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, MD (cardir{at}gmail.com)1,
- 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
- 1Dept. of Endocrinology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
- 2Dept. of Gastroenterology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
- 3Dept. of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
Abstract
Objective: To examine after gastric bypass the effect of peroral vs. gastroduodenal feeding on glucose metabolism.
Research Design and Methods: A type 2 diabetic patient was examined on two 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 mM) and incremental-area-under-the-glucose-curve (0.33 vs. 0.49 mM×min) compared with gastroduodenal feeding . β-cell function (iAUCCpeptide/Glu) was more than 2-fold improved during peroral feeding and the GLP-1 response increased nearly 5-fold.
Conclustions: 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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- Received July 27, 2009.
- Accepted November 11, 2009.
- Copyright © American Diabetes Association
