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Case Reports
. 2010 Feb;33(2):375-7.
doi: 10.2337/dc09-1374. Epub 2009 Nov 16.

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

Carsten Dirksen  1 , Dorte L Hansen, Sten Madsbad, Lisbeth E Hvolris, Lars S Naver, Jens J Holst, Dorte Worm
Affiliations
Case Reports

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

Carsten Dirksen et al. Diabetes Care. 2010 Feb.

Abstract

Objective: To examine after gastric bypass the effect of peroral versus gastroduodenal feeding on glucose metabolism.

Research design and 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.

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Figures

Figure 1
Figure 1
Plasma concentrations of glucose (A), insulin (B), C-peptide (C), glucagon (D), GLP-1 (E), intact GIP (F), PYY (G), and FFAs (H) after peroral or gastroduodenal feeding in a RYGB-operated patient. Figure includes iAUC estimations. Triangles and dotted lines, peroral feeding; circles and solid lines, gastroduodenal feeding.
See this image and copyright information in PMC

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