Prediction of Long-Term Diabetes Remission After RYGB, Sleeve Gastrectomy, and Adjustable Gastric Banding Using DiaRem and Advanced-DiaRem Scores

Abstract

Purpose

DiaRem is a clinical scoring system designed to predict diabetes remission (DR) 1-year post-Roux-en-Y gastric bypass (RYGB). We examined long-term (2- and 5-year) postoperative DR prediction by DiaRem and an advanced-DiaRem (Ad-DiaRem) score following RYGB, sleeve gastrectomy (SG), and gastric banding (GB).

Methods

We accessed data from a computerized database of persons with type 2 diabetes and BMI ≥ 30 kg/m2 who underwent RYGB, SG, or GB, and determined DR status 2- and 5-year postoperative according to preoperative DiaRem and the Ad-DiaRem calculated scores.

Results

Among 1459 patients with 5-year postoperative diabetes status data, 53.6% exhibited DR. For RYGB, Ad-DiaRem trended to exhibit mildly improved predictive capacity 5-year postoperatively compared to DiaRem: Areas under receiver operating characteristic [AUROC] curves were 0.85 (0.76–0.93) and 0.78 (0.69–0.88), respectively. The positive predictive values (PPVs) detecting > 80% of those achieving DR (i.e., sensitivity ≥ 0.8) were 78.2% and 73.2%, respectively, and higher Ad-DiaRem scores more consistently associated with decreased DR rates. Following SG, both scores had an AUROC of 0.82, but Ad-DiaRem still had a higher PPV for predicting > 80% of those with 5-year postoperative DR (76.2% and 71.0%). Predictive capacity parameters were comparatively lower, for both scores, when considering DR 5-year post-GB (AUROC: 0.73 for both scores, PPV: 66.3% and 64.3%, respectively).

Conclusions

Ad-DiaRem provides modest improvement compared to DiaRem in predicting long-term DR 5-years post-RYGB. Both scores similarly provide fair predictive capacity for 5-year postoperative DR after SG.

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Acknowledgements

We thank Dr. Tal Pecht, Dr. Ilana Harman-Boehm, and Dr. Ilya Polischuck for their support and excellent discussions that contributed to this work. Dr. Dror Dicker is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

This study was supported in part by grants from the Ministry of Science, Technology & Space, Israel (Israeli-French collaboration) and by The Ministe’re de L’Education National, de l’Enseignement Sup’erieur et de la Recherche, France (Maimonide “Franco-Israeli project”).

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DD planned the study, researched the data, reviewed and edited the manuscript, and added to the discussion; RG researched the data and wrote the manuscript; JAW planned the study, researched the data, reviewed and edited the manuscript, and added to the discussion; JDZ researched the data and reviewed the manuscript; NS researched the data; DSC researched the data; RY researched the data; SV researched the data; KC planned the study, researched the data, and reviewed the manuscript; AR planned the study, researched the data, and wrote the manuscript.

Corresponding author

Correspondence to Dror Dicker.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was waived by the ethical committee that approved this study.

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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. OBES SURG 29, 796–804 (2019). https://doi.org/10.1007/s11695-018-3583-3

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Keywords

  • Diabetes remission
  • Bariatric surgery
  • Prediction score