This Post is Brought to You By the Number 3

Photo by L Clock

Yes, the number 3.

 This isn't a Sesame Street thing, timed as a 'November Surprise' to help sway the election.  This may actually be more important than that to a lot of patients out there with type 2 Diabetes and obesity.

I already let you know we were in Vegas recently, some of the Bariatric group at Ellis, to attend the Fall meeting of the ASMBS.  One of the eventful things I got out of the meeting was a review of a recent study that qualified the preoperative predictors for a Diabetic patient and the likelihood of Diabetes remission after Gastric Bypass at 1 year post op.

"Predicting the Glycemic Response to Gastric Bypass Surgery in Patients with Type 2 Diabetes" was a study published in Diabetes Care  October 1, 2012.  It looked at 154 ethnic Chinese subjects, and how their glycemic response was influenced by Bypass at 1 year post op.  It defined remission as a HbA1c of less than or equal to 6%.  Remission was achieved in 107 patients (70%) at 12 mos.

The three (as in 3, our magic # for this post) independent preoperative predictors, and therefore 3 clinically useful cutoffs were as follows:

   1.  Diabetes duration of < 4 years.
   2.  BMI of > 35
   3.  Fasting C-Peptide concentration of 2.9 (let's call it 3 for the fun of it...)

The study further concluded, the combination of 2 of 3 of the clinical predictors allowed for a sensitivity of 82% and a specificity of 87% for remission.

This is huge, Caroline, HUG-E.

I have detailed in this Blog, in previous posts, specific Case Studies supporting this degree of remission after Gastric Bypass surgery.  We have discussed the physio-endocrine mechanisms for the remission, or at least, substantial improvement of glycemic control following Bypass, and to a similar degree Sleeve Gastrectomy.

What this study now shows is two-fold, as I see it.  One, it further underscores the power of the procedure- Gastric Bypass causing Diabetes remission.  And two, it shows that sooner is better, and qualifies the clinical cutoffs for when referring a patient sooner is better.

Sending patients for Bariatric surgical consideration when they still have significant Pancreatic Islet Cell reserve, as implied by the "less than 4 years of Diabetes",  and specifically measuring it by C-Peptide as above 2.9 (greater than 3) will give your patient the best chance at the best result from their Bariatric procedure.

So, perhaps the C-Peptide is a more sensitive indicator for referral then which / how many PO Diabetes medicines the patient is on; how much insulin the patient is on; what type of insulin the patient is on (short or long acting); or how heavy (BMI) the patient is.

It is said, Everything happens in 3's... and maybe it's true...

*3 clinical cutoffs for the best timing for Bypass for best chance of Diabetes remission

*A C-Peptide of 3 or higher will likely lead to greater likelihood of Diabetes remission after surgery

*and, of the 3 common procedures we offer,  Bypass and Sleeve are the most likely to give you the greatest metabolic (Diabetes) benefit for your buck perioperatively.

Lastly, 3 has always been my son's favorite number.  Go Red Dragons!

Enough said.  Viva Las Vegas!