Advertisement

Obesity Surgery

, Volume 26, Issue 10, pp 2418–2424 | Cite as

Preoperative Prediction of Type 2 Diabetes Remission After Gastric Bypass Surgery: a Comparison of DiaRem Scores and ABCD Scores

  • Wei-Jei Lee
  • Keong Chong
  • Shu-Chun Chen
  • James Zachariah
  • Kong-Han Ser
  • Yi-Chih Lee
  • Jung-Chien Chen
Original Contributions

Abstract

Background

Gastric bypass surgery has been well accepted as a novel treatment modality for type 2 diabetes mellitus (T2DM) in obese patients. Some scoring systems have been proposed for the selection of T2DM patients who are eligible for gastric bypass surgery. This study compares two scoring systems with regard to remission of T2DM after gastric bypass surgery.

Methods

This retrospective cohort study included 245 patients (150 females and 95 males) who had undergone gastric bypass surgery for the treatment of T2DM with 1 year follow-up. We examined the predictive power of complete remission of two scoring systems, the DiaRem score, and the ABCD score. The DiaRem score includes the factors of age, HbA1c, medication, and insulin usage. The ABCD score includes the factors of age, BMI, C-peptide level, and duration of T2DM. The rate of remission of T2DM after gastric bypass surgery was evaluated using both scoring systems.

Results

At 1 year after surgery, the percent weight loss was 26.5 % and the mean BMI decreased from 35.7 to 26.2 kg/m2. The mean HbA1c decreased from 8.8 to 6.2 %. A significant number of patients showed improvement in glycemic control, including 130 (53.1 %) patients with complete remission (HbA1c < 6.0 %), 36 (14.7 %) patients with partial remission (HbA1c < 6.5 %), and 26 (10.6 %) patients with improvement (HbA1c < 7 %). Both the DiaRem score and the ABCD score predicted the success of the gastric bypass surgery, but the ABCD score was better at differentiating patients with poorer score (27.9 vs. 9.1 %, p < 0.001).

Conclusions

Gastric bypass surgery is a treatment option for obese T2DM patients. The ABCD score is better at predicting T2DM remission at 1 year after gastric bypass surgery than the DiaRem score.

Keywords

Type 2 diabetes Gastric bypass Predictor Remission 

Notes

Acknowledgments

This work was supported by the grant from Ming-Shen General Hospital (97-A-01).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study, formal consent is not required.

References

  1. 1.
    Zimmer P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. JAMA. 2013;414:782–7.Google Scholar
  2. 2.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefPubMedGoogle Scholar
  3. 3.
    Sjostrom L, Narbro K, Sjostrom D, et al. Effect of bariatric surgery on mortality in Swedish obese subjects. NEJM. 2007;357:741–52.CrossRefPubMedGoogle Scholar
  4. 4.
    Lee WJ, Huang MT, Wang W, et al. Bariatric surgery: Asia-pacific perspective. Obes Surg. 2005;15:751–7.CrossRefPubMedGoogle Scholar
  5. 5.
    Lee WJ, Chong K, Ser KH, et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg. 2011;146:143–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Cohen RV, Pinheiro JC, Schiavon C, et al. Effective of gastric bypass surgery in patients with type 2 diabetes and only mild obesity. Diabetis Care. 2012;35:1420–8.CrossRefGoogle Scholar
  7. 7.
    Schauer PR, Kashyap SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366:1567–76.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the diabetes surgery study randomized clinical trial. JAMA. 2013;309:2240–9.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Liang Z, Wu Q, Chen B, et al. Effect of laparoscopic Roux-en-Y gastric bypass for type 2 diabetes mellitus with hypertension: a randomized controlled trial. Diabetes Res Clin Pract. 2013;101:50–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes. N Engl J Med. 2014;370:2002–13.CrossRefPubMedGoogle Scholar
  11. 11.
    Arterburn DE, Bogart A, Scherwood NE, et al. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obes Surg. 2013;23:93–102.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Sjostrom L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.CrossRefPubMedGoogle Scholar
  13. 13.
    DiGiorgi M, Rosen DJ, Choi JJ, et al. Re-emergence of diabetes after gastric bypass in patients with mid- to long-term follow-up. Surg Obes Relat Dis. 2010;6:249–53.CrossRefPubMedGoogle Scholar
  14. 14.
    Chikunguwo SM, Wolfe LG, Dodson P, et al. Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010;6:254–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Ikramuddin S, Billington C, Lee WJ, et al. Roux-en-Y gastric bypass for diabetes (the Diabetes Surgery Study): 2-year outcomes of a 5-year, randomized, controlled trial. Lancet Diabetes Endocrinol. 2015;3:413–22.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hayes MT, Hunt LA, Foo J, et al. A model for predicting the resolution of type 2 diabetes in severely obese subjects following Roux-en Y gastric bypass surgery. Obes Surg. 2011;21:910–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Ramos- Levi AM, Matia P, Cabrerizo L, et al. Statistical models to predict type 2 diabetes remission after bariatric surgery. J Diabetes. 2014;6:472–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Lee WJ, Hur KY, Lakadawala M, et al. Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score. Surg Obes Relat Dis. 2013;9:379–84.CrossRefPubMedGoogle Scholar
  19. 19.
    The effect and predictive score of gastric bypass and sleeve gastrectomy on type 2 diabetes mellitus patients with BMI < 30 Kg/m2. Obes Surg. 2015.Google Scholar
  20. 20.
    Still CD, Wood GC, Benotti P, et al. A probability score for preoperative prediction of type 2 diabetes remission following RYGB surgery. Lancet Diabetes Endocrinol. 2014;2:38–45.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Aminian A, Brethauer SA, Kashyap SR, et al. DiaRem score: external validation. Lancet Diabetes Endocrinol. 2014;2:12–3.CrossRefPubMedGoogle Scholar
  22. 22.
    Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 2003;26:S5–S20.Google Scholar
  23. 23.
    Buse JB, Laughlin S, Caprio S, et al. How do we define cure of diabetes? Diabetes Care. 2009;32:2133–5.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Lee WJ, Yu PJ, Wang W, et al. Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg. 2005;242:20–8.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Lee WJ, Lee KT, Kasama K, et al. Laparoscopic single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG): short-term result and comparison with gastric bypass. Obes Surg. 2014;24:109–13.CrossRefPubMedGoogle Scholar
  26. 26.
    Aarts EO, Janssen J, Janssen IM, et al. Preoperative fasting plasma C-peptide level may help to predict diabetes outcome after gastric bypass surgery. Obes Surg. 2013;23:867–73.CrossRefPubMedGoogle Scholar
  27. 27.
    Nannipieri M, Baldi S, Mari A, et al. Roux-en-Y gastric bypass and sleeve gastrectomy: mechanisms of diabetes remission and role of gut hormones. J Clin Endocrinol Metab. 2013;98:4391–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Lee YC, Lee WJ, Liew PL. Predictors of remission of type 2 diabetes mellitus in obese patients after gastrointestinal surgery. Obes Res Clin Pract. 2013;7:e494–500.CrossRefPubMedGoogle Scholar
  29. 29.
    Robert M, Ferrand-Gaillard C, Disse E, et al. Predictive factors of type 2 diabetes remission 1 year after bariatric surgery: impact of surgical techniques. Obes Surg. 2013;23:770–5.CrossRefPubMedGoogle Scholar
  30. 30.
    Ramos-Levi AM, Matia P, Cabrerizo L, et al. C-peptide levels predict type 2 diabetes remission after bariatric surgery. Nutr Hosp. 2013;28:1599–603.PubMedGoogle Scholar
  31. 31.
    Adams ST, Salhab M, Hussain ZI, et al. Preoperatively determinable factors predictive of diabetes mellitus remission following Roux-en-Y gastric bypass: a review of the literature. Acta Diabetol. 2013;50:475–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Wang GF, Yan YX, Xu N, et al. Predictive factors of type 2 diabetes mellitus remission following bariatric surgery: a meta-analysis. Obes Surg. 2015;25:199–208.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Wei-Jei Lee
    • 1
  • Keong Chong
    • 2
  • Shu-Chun Chen
    • 1
  • James Zachariah
    • 1
  • Kong-Han Ser
    • 1
  • Yi-Chih Lee
    • 3
  • Jung-Chien Chen
    • 1
  1. 1.Department of SurgeryMin-Sheng General HospitalTauoyanRepublic of China
  2. 2.Department of Internal MedicineMin-Sheng General HospitalTauoyanRepublic of China
  3. 3.Department of International BusinessChien Hsin University of Science and TechnologyTauoyanRepublic of China

Personalised recommendations