About 60% of patients with type 2 diabetes mellitus achieve remission after Roux-en-Y gastric bypass ( RYGB ) surgery. No accurate method is available to preoperatively predict the probability of remission.
The aim of study was to develop a way to predict probability of diabetes mellitus remission after RYGB surgery on the basis of preoperative clinical criteria.
In a retrospective cohort study, researchers have identified individuals with type 2 diabetes mellitus for whom electronic medical records were available from a primary cohort of 2300 patients who underwent RYGB surgery at the Geisinger Health System ( Danville, PA, USA ) between Jan 1, 2004, and Feb 15, 2011.
Partial and complete remission were defined according to the American Diabetes Association ( ADA ) criteria.
Investigators have examined 259 clinical variables for our algorithm and used multiple logistic regression models to identify independent predictors of early remission ( beginning within first 2 months after surgery and lasting at least 12 months ) or late remission ( beginning more than 2 months after surgery and lasting at least 12 months ).
Electronic medical records were available for 690 patients in the primary cohort, of whom 463 ( 63% ) had achieved partial or complete remission.
Four preoperative clinical variables were included in the final Cox regression model: insulin use, age, HbA1c concentration, and type of antidiabetic drugs.
Researchers have developed a DiaRem score that ranges from 0 to 22, with the greatest weight given to Insulin use before surgery ( adding ten to the score; HR 5.90; p less than 0.0001 ).
Kaplan-Meier analysis showed that 88% of patients who scored 0-2, 64% of those who scored 3-7, 23% of those who scored 8-12, 11% of those who scored 13-17, and 2% of those who scored 18-22 has achieved early remission ( partial or complete ).
As in the primary cohort, the proportion of patients achieving remission in the replication cohorts was highest for the lowest scores, and lowest for the highest scores.
In conclusion, the DiaRem score is a novel preoperative method to predict the probability of remission of type 2 diabetes mellitus after RYGB surgery. ( Xagena )
Still CD et al, The Lancet Diabetes & Endocrinology 2014; 38-45