Postprandial diabetic glucose tolerance is normalized by gastric bypass feeding as opposed to gastric feeding and is associated with exaggerated GLP-1 secretion: a case report.
OBJECTIVE
To examine after gastric bypass the effect of peroral versus gastroduodenal feeding on glucose metabolism.


METHODS
A type 2 diabetic patient was examined on 2 consecutive days 5 weeks after gastric bypass. A standard liquid meal was given on the first day into the bypassed gastric remnant and on the second day perorally. Plasma glucose, insulin, C-peptide, glucagon, incretin hormones, peptide YY, and free fatty acids were measured.


RESULTS
Peroral feeding reduced 2-h postprandial plasma glucose (7.8 vs. 11.1 mmol/l) and incremental area under the glucose curve (iAUC) (0.33 vs. 0.49 mmol . l(-1) . min(-1)) compared with gastroduodenal feeding. beta-Cell function (iAUC(Cpeptide/Glu)) was more than twofold improved during peroral feeding, and the glucagon-like peptide (GLP)-1 response increased nearly fivefold.


CONCLUSIONS
Improvement in postprandial glucose metabolism after gastric bypass is an immediate and direct consequence of the gastrointestinal rearrangement, associated with exaggerated GLP-1 release and independent of changes in insulin sensitivity, weight loss, and caloric restriction.
Dirksen
Carsten
C
Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark. cardir@gmail.com
Hansen
Dorte L
DL
Madsbad
Sten
S
Hvolris
Lisbeth E
LE
Naver
Lars S
LS
Holst
Jens J
JJ
Worm
Dorte
D
D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000601:surgery; D004750:Enteral Nutrition; D005230:Fatty Acids, Nonesterified / Q000097:blood; D015390:Gastric Bypass; D005934:Glucagon / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood / Q000378:metabolism*; D006801:Humans; D054795:Incretins / Q000097:blood; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D019894:Peptide YY / Q000097:blood; D011184:Postoperative Period; D019518:Postprandial Period / Q000502:physiology*
D001786:Blood Glucose; D002096:C-Peptide; D005230:Fatty Acids, Nonesterified; D054795:Incretins; D019894:Peptide YY; D052216:Glucagon-Like Peptide 1; D005934:Glucagon