To examine after gastric bypass the effect of peroral versus gastroduodenal feeding on glucose metabolism. 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. Peroral feeding reduced 2-h postprandial plasma glucose (7.8 vs. 11.1 mmol/1) and incremental area under the glucose curve (iAUC) (0.33 vs. 0.49 mmol * 1^sup -1^ * min^sup -1^) compared with gastroduodenal feeding. β-Cell function (iAUC^sub Cpeptide/Glu^) was more than twofold improved during peroral feeding, and the glucagon-like peptide (GLP)-1 response increased nearly fivefold. 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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