Clinicians can use a simple algorithm to help predict which patients are likely to have type 2 diabetes cured by bariatric surgery, according to a new analysis.
Researchers examined the long-term predictive accuracy of the DiaRem score, which they had previously validated to predict whether bariatric surgery will lead to remission of diabetes lasting at least 1 year. Results were published online on April 20 by JAMA Surgery.
DiaRem, a weighted score ranging from 0 to 22 points, is based on age, insulin dependence, diabetes medication use, and HbA1c level. Researchers categorized 407 patients with type 2 diabetes who had Roux-en-Y gastric bypass (RYGB) surgery by DiaRem score: 0 to 2, 3 to 7, 8 to 12, 13 to 17, and 18 to 22 points.
Participants (mean age, 51.1 years; 75% women) had undergone surgery between June 2001 and December 2010 at a single medical center. The sample was a subset of patients from the original DiaRem validation study who had 5 years of postoperative data. Median follow-up was 7.1 years. After calculating each patient's preoperative DiaRem score, researchers determined the extent of their diabetes remission based on post-RYGB surgery criteria set by the American Diabetes Association.
Complete remission was defined as no diabetes treatment for 1 year and a return to normal glycemic measures (HbA1c level <5.7%; fasting glucose level <100 mg/dL [5.55 mmol/L]). Patients were considered to be cured if complete remission lasted at least 5 years. Partial remission was defined as no active treatment or procedures for 1 year, plus hyperglycemia below diagnostic thresholds for diabetes (HbA1c level <6.5%; fasting glucose level <125 mg/dL [6.94 mmol/L]). Partial remission lasting at least 5 years was considered to be prolonged partial remission.
Of 407 patients, 144 (35%) experienced 1 year or more of complete remission, and 97 (24%) had partial remission lasting at least 1 year. Eighty-three patients (20%) went on to be cured, and another 102 (25%) achieved prolonged partial remission. The proportion of patients achieving remission of any duration decreased as DiaRem scores increased (P<0.001). Of the 100 patients with scores of 0 to 2, 82 (82%) experienced prolonged partial remission, and 50 (50%) were cured. None of the 33 patients with a score of 18 or higher achieved these outcomes.
The DiaRem score is calculated by summing the following 4 scores: age (<40 years=0 points, 40 to 49 years=1 point, 50 to 59 years=2 points, and ≥60 years=3 points); HbA1c level (<6.5%=0 points, 6.5% to 6.9%=2 points, 7% to 8.9%=4 points, and ≥9%=6 points); other diabetes drugs (metformin only=0 points, sulfonylureas and insulin-sensitizing agent other than metformin=3 points); and treatment with insulin (no=0 points, yes=10 points).