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Score predicted remission of diabetes in gastric-bypass candidates
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Researchers have developed a new scoring system that could predict the potential remission of diabetes before patients undergo Roux-en-Y gastric bypass.
“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,” study researcher George Argyropoulos, PhD, of the Geisinger Health System in Danville, Penn., said in a press release.
In their retrospective cohort study, Argyropoulos and colleagues examined the electronic medical records of 690 patients who underwent Roux-en-Y gastric bypass at the Geisinger Health System between January 2004 and February 2011.
Patients were divided into two groups: those who used insulin before surgery and those who did not; they were further categorized by their remission status. Early remission was considered to be remission occurring in the first 2 months after surgery and continuing for 12 months; late remission was considered to begin more than 2 months after surgery and continuing 12 months, researchers wrote. According to data, 463 (63%) patients demonstrated partial or full diabetes remission, based on the electronic medical records.
The DiaRem score ranged from 0 to 22, using age, HbA1c, insulin treatment and other diabetes drugs to tally a patient’s score. The higher the age, HbA1c and drugs used, the higher one’s score, with 10 points added to those who used insulin before surgery (HR=5.9; 95% CI, 4.41-7.9), researchers wrote.
Data indicate that 88% (95% CI, 83-92) of patients who scored 0 to 2; 64% (95% CI, 58-71) who scored 3 to 7; 23% (95% CI, 13-33) who scored 8 to 12; 11% (95% CI, 6-16) who scored 13 to 17, and 2% (95% CI, 0-5) who scored 18 to 22 displayed early remission.
In an accompanying commentary, Dimitri J. Pournaras, PhD, MRCS, of the division of investigative science at the Imperial College of London, and Carel W. le Roux, MBChB, MSC, MRCP, FRCPath, PhD, of the Imperial College of London and Diabetes Complication Research Centre at the University College Dublin, wrote that the DiaRem score could help clinicians determine treatment and management options in addition to improving surgical procedures.
“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,” Pournaras and le Roux wrote. “This research could even challenge present guidelines for provision of weight-loss surgery, which mostly depends on BMI.”
For more information:
Pournaras DJ. Lancet. 2013;doi:10.1016/S2213-8587(13)70108-6.
Still CD. Lancet. 2013;doi:10.1016/S2213-8587(13)70070-6.
Disclosure: The researchers report no relevant financial disclosures. Pournaras reports no relevant financial disclosures.