Exhibit E

Photo by M Clock

It's time for another patient profile.  And it's time for a Band Diabetes success story.

If you haven't already done so, make sure you take a look at the previous section of posts exclusively on the Gastric Band (Backstage Pass to the Band), and take note of it...

The Band is a valuable tool in the battle against Diabesity as well. 

 Maybe not as sexy as the near immediate metabolic benefit of the Sleeve and the Bypass, with the gastric transection required to do the procedure, but it still has it's place and a potential long term benefit.  

Again, as the studies show, surgery beats non-surgical weight loss, in terms of durability, hands down.

Here is this patient's story, I saw her this week in follow up.

Demographic:  45 y/o F

Start Weight:  230 lb  BMI:  35.6

Date of Surgery:  5/2010  Laparoscopic Adjustable Gastric Banding

DM Hx:  Onset of Diabetes type 2 9/2009.  Started oral agent at that time, Glucophage, but quickly discontinued due to GI side effects.  Glipizide ER 7.5 QD was then started with less side effects, with good results.  Meds were initiated after  failed attempt at weight loss to improve her insulin sensitivity and improve her glycemic control.  BG 180 random, glyco was 8.0 at time of referral for Band. Patient wanted a way to curb her appetite and achieve a durable weight loss to help her DM2 and Hyperlipidemia.  No DM complications at time of surgery.

Current DM Hx:  Current weight is 189, BMI of 30.  Off oral DM meds, last Glycohemoglobin  was 6.1.  Much more active now with exercise, and enjoying her sense of decreased hunger in between meals and the reinforced nature of appropriate portion control.  She is also happy about the improvement in her lipid panel- had labs drawn per her PCP recently and she reported an improved total cholesterol, but I didn't get her actual breakdown yet in the mail.  

Take Home Point:  Nice to have a young patient with mild early Diabetic disease undergo a surgical procedure and see such a drastic improvement in her control of glucose, currently off all meds.  That's the way to get the biggest bang for your Bariatric buck.  Add to that her improved sense of well-being, more palatable / tolerable exercise, and improvement in other co morbidities, and we have a winner!

Who also wins though?  The PCP for an easier time managing this patient as far as her co morbidities go.  The health care system for less burdened care with additional Rx and specialist consults potentially in the future, etc. And of course the patient, for the reasons listed above.

In some ways, this is a simple patient presentation, but it also highlights catching the patient early at a lower BMI, earlier in their Diabetic disease, and being responsive to her desire to have the surgery for her well-researched reasons for health benefits beyond medicines. I believe that's a Trifecta!

It also illustrates the fact that even modest weight loss, in the right  setting, can make a huge difference in a patient's health.  Some of you doubters out there may say that the same results can be achieved with lifestyle modification or other non-surgical means, and you may be right... but surgical weight loss has repeatedly stood the test of time vs. non-surgical means.  I agree though, neither is perfect.

Ask someone who has a substantial weight / BMI how many diets and weight loss programs they have tried...and how much weight they have lost...and kept off...   If it were only that "easy"...