Predicting remission of diabetes post metabolic surgery: a comparison of ABCD, diarem, and DRS scores
- 231 Downloads
Obesity is one of the major causes for development of T2DM. Metabolic surgery has been proved to be a successful and cost-effective treatment modality for managing the patients with obesity and T2DM. Many scoring systems and models have been described in literature to predict the outcome of T2DM after metabolic surgery. The aim of this study is to compare the efficacy of Diarem, DRS, and ABCD score in predicting the T2DM remission.
A total number of 102 diabetic patients, who underwent LMGB/LOAGB, were selected for this study. A retrospective analysis of the three scoring systems when applied to these patients and their predictive abilities were analyzed.
At 1 year after surgery, 72 (70.59%) patients achieved remission of T2DM. Though the pairwise comparisons between AUC on ROC analysis of ABCD, Diarem, and DRS scores does not show statistically significant difference between them, Diarem score has the maximum relative area under ROC curves. By multivariate analysis, it was found that factors significantly associated with T2DM remission were duration of T2DM, C-peptide, and Pre-Op HbA1c.
Among the three scoring systems, though DiaRem score has the best sensitivity and specificity and maximum AUC, no statistically significant difference was found in their diabetes remission predicting abilities. A shorter duration of T2DM, a lower HbA1C, and higher levels of C-peptide were significantly associated with a higher chance of T2DM remission.
KeywordsT2DM (type 2 diabetes mellitus) LMGB (laparoscopic mini gastric bypass) LOAGB (laparoscopic one anastamosis gastric bypass) AUC (area under curve) ROC (receiver operating curve)
We extend our heartfelt gratitude to Dr. Aruna Tantia, Dr. Pramod Sureka, Dr. Namrata Biswas, Dr. Abhijit Hazra, Dr. Ramanuj Mukherjee, Dr. Bimalendu Sen, Dr. Debjit Ghosh, Shampa Ghosh, Jhuma Chowdhury, Sonam Gupta, Hanie Gupta, Ram Sundar Bhandari, and OT staffs who have worked to make this project a success. The staffs of ILS Hospital deserve special mention for their dedicated support.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Statement of Human and Animal Rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 2.American Diabetes Association. Obesity management for the treatment of type 2 diabetes. Sec. 6. In standards of medical care in Diabetes—2016. Diabetes Care. 2016;39(Suppl. 1):S47–51.Google Scholar
- 3.De Luca M, Angrisani L, Himpens J, et al. Indications for surgery for obesity and weight-related diseases: position statements from the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Obes Surg. 2016;26(8):1659–96. https://doi.org/10.1007/s11695-016-2271-4.CrossRefPubMedGoogle Scholar
- 19.Cersosimo E, Triplitt C, Mandarino LJ, et al. Pathogenesis of type 2 diabetes mellitus. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–2015 May 28.
- 33.Panunzi S, De Gaetano A, Carnicelli A, et al. Predictors of remission of diabetes mellitus in severely obese individuals undergoing bariatric surgery: do BMI or procedure choice matter? A metaanalysis. Ann Surg. 2015;261(3):459–67. https://doi.org/10.1097/SLA.0000000000000863.CrossRefPubMedGoogle Scholar
- 36.Tharakan G, Scott R, Szepietowski O, et al. Limitations of the DiaRem score in predicting remission of diabetes following Roux-En-Y gastric bypass (RYGB) in an ethnically diverse population from a single institution in the UK. Obes Surg. 2017;27(3):782–6. https://doi.org/10.1007/s11695-016-2368-9.CrossRefPubMedGoogle Scholar