Abstract
PurposeBariatric surgery has proven to be the most efficient treatment for obesity and type 2 diabetes mellitus (T2DM). Despite detailed qualification, desirable outcome after an intervention is not achieved by every patient. Various risk prediction models of diabetes remission after metabolic surgery have been established to facilitate the decision-making process. The purpose of the study is to validate the performance of available risk prediction scores for diabetes remission a year after surgical treatment and to determine the optimal model.MethodsA retrospective analysis comprised 252 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2009 and 2017 and completed 1-year follow-up. The literature review revealed 5 models, which were subsequently explored in our study. Each score relationship with diabetes remission was assessed using logistic regression. Discrimination was evaluated by area under the receiver operating characteristic (AUROC) curve, whereas calibration by the Hosmer–Lemeshow test and predicted versus observed remission ratio.ResultsOne year after surgery, 68.7% partial and 21.8% complete diabetes remission and 53.4% excessive weight loss were observed. DiaBetter demonstrated the best predictive performance (AUROC 0.81; 95% confidence interval (CI) 0.71–0.90; p-value > 0.05 in the Hosmer–Lemeshow test; predicted-to-observed ratio 1.09). The majority of models showed acceptable discrimination power. In calibration, only the DiaBetter score did not lose goodness-of-fit in all analyzed groups.ConclusionThe DiaBetter score seems to be the most appropriate tool to predict diabetes remission after metabolic surgery since it presents adequate accuracy and is convenient to use in clinical practice. There are no accurate models to predict T2DM remission in a patient with advanced diabetes.
Highlights
Nowadays, the focus on bariatric treatment is gradually shifting from the primary goal of body weight reduction towards the remission of obesity-related metabolic diseases [1]
Our study demonstrates that decreasing individualized metabolic surgery (IMS), DiaRem, Ad-DiaRem, and DiaBetter scores, and increasing score proposed by Robert et al were significantly associated with increasing likelihood of diabetes remission 1 year after bariatric surgery
We aimed to provide the most comprehensive external validation of current risk prediction models of diabetes remission 1 year after bariatric surgery and identify the optimal one to use in clinical practice
Summary
The focus on bariatric treatment is gradually shifting from the primary goal of body weight reduction towards the remission of obesity-related metabolic diseases [1]. Surgical procedures have proven to be the most effective type of T2DM treatment, with a postoperative remission rate of up to 78% [3, 4]. These observations have recently led to changes in guidelines, which recommend bariatric procedures to be considered as “metabolic surgery” in the treatment of T2DM, even for those who are merely overweight [5]. Earlier intervention may provide better long-term metabolic outcomes in patients with a high possibility of diabetes remission [5, 7]. The ability to distinguish patients eligible for surgical treatment is economically beneficial as it would decrease long-term healthcare costs for the entire public health system [9]
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