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01-10-2017 | Article

The advanced-DiaRem score improves prediction of diabetes remission 1 year post-Roux-en-Y gastric bypass

Authors: Judith Aron-Wisnewsky, Nataliya Sokolovska, Yuejun Liu, Doron S. Comaneshter, Shlomo Vinker, Tal Pecht, Christine Poitou, Jean-Michel Oppert, Jean-Luc Bouillot, Laurent Genser, Dror Dicker, Jean-Daniel Zucker, Assaf Rudich, Karine Clément

Published in: Diabetologia | Issue 10/2017

Abstract

Aims/hypothesis

Not all people with type 2 diabetes who undergo bariatric surgery achieve diabetes remission. Thus it is critical to develop methods for predicting outcomes that are applicable for clinical practice. The DiaRem score is relevant for predicting diabetes remission post-Roux-en-Y gastric bypass (RYGB), but it is not accurate for all individuals across the entire spectrum of scores. We aimed to develop an improved scoring system for predicting diabetes remission following RYGB (the Advanced-DiaRem [Ad-DiaRem]).

Methods

We used a retrospective French cohort (n = 1866) that included 352 individuals with type 2 diabetes followed for 1 year post-RYGB. We developed the Ad-DiaRem in a test cohort (n = 213) and examined its accuracy in independent cohorts from France (n = 134) and Israel (n = 99).

Results

Adding two clinical variables (diabetes duration and number of glucose-lowering agents) to the original DiaRem and modifying the penalties for each category led to improved predictive performance for Ad-DiaRem. Ad-DiaRem displayed improved area under the receiver operating characteristic curve and predictive accuracy compared with DiaRem (0.911 vs 0.856 and 0.841 vs 0.789, respectively; p = 0.03); thus correcting classification for 8% of those initially misclassified with DiaRem. With Ad-DiaRem, there were also fewer misclassifications of individuals with mid-range scores. This improved predictive performance was confirmed in independent cohorts.

Conclusions/interpretation

We propose the Ad-DiaRem, which includes two additional clinical variables, as an optimised tool with improved accuracy to predict diabetes remission 1 year post-RYGB. This tool might be helpful for personalised management of individuals with diabetes when considering bariatric surgery in routine care, ultimately contributing to precision medicine.

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Title: The advanced-DiaRem score improves prediction of diabetes remission 1 year post-Roux-en-Y gastric bypass
Authors: Judith Aron-Wisnewsky
Nataliya Sokolovska
Yuejun Liu
Doron S. Comaneshter
Shlomo Vinker
Tal Pecht
Christine Poitou
Jean-Michel Oppert
Jean-Luc Bouillot
Laurent Genser
Dror Dicker
Jean-Daniel Zucker
Assaf Rudich
Karine Clément
Publication date: 01-10-2017
Publisher: Springer Berlin Heidelberg
Published in: Diabetologia / Issue 10/2017
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-017-4371-7

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