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Surgical Endoscopy

, Volume 31, Issue 2, pp 538–542 | Cite as

Type 2 diabetes remission following gastric bypass: does diarem stand the test of time?

  • J. Hunter Mehaffey
  • Mathew G. Mullen
  • Rachel L. Mehaffey
  • Florence E. Turrentine
  • Steven K. Malin
  • Jennifer L. Kirby
  • Bruce Schirmer
  • Peter T. Hallowell
Article

Abstract

Objective(s)

Roux-en-Y Gastric Bypass (RYGB) is well known to ameliorate type 2 diabetes mellitus (T2DM), and recent work suggests that the preoperative DiaREM model predicts successful remission up to 1 year post-RYGB. However, no data exist for long-term validity. Therefore, we sought to determine the utility of this score on long-term RYGB effectiveness for T2DM resolution at 2 and 10 years, respectively.

Methods

T2DM patients (Age: 48, BMI: 49, HbA1C: 8.1) undergoing RYGB at the University of Virginia between 2004–2006 (n = 42) and 2012–2014 (n = 59) were evaluated prospectively to assess preoperative DiaREM score, defined from insulin use, age, HbA1C, and type of antidiabetic medication. T2DM partial remission status was based on the American Diabetes Association guidelines (HbA1C < 6.5 % and fasting glycemia <125 mg/dL, and no anti-diabetic medications). Chi-square test was used to compare patient’s T2DM status to their DiaREM probability of remission.

Results

Among RYGB patients with 2-year postoperative data, 2 were lost (n = 1 no follow-up and n = 1 died) resulting in 57 patients for analysis. For the 10-year postoperative data, 11 were lost (n = 6 no follow-up and n = 5 died), thereby resulting in only 31 patients for analysis. Patients were distributed by DiaREM score to correlate with the predicted probability of remission as follows: 0–2 (Predicted 94 %, 2-year 100 % p = 0.61, 10-year 100 % p = 0.72), 3–7 (Predicted 76 %, 2-year 94 % p = 0.08, 10-year 83 % p = 0.57), 8–12 (Predicted 36 %, 2-year 47 % p = 0.38, 10-year 43 % p = 0.72), 13–17 (Predicted 22 %, 2-year 20 % p = 0.92, 10-year 33 % p = 0.64), and 18–22 (Predicted 9 %, 2-year 15 % p = 0.40, 10-year 14 % p = 0.64).

Conclusions

Preoperative DiaREM scores are a good tool for predicting both short- and long-term T2DM remissions following RYGB. This study highlights the need to identify strategies that improve T2DM remission in those at highest risk.

Keywords

Bariatric surgery Diabetes remission DiaREM Obesity 

Notes

Compliance with ethical standards

Disclosures

Research reported in this publication was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number T32HL007849. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • J. Hunter Mehaffey
    • 1
  • Mathew G. Mullen
    • 1
  • Rachel L. Mehaffey
    • 2
  • Florence E. Turrentine
    • 1
  • Steven K. Malin
    • 3
    • 4
  • Jennifer L. Kirby
    • 2
    • 4
  • Bruce Schirmer
    • 1
  • Peter T. Hallowell
    • 1
  1. 1.Department of SurgeryUniversity of VirginiaCharlottesvilleUSA
  2. 2.Department of Internal MedicineUniversity of VirginiaCharlottesvilleUSA
  3. 3.Department of KinesiologyUniversity of VirginiaCharlottesvilleUSA
  4. 4.Division of Endocrinology and MetabolismUniversity of VirginiaCharlottesvilleUSA

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