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01-07-2018 | Original Contributions

Predicting remission of diabetes post metabolic surgery: a comparison of ABCD, diarem, and DRS scores

Authors: Anmol Ahuja, Om Tantia, Tamonas Chaudhuri, Shashi Khanna, Shivakumar Seetharamaiah, Kajari Majumdar, Ghanshyam Goyal

Published in: Obesity Surgery | Issue 7/2018

Abstract

Background

Obesity is one of the major causes for development of T2DM. Metabolic surgery has been proved to be a successful and cost-effective treatment modality for managing the patients with obesity and T2DM. Many scoring systems and models have been described in literature to predict the outcome of T2DM after metabolic surgery. The aim of this study is to compare the efficacy of Diarem, DRS, and ABCD score in predicting the T2DM remission.

Methods

A total number of 102 diabetic patients, who underwent LMGB/LOAGB, were selected for this study. A retrospective analysis of the three scoring systems when applied to these patients and their predictive abilities were analyzed.

Results

At 1 year after surgery, 72 (70.59%) patients achieved remission of T2DM. Though the pairwise comparisons between AUC on ROC analysis of ABCD, Diarem, and DRS scores does not show statistically significant difference between them, Diarem score has the maximum relative area under ROC curves. By multivariate analysis, it was found that factors significantly associated with T2DM remission were duration of T2DM, C-peptide, and Pre-Op HbA1c.

Conclusions

Among the three scoring systems, though DiaRem score has the best sensitivity and specificity and maximum AUC, no statistically significant difference was found in their diabetes remission predicting abilities. A shorter duration of T2DM, a lower HbA1C, and higher levels of C-peptide were significantly associated with a higher chance of T2DM remission.

Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56. e5. https://doi.org/10.1016/j.amjmed.2008.09.041.CrossRefPubMed

American Diabetes Association. Obesity management for the treatment of type 2 diabetes. Sec. 6. In standards of medical care in Diabetes—2016. Diabetes Care. 2016;39(Suppl. 1):S47–51.

De Luca M, Angrisani L, Himpens J, et al. Indications for surgery for obesity and weight-related diseases: position statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg. 2016;26(8):1659–96. https://doi.org/10.1007/s11695-016-2271-4.CrossRefPubMedPubMedCentral

Hayes MT, Hunt LA, Foo J, et al. A model for predicting the resolution of type 2 diabetes in severely obese subjects following Roux-en Y gastric bypass surgery. Obes Surg. 2011;21(7):910–6. https://doi.org/10.1007/s11695-011-0370-9.CrossRefPubMed

Ramos Levi AM, Matia P, Cabrerizo L, et al. Statistical models to predict type 2 diabetes remission after bariatric surgery. J Diabetes. 2014;6(5):472–7. https://doi.org/10.1111/1753-0407.12127.CrossRefPubMed

Lee WJ, Hur KY, Lakadawala M, et al. Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score. Surg Obes Relat Dis. 2013;9(3):379–84. https://doi.org/10.1016/j.soard.2012.07.015.CrossRefPubMed

Still CD, Wood GC, Benotti P, et al. A probability score for preoperative prediction of type 2 diabetes remission following RYGB surgery. Lancet Diabetes Endocrinol. 2014;2(1):38–45. https://doi.org/10.1016/S2213-8587(13)70070-6.CrossRefPubMedPubMedCentral

Ugale S, Gupta N, Modi KD, et al. Prediction of remission after metabolic surgery using a novel scoring system in type 2 diabetes—a retrospective cohort study. J Diabetes Metab Disord. 2014;13(1):89. https://doi.org/10.1186/s40200-014-0089-y.CrossRefPubMedPubMedCentral

Aminian A, Brethauer A, Andalib A, et al. Individualized metabolic surgery score: procedure selection based on diabetes severity. Ann Surg. 2017;266(4):650–7. https://doi.org/10.1097/SLA.0000000000002407.CrossRefPubMed

10.

Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133–5. https://doi.org/10.2337/dc09-9036.CrossRefPubMedPubMedCentral

11.

Rutledge R. The mini-gastric bypass: experience with the 1,274 cases. Obes Surg. 2001;11(3):276–80. https://doi.org/10.1381/096089201321336584.CrossRefPubMed

12.

Seetharamaiah S, Tantia O, Goyal G, et al. LSG vs OAGB—1 year follow-up data—a randomized control trial. Obes Surg. 2017;27(4):948–54. https://doi.org/10.1007/s11695-016-2403-x.CrossRefPubMed

13.

Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047–53. https://doi.org/10.2337/diacare.27.5.1047.CrossRefPubMed

14.

Barry JDMT, Stephens JW, et al. Predicting the resolution of type 2 diabetes after bariatric surgical procedures: a concise review. J Diabetes Metab. 2015;6(10):1–5.CrossRef

15.

Lee W-J, Chong K, Chen J-C, et al. Predictors of diabetes remission after bariatric surgery in Asia. Asian J Surg. 2012;35(2):67–73. https://doi.org/10.1016/j.asjsur.2012.04.010.CrossRefPubMed

16.

Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–52. https://doi.org/10.1097/00000658-199509000-00011.CrossRefPubMedPubMedCentral

17.

Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238:467–85.PubMedPubMedCentral

18.

Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93. https://doi.org/10.1056/NEJMoa035622.CrossRefPubMed

19.

Cersosimo E, Triplitt C, Mandarino LJ, et al. Pathogenesis of type 2 diabetes mellitus. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–2015 May 28.

20.

Praveen Raj P, Bhattacharya S, Saravana Kumar S, et al. Do bariatric surgery-related type 2 diabetes remission predictors add clinical value? A study on Asian Indian obese diabetics. Obes Surg. 2017;27(8):2113–9. https://doi.org/10.1007/s11695-017-2615-8.CrossRefPubMed

21.

Hamza N, Abbas MH, Darwish A, et al. Predictors of remission of type 2 diabetes mellitus after laparoscopic gastric banding and bypass. Surg Obes Relat Dis. 2011;7(6):691–6. https://doi.org/10.1016/j.soard.2010.03.292.CrossRefPubMed

22.

Huang C-K, Shabbir A, Lo C-H, et al. Laparoscopic roux-en-Y gastric bypass for the treatment of type II diabetes mellitus in Chinese patients with body mass index of 25-35. Obes Surg. 2011;21(9):1344–9. https://doi.org/10.1007/s11695-011-0408-z.CrossRefPubMedPubMedCentral

23.

Wang G-F, Yan Y-X, Xu N, et al. Predictive factors of type 2 diabetes mellitus remission following bariatric surgery: a meta-analysis. Obes Surg. 2015;25(2):199–208. https://doi.org/10.1007/s11695-014-1391-y.CrossRefPubMed

24.

Bhasker AG, Remedios C, Batra P, et al. Predictors of remission of T2DM and metabolic effects after laparoscopic Roux-en-y gastric bypass in obese Indian diabetics-a 5-year study. Obes Surg. 2015;25(7):1191–7. https://doi.org/10.1007/s11695-014-1501-x.CrossRefPubMed

25.

Lee W-J, Hur KY, Lakadawala M, et al. Gastrointestinal metabolic surgery for the treatment of diabetic patients: a multi-institutional international study. J Gastrointest Surg. 2012;16(1):42–5.CrossRef

26.

Lee MH, Lee W-J, Chong K, et al. Predictors of long-term diabetes remission after metabolic surgery. J Gastrointest Surg. 2015;19(6):1015–21. https://doi.org/10.1007/s11605-015-2808-1.CrossRefPubMed

27.

Rosenthal R, Li X, Samuel S, et al. Effect of sleeve gastrectomy on patients with diabetes mellitus. Surg Obes Relat Dis. 2009;5(4):429–34. https://doi.org/10.1016/j.soard.2008.11.006.CrossRefPubMed

28.

Lee WJ, Ser KH, Chong K, et al. Laparoscopic sleeve gastrectomy for diabetes treatment in non-morbidly obese patients: efficacy and change of insulin secretion. Surgery. 2010;147(5):664–9. https://doi.org/10.1016/j.surg.2009.10.059.CrossRefPubMed

29.

Hall TC, Pellen MG, Sedman PC, et al. Preoperative factors predicting remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass surgery for obesity. Obes Surg. 2010;20(9):1245–50. https://doi.org/10.1007/s11695-010-0198-8.CrossRefPubMed

30.

Robert M, Ferrand-Gaillard C, Disse E, et al. Predictive factors of type 2 diabetes remission 1 year after bariatric surgery: impact of surgical techniques. Obes Surg. 2013;23(6):770–5. https://doi.org/10.1007/s11695-013-0868-4.CrossRefPubMed

31.

Dixon JB, Chuang L-M, Chong K, et al. Predicting the glycemic response to gastric bypass surgery in patients with type 2 diabetes. Diabetes Care. 2013;36(1):20–6. https://doi.org/10.2337/dc12-0779.CrossRefPubMed

32.

Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85. https://doi.org/10.1056/NEJMoa1200111.CrossRefPubMed

33.

Panunzi S, De Gaetano A, Carnicelli A, et al. Predictors of remission of diabetes mellitus in severely obese individuals undergoing bariatric surgery: do BMI or procedure choice matter? A metaanalysis. Ann Surg. 2015;261(3):459–67. https://doi.org/10.1097/SLA.0000000000000863.CrossRefPubMed

34.

Lee W-J, Chong K, Chen S-C, et al. Preoperative prediction of type 2 diabetes remission after gastric bypass surgery: a comparison of DiaRem scores and ABCD scores. Obes Surg. 2016;26(10):2418–24. https://doi.org/10.1007/s11695-016-2120-5.CrossRefPubMed

35.

Aminian A, Brethauer SA, Kashyap SR, et al. DiaRem score: external validation. Lancet Diabetes Endocrinol. 2014;2(1):12–3. https://doi.org/10.1016/S2213-8587(13)70202-X.CrossRefPubMed

36.

Tharakan G, Scott R, Szepietowski O, et al. Limitations of the DiaRem score in predicting remission of diabetes following Roux-En-Y gastric bypass (RYGB) in an ethnically diverse population from a single institution in the UK. Obes Surg. 2017;27(3):782–6. https://doi.org/10.1007/s11695-016-2368-9.CrossRefPubMed

37.

Lee WJ, Almulaifi A, Chong K, et al. The effect and predictive score of gastric bypass and sleeve gastrectomy on type 2 diabetes mellitus patients with BMI < 30 kg/m². Obes Surg. 2015;25(10):1772–8. https://doi.org/10.1007/s11695-015-1603-0.CrossRefPubMed

38.

Pournaras DJ, Roux CW. Can we predict diabetes remission after weight loss surgery? Lancet Diabetes Endocrinol. 2014;2(1):4–6. https://doi.org/10.1016/S2213-8587(13)70108-6.CrossRefPubMed

Title: Predicting remission of diabetes post metabolic surgery: a comparison of ABCD, diarem, and DRS scores
Authors: Anmol Ahuja
Om Tantia
Tamonas Chaudhuri
Shashi Khanna
Shivakumar Seetharamaiah
Kajari Majumdar
Ghanshyam Goyal
Publication date: 01-07-2018
Publisher: Springer US
Published in: Obesity Surgery / Issue 7/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-018-3136-9

At a glance: The STEP trials

Springer Medicine

Predicting remission of diabetes post metabolic surgery: a comparison of ABCD, diarem, and DRS scores

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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