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Score generated from medical records may predict diabetes remission after bariatric surgery
The DiaRem score, generated from data readily available in medical records, may help identify patients with type 2 diabetes who will experience long-term diabetes remission after bariatric surgery, according to a recent review.
“There are sufficient data in existing electronic health record systems that can be used to facilitate tailored treatment decisions,” the researchers wrote.
Annemarie G. Hirsch, PhD, MPH, of Geisinger Health System in Danville, Pennsylvania, and colleagues reviewed electronic health records up to 8 years after Roux-en-Y gastric bypass procedures (RYGB) on 407 adults (mean age, 51.1 years; 75% women) with type 2 diabetes. All participants underwent RYGB at Geisinger Health System. Follow-up was conducted for a median of 7.1 years.
Annemarie G. Hirsch
The DiaRem score is based on preoperative age, insulin dependence, diabetes medication use and HbA1c; scores range from 0 to 22. Return to normal glycemic measures and no diabetes treatment for 1 year was considered complete remission, and participants were considered cured if remission lasted at least 5 years. Hyperglycemia below diagnostic thresholds for diabetes and no active treatment for procedures for 1 year was considered partial remission, and participants were classified as having prolonged partial remission if it lasted at least 5 years. Participants were divided into groups based on DiaRem score (0-2, 3-7, 8-12, 13-17 and 18-22 points).
Thirty-five percent of participants experienced 1 or more years of complete remission, and 24% had partial remission that lasted at least 1 year; 20% were cured of diabetes, and 25% had prolonged partial remission.
The proportion of participants achieving remission decreased with increasing DiaRem score (P < .001): 82% of participants with scores of 0 to 2 (n = 100) experienced prolonged partial remission compared with no participants with scores of 18 or higher (n = 33). Fifty percent of the patients with scores of 0 to 2 were cured compared with none with scores of 18 or higher.
“Bariatric surgery is currently the most effective treatment in reversing insulin resistance in patients with type 2 diabetes,” Hirsch told Endocrine Today. “However, like so many things in medicine, bariatric surgery is not a one-size-fits-all treatment for diabetes. For patients with certain characteristics, more than 80% of patients can expect long-term remission of disease, while for others the chance is very small. The DiaRem score provides patients with a personalized prediction of whether or not they can expect to be disease free for years after surgery.” – by Amber Cox
For more information:
Annemarie G. Hirsch, PhD, MPH, can be reached at Center for Health Research, Geisinger Health System, 100 N. Academy Ave., Danville, PA 17822; email: aghirsch@gesinger.edu.
Disclosure: The researchers report no relevant financial disclosures.