Dror Dicker, MD, and fellow researchers in Israel and France have found that the Advanced DiaRem tool is superior to the conventional DiaRem scoring system and provides fair predictive value for 5-year postoperative diabetes remission following weight reduction surgery. Click through the slides below for details on their study and take home points for clinical practice.
Predicting Diabetes Remission Post-Bariatric Surgery
Bariatric Surgery and Diabetes. Due to a large number of bariatric procedures, it would be useful to have an accurate predictive tool for post-surgical, long-term DR. The DiaRem score has been shown to have acceptable predictive power for DR following RYGB and other weight loss surgeries. However, a newly proposed scoring system, Advanced DiaRem, is based on the DiaRem but has redefined penalty scores for risk factors. Authors of this study sought to determine the capacity of these 2 related scores to predict DR at 2 and 5 years post-bariatric surgery.
The Study. Authors assessed data from a large, computerized database of patients having undergone bariatric surgery with a focus on patients with a BMI of ≥30 kg/m2 and a T2DM diagnosis before surgery. At 2 years, 1502 patients had T2DM status measures available and 1459 patients had them available at 5 years. Ad-DiaRem included Dia-Rem criteria, number of antidiabetic drugs, and diabetes duration. Predictive performances for DiaRem and Ad-DiaRem were evaluated and reported.
The Results. Among subjects with 5-yr postop T2DM status data, 53.6% exhibited DR. For RYGB, Ad-DiaRem showed mildly improved predictive capacity at 5-yrs postop vs DiaRem. PPV detecting >80% of those achieving DR (sensitivity ≥0.8) were 78.2% for Ad-DiaRem and 73.2% for DiaRem. Higher Ad-DiaRem scores were more consistently associated with decreased DR rates. Predictive capacity parameters were comparatively lower, for both scores, when considering DR 5-yr post-gastric banding.
Take Home Points. Ad-DiaRem may help improve the precision of care for obese persons with T2DM who are candidates for bariatric surgery. The ability to predict response to weight reduction surgery offers both patients and physicians clarity when making this important medical decision. A key benefit for using Ad-DiaRem vs DiaRem is the ability of the former to predict outcomes at 5 yrs post-RYGB.
Perspective. "The current study focuses on outcomes, more specifically DR, rather than on the surgery itself. While weight loss itself is an essential goal of bariatric surgery, the authors highlight the equal importance of disease remission, given the role of diabetes as a risk factor for neurologic and cardiovascular disease regardless of BMI. Predictive tools like the Ad-DiaRem allow us to gauge the worth of a procedure for a patient which is crucial when contemplating an invasive and costly procedure not free from risk in itself.”
Reference: Dicker D, Golan R, Aron-Wisnewsky J, et al. Prediction of long-term diabetes remission after RYGB, sleeve gastrectomy, and adjustable gastric banding using DiaRem and Advanced-DiaRem scores [published ahead of print November 22, 2018]. Obes Surg. doi: 10.1007/s11695-018-3583-3.
