Health Effects of Liposuction in Overweight Women With Elevated Insulin Levels, Impaired Glucose Tolerance and/or Type 2 Diabetes
Health Effects of Liposuction in Overweight Women With Elevated Insulin Levels, Impaired Glucose Tolerance and/or Type 2 Diabetes
This study is for women who have already decided to undergo liposuction at Georgetown
 University Medical Center in Washington, D.C. To take part in this study, a woman must first
 meet with the plastic surgeons there, and be accepted by them to have liposuction. This study
 will investigate whether large volume liposuction improves risk factors for heart disease in
 overweight women with type 2 (adult onset) diabetes, impaired glucose tolerance, or elevated
 blood insulin levels. Large volume liposuction is the surgical removal of at least 10 pounds
 (4.5 kg) of body fat, usually from the abdomen, hips or chest. Risk factors for heart disease
 include high blood pressure and elevated levels of blood lipids (cholesterol and
 triglycerides), blood glucose (sugar), and blood insulin. Subjects who participate in all
 parts of this study will receive a total of $930.00.

 Overweight women 18 years or older with high blood insulin levels, impaired glucose
 tolerance, or type 2 diabetes, who are planning to have large volume liposuction performed at
 Georgetown University Medical Center in Washington, D.C., may be eligible for this study. For
 a subject to be accepted into this study, she must first meet with the plastic surgeons at
 Georgetown University Medical Center, and they have to agree to perform large volume
 liposuction. The decision that someone is suitable for liposuction is not under the control
 of the NIH or of any NIH investigator.

 Those enrolled will undergo the following procedures at four separate times - before
 undergoing liposuction, 4 weeks after surgery, 4 months after surgery and 1 year after
 surgery:

 -  Body measurements - taken with calipers to measure several skinfold thicknesses (the
 width of a fat fold) and with a tape measure to measure the circumference of parts of
 the body.

 -  Urine sample and 6-hour urine collection - to test for pregnancy and to evaluate kidney
 function.

 -  Glucose tolerance test - measures insulin sensitivity and how the body uses sugar, how
 well insulin works, and insulin sensitivity. The procedure involves placement of two
 catheters (thin, flexible tubes) through a needle into a vein in each arm. Sugar water
 is infused into one catheter and 20 minutes into the test a small amount of insulin is
 injected. Blood samples are drawn from the other catheter at frequent intervals for a
 total of 5 hours.

 -  Electrocardiogram (ECG) and echocardiography - measure the heart's electrical activity
 and function.

 -  Abdominal computerized tomography (CT) scan - produces images for measuring body fat in
 the abdomen. (not done at the 4-week visit). Takes about half an hour to complete.

 -  DXA X-ray - measures body fat, muscle and bone mineral content. Takes about half an hour
 to complete.

 -  Bod Pod - capsule-like device used to determine the proportion of body weight composed
 of fat and non-fat tissue. Takes less than 10 minutes

 -  Bioelectric impedance analysis device - measures the proportions of body fat based on
 electrical conduction of a small electric current. Takes 2-3 minutes.

 -  24-hour blood pressure monitoring - a device attached to a blood pressure cuff strapped
 to the arm measures blood pressure every 15 to 30 minutes continuously for 24 hours.

 -  Vascular reactivity tests - a blood pressure cuff is inflated for about 4 minutes before
 deflating, providing information on the function of the small blood vessels in the skin,
 as well as an idea of the function level of small blood vessels elsewhere in the body.
 Takes half an hour.

 -  Blood samples - collected to evaluate kidney and liver function and to measure body
 lipids, such as cholesterol, minerals, and other substances.
Obesity is a major predisposing factor for future Type 2 diabetes because it is often
 associated with insulin resistance and impaired glucose tolerance. Insulin resistance has
 been suggested as the common link for other aspects of the cardiac dysmetabolic syndrome that
 includes hypertension, dyslipidemia, obesity, and macrovascular arterial disease. There are
 racial disparities in the prevalence of both obesity and Type 2 diabetes: Compared with
 non-Hispanic Caucasians, African American women have almost twice the prevalence of
 overweight, obesity, and Type 2 diabetes.

 Because data from predominantly Caucasian populations suggest that the quantity of truncal
 (sometimes called upper body) adipose tissue, which includes the adipose tissue surrounding
 the abdominal viscera, is far more important for risk stratification than that found in the
 limbs or buttocks, which contain subcutaneous adipose tissue, it has been presumed that
 attempts at treatment of obesity should concentrate on reducing visceral fat. However,
 despite their greater risks for the complications of obesity, African Americans have less
 visceral abdominal adipose tissue than Caucasians matched for body weight. Further, recent
 metabolic studies suggest that upper body subcutaneous adipose tissue may play a significant
 role, particularly for African Americans, in the comorbid metabolic conditions associated
 with obesity.

 With the advent of the large volume liposuction technique, selective removal of substantial
 quantities of subcutaneous adipose tissue has become possible. It is unknown whether the
 complications of obesity can be ameliorated by removal of subcutaneous adipose tissue, but
 one preliminary study suggests that fasting hyperinsulinism can be improved by this approach.

 We propose to conduct a pilot study of 10 patients (five Caucasians and five
 African-Americans) who plan to undergo liposuction. We will investigate how large volume
 liposuction affects the metabolic complications of obesity in overweight patients who have
 hyperinsulinemia, impaired glucose tolerance, or type 2 diabetes. We will investigate the
 effects of liposuction on various indices of the cardiac dysmetabolic syndrome by performing
 studies of insulin sensitivity and lipid metabolism at four time points: before large volume
 liposuction, 1 month after liposuction, 4 months after liposuction, and 1 year after
 liposuction. At each visit we will study body composition, blood pressure, cardiac function,
 dietary habits, insulin insensitivity, free fatty acids, and lipid profiles.
Patients must be in good general health. Patients with chronic stable complications of Type
 2 diabetes or stable obesity related comorbid conditions will not be excluded.

 Obesity: Defined as subjects having a body mass index greater than 30 kg/m(2). Weight must
 be less than 300 lb (136 kg) because of limits related to the DXA and CT scanners.

 Patients with Type 2 Diabetes, impaired glucose tolerance, or hyperinsulinemia are
 eligible.

 Patients' age must be greater than or equal to 18 years at the start of the study.

 Patients must be planning to undergo large volume liposuction.

 Premenopausal women participating in the study must have a negative pregnancy test at the
 start of the study and will be required to remain on some form of effective contraception
 for the duration of the study.

 Patients recruited for the pilot study will be required to have all four grandparents and
 both parents to be either all non-Hispanic Caucasians or non-Hispanic African-American.

 Volunteers with the presence of significant, unstable or evolving renal disease are not
 eligible. Subjects must not have calculated (age and weight corrected) creatinine
 clearances below 50 ml/min or significant worsening of serum creatinine levels during the
 course of the study (greater than 30% increase from baseline).

 Volunteers with the presence of significant, unstable or evolving hepatic disease
 associated with SGOT and/or SGPT greater than 2.5 times normal are not eligible.

 Volunteers with the presence of significant, evolving or unstable cardiac disease are not
 eligible. Subjects with NYHA stage 3 or 4 disease will be excluded from the study.

 Volunteers with the presence of significant, evolving or unstable pulmonary disease
 including uncontrolled bronchial asthma and/or chronic bronchitis are not eligible.

 Volunteers with the presence of other uncontrolled or unstable medical conditions including
 uncontrolled thyroid disease, Cushing's syndrome, autoimmune or gastrointestinal disease
 are not eligible.

 Volunteers who are pregnant are not eligible.

 Volunteers must not have uncontrolled Type 2 diabetes as evidenced by recent coma or
 pre-coma states, frequent episodes of hypoglycemia, predominantly severe hyperglycemia
 (plasma glucose greater than 400 mg/dl) in the past three months prior to study
 commencement, a glycosylated hemoglobin (HBA1C) value greater than 10 in the past three
 months prior to the study commencement, and frequent or recurrent episodes of ketosis
 (ketonuria and/or ketonemia).

 Volunteers with uncontrolled, significant or evolving psychiatric/psychological syndromes
 which in the opinion of the investigators would place the patient at increased risk during
 the course of the study or would impede competence and/or ability to complete the study are
 not eligible.

 Volunteers with current history of illicit substance abuse and/or alcoholism based on
 reported history and the CAGE questionnaire are not eligible.

 Volunteers must not have a recent use (within the preceding 6 months) of anorexiant
 medications or medications that would affect nutrient absorption such as orlistat or
 acarbose.

 Volunteers must not be receiving treatment with an insulin-sensitizing medication such as
 metformin or the thiazolidinediones. Use of insulin, meglitides or the sulphonylureas will
 not constitute an exclusion.

 Volunteers with an absence of spontaneous menses for greater than 1 year are not eligible.