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Diabet Med. 2018 Mar;35(3):360-367. doi: 10.1111/dme.13532. Epub 2017 Nov 21.

Type 2 diabetes remission 2 years post Roux-en-Y gastric bypass and sleeve gastrectomy: the role of the weight loss and comparison of DiaRem and DiaBetter scores.

Author information

1
Centre for Obesity Research, Rayne Institute, University College London, London, UK.
2
University College London Hospital Bariatric, Centre for Weight Management and Metabolic Surgery, London, UK.
3
Department of Epidemiology & Public Health, London, UK.
4
Health and Social Surveys Research Group, Research Department of Epidemiology and Public Health, University College London, London, UK.
5
Department of Endocrinology, Imperial College Healthcare NHS Trust, London, UK.
6
Clinical and Experimental Surgery Department, Medical Research Institute, University of Alexandria, Alexandria, Egypt.
7
Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal.
8
Clinical and Experimental Endocrinology, Department of Anatomy, Multidisciplinary Unit for Biomedical Research (UMIB), Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal.
9
Endocrine Unit, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal.
10
National Institute of Health Research, University College London Hospital Biomedical Research Centre, London, UK.

Abstract

AIMS:

The comparative efficacy of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy on Type 2 diabetes remission and the role of weight loss are unclear. The DiaRem diabetes remission prediction score uses HbA1c , age and diabetes medications but not diabetes duration. The aim of this study was to compare the DiaRem with the DiaBetter score that includes diabetes duration, upon combined (complete plus partial) 2-year post-surgery diabetes remission in people following RYGB and sleeve gastrectomy, and to investigate the relationship between weight loss and diabetes remission.

METHODS:

A retrospective single-centre cohort study of obese people with diabetes who underwent RYGB (107) or sleeve gastrectomy (103) and a validation cohort study (173) were undertaken. Diabetes remission, % weight loss, DiaRem, DiaBetter scores and areas under receiving operator characteristic (ROC) curves were calculated. The relationship between % weight loss and diabetes remission was investigated using logistic regression.

RESULTS:

The proportion of people achieving diabetes remission was highest for those with the lowest DiaBetter and DiaRem scores. Areas under the ROC curves were comparable [DiaBetter: 0.867 (95%CI: 0.817-0.916); DiaRem: 0.865 (95%CI: 0.814-0.915), P=0.856]. Two-year % weight loss was higher post RYGB [26.6 (95%CI: 24.8-28.4)] vs post-sleeve gastrectomy [20.6 (95%CI: 18.3-22.8), P<0.001]. RYGB had 151% higher odds of diabetes remission [OR 2.51 (95%CI: 1.12-5.60), P=0.025]. This association became non-significant when adjusted for % weight loss.

CONCLUSION:

DiaBetter and DiaRem scores predict diabetes remission following both procedures. Two-year % weight loss plays a key role in determining diabetes remission.

PMID:
29055156
PMCID:
PMC5836992
DOI:
10.1111/dme.13532
[Indexed for MEDLINE]
Free PMC Article

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