Resumen de 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, Dorte L. Hansen, Sten Madsbad, Lisbeth E. Hvolris, Lars S. Naver, Jens J. Holst, Dorte Worm
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.
