Score predicts diabetes remission after Roux-en-Y surgery

Researchers created a new score, based on four variables, which can help predict whether a patient will have remission of type 2 diabetes after Roux-en-Y gastric bypass surgery.

The score, which the researchers named the DiaRem score, was created based on a retrospective cohort study of 690 patients with type 2 diabetes who had the surgery at one hospital in 2004 to 2011. Patients were followed for partial or complete remission lasting at least 12 months after surgery. Partial remission was defined as hemoglobin A1c (HbA1c) less than 6.5% and fasting blood glucose less than 126 mg/dL, while complete remission was an HbA1c less than 6.0% with fasting blood glucose less than 100 mg/dL, both with no antidiabetic medication. Results were published by The Lancet Diabetes & Endocrinology on Sept. 13.

After examining 259 variables, researchers identified four that best predicted partial or complete remission in the 463 surgical patients (63%) who achieved either type of remission. Insulin use before surgery was the strongest predictor (patients who used insulin were least likely to have remission), so it was given the most weight (10 points in the 22-point score). Other factors that predicted remission were younger age, lower HbA1c and not taking the combination of both insulin-sensitizing agents (other than metformin) and sulfonylureas.

Among patients with the lowest scores, 88% had remission after surgery, compared to only 0.5% of the highest-scoring patients. The researchers validated their findings in two replication cohorts and concluded that their DiaRem score could be used preoperatively to predict diabetes remission after Roux-en-Y (but not other types of bariatric surgery). This study also found for the first time that, among patients who took insulin, use of incretin mimetics increased the chance of remission, a finding that needs further confirmation, the authors noted.

The score could help with treatment selection for diabetes and management of expectations in patients who are undergoing Roux-en-Y, an accompanying comment noted. However, more research is needed to validate the findings and assess the effects of surgery on other endpoints, including mortality. Clinicians should also remember that even patients who are unlikely to achieve diabetes remission from surgery may see significant benefits from the procedure, the comment concluded.