Skip to main content

Advertisement

SpringerLink
Log in

Metabolic Surgery Diabetes Remission (MDR) Score: a New Preoperative Scoring System for Predicting Type 2 Diabetes Remission at 1 Year After Metabolic Surgery in the Singapore Multi-ethnic Asian Setting

  • Original Contributions
  • Published:
Obesity Surgery Aims and scope Submit manuscript

Abstract

Purpose

The utility of available scoring systems for type 2 diabetes (T2D) remission prediction after metabolic surgery has not been defined in a multi-ethnic Asian population like Singapore. We sought to assess the predictive performance of the Asia-developed ABCD scoring system for T2D remission after metabolic surgery, and develop a new algorithm to improve prediction.

Materials and Methods

We conducted a retrospective analysis of adults with T2D who underwent either Roux-en-Y gastric bypass or sleeve gastrectomy between 2007 and 2018, and followed for 1 year postoperatively (n = 114, mean age 46 ± 9 years, 48.2% men, body mass index 40.1 ± 6.6 kg/m2). The primary outcome was complete T2D remission defined as HbA1c < 6% without the use of anti-diabetic medication at 1 year after surgery.

Results

Complete T2D remission was observed in 47.4% of subjects at 1 year post-surgery. Stepwise logistic regression identified preoperative age, T2D duration, HbA1c, and β-cell function (estimated by the homeostasis model) as predictors of complete T2D remission. Based on these four variables, we constructed a new 10-point scoring system named Metabolic surgery Diabetes Remission (MDR) score. Compared with ABCD, MDR produced fewer misclassifications at the mid-high scores, achieving a predictive accuracy of 71–100% at 6 points and above. In addition, MDR achieved a higher area under the receiver operating characteristic curve than ABCD for the primary outcome (0.79 versus 0.67, P = 0.007).

Conclusion

MDR may serve as a useful clinical scoring system for predicting short-term T2D remission after metabolic surgery in Singapore’s multi-ethnic Asian cohort.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366:1577–85.

    Article  CAS  Google Scholar 

  2. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med. 2017;376:641–51.

    Article  Google Scholar 

  3. 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.

    Article  Google Scholar 

  4. Lee WJ, Almulaifi A, Tsou JJ, et al. Laparoscopic sleeve gastrectomy for type 2 diabetes mellitus: predicting the success by abcd score. Surg Obes Relat Dis. 2015;11:991–6.

    Article  Google Scholar 

  5. Still CD, Wood GC, Benotti P, et al. Preoperative prediction of type 2 diabetes remission after roux-en-y gastric bypass surgery: a retrospective cohort study. Lancet Diabetes Endocrinol. 2014;2:38–45.

    Article  Google Scholar 

  6. Aron-Wisnewsky J, Sokolovska N, Liu Y, et al. The advanced-diarem score improves prediction of diabetes remission 1 year post-roux-en-y gastric bypass. Diabetologia. 2017;60:1892–902.

    Article  Google Scholar 

  7. Aminian A, Brethauer SA, Andalib A, et al. Individualized metabolic surgery score: procedure selection based on diabetes severity. Ann Surg. 2017;266:650–7.

    Article  Google Scholar 

  8. Levy JC, Matthews DR, Hermans MP. Correct homeostasis model assessment (homa) evaluation uses the computer program. Diabetes Care. 1998;21:2191–2.

    Article  CAS  Google Scholar 

  9. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–45.

    Article  CAS  Google Scholar 

  10. Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3:32–5.

    Article  CAS  Google Scholar 

  11. Park JY, Kim YJ. Prediction of diabetes remission in morbidly obese patients after roux-en-y gastric bypass. Obes Surg. 2016;26:749–56.

    Article  Google Scholar 

  12. Naitoh T, Kasama K, Seki Y, et al. Efficacy of sleeve gastrectomy with duodenal-jejunal bypass for the treatment of obese severe diabetes patients in Japan: a retrospective multicenter study. Obes Surg. 2018;28:497–505.

    Article  Google Scholar 

  13. Kam H, Tu Y, Pan J, et al. Comparison of four risk prediction models for diabetes remission after roux-en-y gastric bypass surgery in obese chinese patients with type 2 diabetes mellitus. Obes Surg. 2020; (in press)

  14. Parvaresh Rizi E, Teo Y, Leow MK, et al. Ethnic differences in the role of adipocytokines linking abdominal adiposity and insulin sensitivity among asians. J Clin Endocrinol Metab. 2015;100:4249–56.

    Article  Google Scholar 

  15. Taylor R, Holman RR. Normal weight individuals who develop type 2 diabetes: the personal fat threshold. Clin Sci (Lond). 2015;128:405–10.

    Article  Google Scholar 

  16. Reilly SM, Saltiel AR. Adapting to obesity with adipose tissue inflammation. Nat Rev Endocrinol. 2017;13:633–43.

    Article  CAS  Google Scholar 

  17. Fang Y-L, Lee W-J. Predictors for type 2 diabetes mellitus remission after metabolic/bariatric surgery. Ann Laparosc and Endosc Surg. 2017): Annals of Laparoscopic and Endoscopic Surgery;2(7):2017.

    Google Scholar 

  18. Monnier L, Colette C, Thuan JF, et al. Insulin secretion and sensitivity as determinants of hba1c in type 2 diabetes. Eur J Clin Investig. 2006;36:231–5.

    Article  CAS  Google Scholar 

  19. Paszkiewicz RL, Bergman RN. Mechanisms of improved glucose handling after metabolic surgery: the big 6. Surg Obes Relat Dis. 2016;12:1192–8.

    Article  Google Scholar 

  20. Chen C, Cohrs CM, Stertmann J, et al. Human beta cell mass and function in diabetes: recent advances in knowledge and technologies to understand disease pathogenesis. Mol Metab. 2017;6:943–57.

    Article  CAS  Google Scholar 

  21. 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.

    Article  CAS  Google Scholar 

  22. Salminen P, Helmio M, Ovaska J, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic roux-en-y gastric bypass on weight loss at 5 years among patients with morbid obesity: the sleevepass randomized clinical trial. JAMA. 2018;319:241–54.

    Article  Google Scholar 

  23. Peterli R, Wolnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic roux-en-y gastric bypass on weight loss in patients with morbid obesity: the sm-boss randomized clinical trial. JAMA. 2018;319:255–65.

    Article  Google Scholar 

Download references

Acknowledgments

We would like to thank Lucy Kong for assisting in patient recruitment, and Joel Lim and Liu Song He for their help in data extraction.

Funding

This study was supported by Alexandra Health Small Innovative Grant SIG14034, Alexandra Health Enabling Grant AHEG1706, and Alexandra Health Science Translational and Applied Research Grant STAR18106.

Author information

Authors and Affiliations

  1. Clinical Research Unit, Khoo Teck Puat Hospital, Singapore, Singapore

    Mei Chung Moh, Boon Khim Lim, Tavintharan Subramaniam & Su Chi Lim

  2. Department of General Surgery, Khoo Teck Puat Hospital, Singapore, Singapore

    Anton Cheng, Chun Hai Tan, Bo Chuan Tan & Deborah Ng

  3. Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, 676 Woodlands Drive 71 #03-01, Singapore, 730676, Singapore

    Chee Fang Sum, Tavintharan Subramaniam & Su Chi Lim

  4. Saw Swee Hock School of Public Health, National University Hospital, Singapore, Singapore

    Su Chi Lim

Authors
  1. Mei Chung Moh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anton Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chun Hai Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Boon Khim Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bo Chuan Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Deborah Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chee Fang Sum
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tavintharan Subramaniam
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Su Chi Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Su Chi Lim.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

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.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moh, M.C., Cheng, A., Tan, C.H. et al. Metabolic Surgery Diabetes Remission (MDR) Score: a New Preoperative Scoring System for Predicting Type 2 Diabetes Remission at 1 Year After Metabolic Surgery in the Singapore Multi-ethnic Asian Setting. OBES SURG 30, 3387–3393 (2020). https://doi.org/10.1007/s11695-020-04576-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11695-020-04576-3

Keywords

Search

Navigation