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 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 mMxmin) compared with gastroduodenal feeding . β-cell function (iAUC_Cpeptide/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.

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