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, MD1,
- Dorte L. Hansen, MD, PHD1,
- Sten Madsbad, DMSC1,
- Lisbeth E. Hvolris, MD2,
- Lars S. Naver, MD2,
- Jens J. Holst, DMSC3 and
- Dorte Worm, MD, PHD1
- 1Department of Endocrinology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark;
- 2Department of Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark;
- 3Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Corresponding author: Carsten Dirksen, cardir{at}gmail.com.
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. β-Cell function (iAUCCpeptide/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.
Footnotes
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received July 27, 2009.
- Accepted November 9, 2009.
- © 2010 by the American Diabetes Association.
