Sep 20 2013
By Joanna Lyford, Senior medwireNews Reporter
A new scoring system offers a “scientifically valid” way of predicting the 5-year likelihood for diabetes remission in patients undergoing gastric bypass surgery, say the researchers who developed the score.
The DiaRem score will help clinicians to assess the risks and benefits of Roux-en-Y gastric bypass (RYGB) surgery and to decide whether additional measures are needed to improve the odds for remission, explain George Argyropoulos (Weis Center for Research, Danville, Pennsylvania, USA) and team.
RYGB is performed primarily to achieve weight loss in morbidly obese individuals, but its impact on metabolic parameters – and specifically the 60% rate of diabetes remission – has raised interest in RYGB as a way to control diabetes in less severely overweight people.
In this study, Argyropoulos and colleagues retrospectively analyzed information on 690 patients with Type 2 diabetes who underwent RYGB surgery over a 7-year period. The mean body mass index prior to surgery was 49.4 kg/m2, 73% were women, and 36% were using insulin.
In all, 463 (63%) achieved partial or complete remission, according to the American Diabetes Association criteria. Kaplan-Meier curves showed that the proportion of patients who achieved partial or complete remission was 49% at 14 months, 58% at 2 years, 65% at 3 years, 66% at 4 years, and 68% at 5 years.
The researchers looked for correlations between preoperative clinical variables and postoperative diabetes remission. Of 259 variables examined, four – insulin use, age, glycated hemoglobin level, and type of antidiabetic drugs – were significant independent predictors for remission.
These variables were then stratified and assigned weights to develop the final DiaRem score, which ranges from 0 to 22. In the primary cohort, the proportion of patients who achieved remission was 88% of those with a score of 0–2, 64% with 3–7, 23% with 8–12, 11% with 13–17, and 2% with 18–22 points.
The score was then validated in two additional cohorts; again, the proportion of patients achieving remission in the replication cohorts was highest for the lowest scores, and lowest for the highest scores.
Writing in an accompanying comment, Dimitri Pournaras and Carel le Roux, both from Imperial College London, UK, say that DiaRem “could help with selection of appropriate treatment and management of expectations held by both the patient and the multidisciplinary team involved in the patient's care.”
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