Details of a new scoring system, named DiaRem, which can predict which people are most likely to achieve diabetes remission within a 5-year time period after gastric bypass surgery, have been published today in The Lancet.
The system, which is based on four basic pre-operative clinical variables, was created following the retrospective analysis of 690 obese people with type 2 diabetes, who underwent Roux-en-Y gastric bypass (RYGB) at the Geisinger Health System Clinic, Danville, USA, between 2004–2011. In total, 463 (63%) of this population were reported to achieve partial or complete diabetes remission.
Four independent predictors of diabetes remission, including, pre-operative insulin use, age, HbA1c and anti-diabetic drug use were considered when assigning participants a DiaRem score between 0–22. Individuals with a lower DiaRem were found to have the greatest likelihood of achieving diabetes remission, whilst those with a higher score had the smallest likelihood of remission.
The validity of the DiaRem score was measured by analysing diabetes remission rates 14 months after surgery in two independent cohorts of people (n=389). The researchers found that lower DiaRem scores were correlated with a greater rate of remission and higher scores were associated with reduced remission rates, mirroring the findings from the primary cohort.
Lead author George Argyropoulos said: “Our novel DiaRem score will give patients and physicians a scientifically valid way of assessing the merits of gastric bypass surgery for treating diabetes and deciding whether additional measures should be taken to improve the odds of remission.”
Dimitri J Pournaras and Carel W le Roux, from Imperial College London, UK commented: “The DiaRem score could help with selection of appropriate treatment and management of expectations held by both the patient and the multidisciplinary team involved in the patient’s care. Additionally, it could scientifically improve the comparison of different surgical procedures by allowing appropriate stratification of probability of remission. However, further prospective studies are needed to validate these potential uses. Future research in this area will increase the accuracy of outcome predictions in different populations, age groups, and interventional approaches. This research could even challenge present guidelines for provision of weight-loss surgery, which mostly depends on BMI.”
