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Diabetes remission rates after RYGB affected by study duration
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Definitions of remission and study duration substantially affect reported rates of diabetes remission after Roux-en-Y gastric bypass, according to a literature review.
“Endocrinologists should consider which definitions of remission are appropriate for a given situation — partial vs. complete remission, cumulative vs. prevalent remission, or short-term vs. long-term outcomes — when making clinical recommendations about Roux-en-Y gastric bypass (RYGB),” Deanna J.M. Isaman, PhD, of the department of biostatistics at the University of Michigan in Ann Arbor, told Endocrine Today. “Our results enable physicians to convert reported outcomes into meaningful estimates.”
Isaman and colleagues conducted a literature review on 10 large, recent (index surgery since 2000) studies of diabetes remission after RYGB. Definitions of remission (partial vs. complete), length of follow-up (1 years vs. 3 years), reported outcomes (cumulative vs. prevalent remission) and risks of attrition bias differed between the studies.
In studies evaluating remission rates, the cumulative remission rate was increased by 10 to 30 percentage points when the definition was changed from complete to partial remission. Nearly 70% of variability in remission rates of studies can be explained by study duration; after adjustment for attrition, 87% of the variability could be explained by study duration, the researchers wrote.
After 3 years, the prevalence of complete remission decreased by 21 percentage points, highlighting the difference between cumulative and prevalent remission rates. No significant differences were found between estimates of prevalent and cumulative remission rates 1 year after surgery, but cumulative remission rates were about 30 percentage points higher than prevalent remission rates after 3 years.
“Reported estimates of diabetes remission rates following RYGB do not vary as much as they appear to do,” Isaman told Endocrine Today. “When comparing reported rates using the same definition of remission, the same statistics and the same study duration, results are remarkably similar. We suggest general guidelines for interpreting reported remission rates: Readers should expect rates for partial remission to be 10 to 30 percentage points higher than for complete remission; readers should expect prevalent remission — patients who ever attained remission — at 3 years; readers should expect cumulative remission at 1 year to be approximately 25%, and at 3 years 65% when including patients lost to follow-up.” – by Amber Cox
For more information:
Deanna J.M. Isaman, PhD, can be reached at djmisaman@umich.edu.
Disclosure: The researchers report no relevant financial disclosures.
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