A scoring system based on four clinical variables has the potential to pre-operatively identify patients likely to have remission of diabetes after Roux-en-Y gastric bypass (RYGB) surgery, investigators reported.
The 22-point, insulin-weighted system had a strong inverse association with diabetes remission, ranging from 88 percent of patients who had scores of 0 to 2 to a low of 2 percent for patients with scores of 18 to 22. The system comprises four variables found to have the most influence on diabetes remission: insulin use, age, glycated hemoglobin (HbA1c), and combination therapy with an insulin sensitizer (not metformin) and a sulfonylurea among patients not using insulin.
Baseline insulin use was the strongest predictor of remission, as patients who were not using insulin before surgery had a remission rate of 70.6 percent compared with 10.3 percent for patients who were on insulin at the time of surgery, George Argyropoulos, PhD, of the Geisinger Health System in Danville, Pa., and co-authors reported online in The Lancet.
"The DiaRem score is the first pre-operative way to predict diabetes remission after RYGB surgery and is calculated with four readily obtainable clinical variables," the authors noted in their conclusion. "For example, an individual with a body mass index (BMI) of 39 kg/m2 and a DiaRem score of 22 could benefit from RYGB in terms of weight loss, but would have low probability of diabetes remission and could therefore opt to make intensive lifestyle changes or use incretin mimetics before surgery, which appears to improve the odds of remission for individuals taking insulin."
About 60 percent of obese diabetic patients achieve remission of diabetes after RYGB, a success rate that has led to proposals to apply the surgery specifically as a means to achieve diabetes remission in patients who do not meet accepted criteria for the surgery, such as individuals with BMI 25 to 35.