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Obes Surg. 2019 Mar;29(3):796-804. doi: 10.1007/s11695-018-3583-3.

Prediction of Long-Term Diabetes Remission After RYGB, Sleeve Gastrectomy, and Adjustable Gastric Banding Using DiaRem and Advanced-DiaRem Scores.

Author information

1
Department of Internal Medicine D, Hasharon Hospital, Rabin Medical Center, 7 Keren Kayemet St., 49100, Petah Tikva, Israel. daniel3@013.net.
2
Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel. daniel3@013.net.
3
Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel.
4
Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière hospital, Paris, France.
5
INSERM, UMR S U1166, Nutriomics Team, Paris, France.
6
Sorbonne Universités, UPMC University Paris, 06, UMR_S 1166 I, Nutriomics Team, Paris, France.
7
Institute of Cardiometabolism and Nutrition, ICAN, Integromics team, Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière hospital, Paris, France.
8
Sorbonne Universités, UPMC Univ Paris 06, IHU ICAN, IRD, unité de modélisation mathématique et informatique des systèmes complexes (UMMISCO), F-93143, Bondy, France.
9
Central Headquarters, Clalit Health Services, Tel Aviv, Israel.
10
Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, and the National Institute of Biotechnology in the Negev, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel.

Abstract

PURPOSE:

DiaRem is a clinical scoring system designed to predict diabetes remission (DR) 1-year post-Roux-en-Y gastric bypass (RYGB). We examined long-term (2- and 5-year) postoperative DR prediction by DiaRem and an advanced-DiaRem (Ad-DiaRem) score following RYGB, sleeve gastrectomy (SG), and gastric banding (GB).

METHODS:

We accessed data from a computerized database of persons with type 2 diabetes and BMI ≥ 30 kg/m2 who underwent RYGB, SG, or GB, and determined DR status 2- and 5-year postoperative according to preoperative DiaRem and the Ad-DiaRem calculated scores.

RESULTS:

Among 1459 patients with 5-year postoperative diabetes status data, 53.6% exhibited DR. For RYGB, Ad-DiaRem trended to exhibit mildly improved predictive capacity 5-year postoperatively compared to DiaRem: Areas under receiver operating characteristic [AUROC] curves were 0.85 (0.76-0.93) and 0.78 (0.69-0.88), respectively. The positive predictive values (PPVs) detecting > 80% of those achieving DR (i.e., sensitivity ≥ 0.8) were 78.2% and 73.2%, respectively, and higher Ad-DiaRem scores more consistently associated with decreased DR rates. Following SG, both scores had an AUROC of 0.82, but Ad-DiaRem still had a higher PPV for predicting > 80% of those with 5-year postoperative DR (76.2% and 71.0%). Predictive capacity parameters were comparatively lower, for both scores, when considering DR 5-year post-GB (AUROC: 0.73 for both scores, PPV: 66.3% and 64.3%, respectively).

CONCLUSIONS:

Ad-DiaRem provides modest improvement compared to DiaRem in predicting long-term DR 5-years post-RYGB. Both scores similarly provide fair predictive capacity for 5-year postoperative DR after SG.

KEYWORDS:

Bariatric surgery; Diabetes remission; Prediction score

PMID:
30467708
DOI:
10.1007/s11695-018-3583-3

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