weight loss from a dietician. Whilst 11 patients were given a saline (saltwater) infusion as a placebo over a four-week period.

The team also recruited 21 patients who had undergone bariatric surgery and 22 patients who followed a very low-calorie diet to compare the results of GOP. All patients were given a glucose monitoring device to track their glucose levels following treatment.

The results showed that patients on the GOP treatment lost an average of 4.4kg, compared with 2.5kg for participants receiving a saline placebo. The treatment also had no side effects. However, patients who received bariatric surgery or who followed a very low-calorie diet lost significantly more weight than GOP patients. The changes in weight were 10.3kg for bariatric patient and 8.3kg for patients who followed a very low-calorie diet.

“Although the weight loss was smaller, using the GOP infusion would be preferable as it has fewer side effects than bariatric surgery,” said Tan. “This result shows that it is possible to obtain some of the benefits of a gastric bypass operation without undergoing the surgery itself. If further trials are successful, in future we could potentially give this type of treatment to many more patients.”

The team also found that GOP was capable of lowering blood glucose levels to near-normal levels, with little variation in the blood glucose. Patients who received bariatric surgery also had an overall improvement in blood glucose, but the levels were much more variable, leaving them vulnerable to low blood glucose levels. The team aim to carry out a larger clinical trial to assess the impact of GOP on more patients over a longer period of time.

“We conclude that the postprandial elevations in GLP-1, OXM, and PYY after RYGB may be responsible for the glycaemic improvements and some of the weight loss benefits from surgery. There may be other contributions from surgical anatomical changes that lead to larger weight loss,” they researchers concluded. “GOP achieves superior glucose tolerance to VLCD, reduces glucose variability, and lowers the risk of provoking hypoglycaemia compared with RYGB. Together, this suggests that ‘triple agonism’ with GLP-1, OXM, and PYY is a viable alternative to RYGB for the treatment of diabetes, with favourable effects on body weight, in patients who may not be able to have bariatric surgery.”

To access this paper, please click here

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