Bariatric surgery is recommended as a treatment option in individuals with T2DM and BMI > 35 kg/m2. However, remission of diabetes following bariatric surgery has varied from 24–73% in various studies. A number of scoring systems have been proposed to predict remission of type 2 diabetes mellitus following bariatric surgery. Out of these ABCD score has shown the most promise. The aims of this study were to analyze the effects of bariatric surgery on T2DM patients and to evaluate the possibility of using ABCD score to help with the patient selection.
Material and methods
Between 1 January 2016 and 1 December 2017, patients undergoing bariatric surgery for obesity with T2DM were recruited from DMCH Ludhiana and followed up at 3 months and 6 months after surgery for control/remission of diabetes.
At 6 months, the mean % EWL was 62.74. Significant improvements were noted in FBS (193.05 to 107.97), in HbA1C (8.22 to 6.17), dose of OHAs (1.97 to none), and insulin (32.86 to 5.66). Patients who attained remission were younger, with shorter duration of diabetes and higher C-peptide levels. The preoperative BMI or the % EWL were not predictive of diabetes remission. Higher ABCD scores were significantly associated with higher rates of diabetes remission.
Bariatric surgery leads to substantial weight loss and amelioration of type 2 diabetes. An ABCD score of > 6 predicts diabetes remission following bariatric surgery, and is recommended as an aid for patient selection and counseling.
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Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2014;384(9945):766–81.
Fontaine KR, Redden DT, Wang C, Westfall AO, Allison DB. Years of life lost due to obesity. JAMA. 2003;289:187–93.
Association AD. 8. Obesity management for the treatment of type 2 diabetes: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2019;42(Supplement 1):S81–S9.
Min T, Barry J, Stephens J. Predicting the resolution of type 2 diabetes after bariatric surgical procedures: a concise review. J Diabetes Metab. 2015;6(10).
Lee WJ, Hur KY, Lakadawala M, Kasama K, Wong SK, Chen SC, et al. Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score. Surg Obes Relat Dis. 2013;9(3):379–84.
Lee WJ, Almulaifi A, Tsou JJ, Ser KH, Lee YC, Chen SC. Laparoscopic sleeve gastrectomy for type 2 diabetes mellitus: predicting the success by ABCD score. Surg Obes Relat Dis. 2015;11(5):991–6.
Buse JB, Caprio S, Cefalu WT, Ceriello A, Del Prato S, Inzucchi SE, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133–5.
Deep HS, Singh BP, Singh SP. Evaluation of serum C-peptide levels in type 2 diabetics in Punjabi population. Int J Adv Med. 2017;4(4):1026–30.
Lee WJ, Chong K, Ser KH, Chen JC, Lee YC, Chen SC, et al. C-peptide predicts the remission of type 2 diabetes after bariatric surgery. Obes Surg. 2012;22(2):293–8.
Dixon JB, Chuang LM, Chong K, Chen SC, Lambert GW, Straznicky NE, et al. Predicting the glycemic response to gastric bypass surgery in patients with type 2 diabetes. Diabetes Care. 2013;36(1):20–6.
Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347:f5934.
Chang SH, Stoll CR, Song J, Varela JE, Eagon CJ, Colditz GA. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg. 2014;149(3):275–87.
Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight in comparative studies of bariatric surgery vs conventional medical therapy: a systematic review and meta-analysis. Obes Surg. 2014;24(3):437–55.
Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.
Ikramuddin S, Korner J, Lee WJ, Connett JE, Inabnet WB, Billington CJ, 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(21):2240–9.
Dorman RB, Serrot FJ, Miller CJ, Slusarek BM, Sampson BK, Buchwald H, et al. Case-matched outcomes in bariatric surgery for treatment of type 2 diabetes in the morbidly obese patient. Ann Surg. 2012;255(2):287–93.
Wang GF, Yan YX, Xu N, Yin D, Hui Y, Zhang JP, et al. Predictive factors of type 2 diabetes mellitus remission following bariatric surgery: a meta-analysis. Obes Surg. 2015;25(2):199–208.
Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.
Panunzi S, De Gaetano A, Carnicelli A, Mingrone G. Predictors of remission of diabetes mellitus in severely obese individuals undergoing bariatric surgery: do BMI or procedure choice matter? A meta-analysis. Ann Surg. 2015;261:459–67.
Raj PP, Bhattacharya S, Kumar SS, Sabnis SC, Parthasarathi R, Swamy PD, et al. Do bariatric surgery-related type 2 diabetes remission predictors add clinical value? A study on Asian Indian obese diabetics. Obes Surg. 2017;27(8):2113–9.
Dixon JB, Hur KY, Lee WJ, Kim MJ, Chong K, Chen SC, et al. Gastric bypass in type 2 diabetes with BMI < 30: weight and weight loss have a major influence on outcomes. Diabet Med. 2013;30(4):e127–34.
Lee WJ, Almulaifi A, Chong K, Chen SC, Tsou JJ, Ser KH, et al. The effect and predictive score of gastric bypass and sleeve gastrectomy on type 2 diabetes mellitus patients with BMI < 30 kg/m 2. Obes Surg. 2015;25(10):1772–8.
Bhasker AG, Remedios C, Batra P, Sood A, Shaikh S, Lakdawala M. Predictors of remission of T2DM and metabolic effects after laparoscopic roux-en-Y gastric bypass in obese Indian diabetics—a 5-year study. Obes Surg. 2015;25(7):1191–7.
Lee WJ, Chong K, Chen SC, Zachariah J, Ser KH, Lee YC, et al. Preoperative prediction of type 2 diabetes remission after gastric bypass surgery: a comparison of DiaRem scores and ABCD scores. Obes Surg. 2016;26(10):2418–24.
Aminian A, Brethauer SA, Andalib A, Nowacki AS, Jimenez A, Corcelles R, et al. Individualized metabolic surgery score: procedure selection based on diabetes severity. Ann Surg. 2017;266(4):650–7.
Pournaras DJ, Aasheim ET, Søvik TT, Andrews R, Mahon D, Welbourn R, et al. Effect of the definition of type II diabetes remission in the evaluation of bariatric surgery for metabolic disorders. Br J Surg. 2012;99(1):100–3.
Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, et al. Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. N Engl J Med. 2017;376(7):641–51.
Jiménez A, Casamitjana R, Flores L, Viaplana J, Corcelles R, Lacy A, et al. Long-term effects of sleeve gastrectomy and roux-en-Y gastric bypass surgery on type 2 diabetes mellitus in morbidly obese subjects. Ann Surg. 2012;256(6):1023–9.
Robert M, Ferrand-Gaillard C, Disse E, Espalieu P, Simon C, Laville M, et al. Predictive factors of type 2 diabetes remission 1 year after bariatric surgery: impact of surgical techniques. Obes Surg. 2013;23(6):770–5.
Todkar JS, Shah SS, Shah PS, Gangwani J. Long-term effects of laparoscopic sleeve gastrectomy in morbidly obese subjects with type 2 diabetes mellitus. Surg Obes Relat Dis. 2010;6(2):142–5.
Abbatini F, Rizzello M, Casella G, Alessandri G, Capoccia D, Leonetti F, et al. Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Surg Endosc. 2010;24(5):1005–10.
Yip S, Plank LD, Murphy R. Gastric bypass and sleeve gastrectomy for type 2 diabetes: a systematic review and meta-analysis of outcomes. Obes Surg. 2013;23(12):1994–2003.
Conflict of interest
The authors declare that they have no conflict of interest.
Ethics approval and consent to participate
The study was approved by the institutional ethics committee.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Research & Ethical Committee, DMCH, Ludhiana – ECR/101/Inst/PB/2013/RR-16) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
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Sohal, D.S., Nain, P.S., Singh, P. et al. ABCD score of > 6 predicts diabetes remission following bariatric surgery. Int J Diabetes Dev Ctries (2020). https://doi.org/10.1007/s13410-020-00801-y
- Bariatric surgery
- ABCD score