Evaluation of Prediction Models for Type 2 Diabetes Relapse After Post-bariatric Surgery Remission: a Post hoc Analysis of 15-Year Follow-up Data from the Swedish Obese Subjects (SOS) Study

Abstract

Purpose Many patients achieve type 2 diabetes (T2D) remission after bariatric surgery, but relapse after post-surgery remission is common. Scoring models accurately predict remission up to 5 years after surgery but have not been tested for prediction of longterm T2D relapse. The aim of this work was to test the ability of prediction models and single predictors to identify patients at risk of long-term relapse (10-15 years) after post-surgery T2D remission. Methods We identified 222 individuals with T2D from the surgically treated group in the prospective Swedish Obese Subjects study, who were in remission at the 2-year follow-up and had data available for prediction of long-term T2D relapse. T2D remission/relapse was assessed after 10 and 15 years. Model performance (discrimination) was evaluated by the area under the receiver operating characteristic (AUROC) curves. Results Preoperative prediction of relapse using scores DiaRem, Ad-DiaRem, and DiaBetter and T2D duration alone was poor, as indicated by AUROC curves between 0.61-0.64 at 10 years and 0.62-0.66 at 15 years. Likewise, the 5y-Ad-DiaRem score, which includes early postoperative measures, resulted in AUROC curves of 0.65 and 0.70 for relapse at 10 and 15 years, respectively. Two-year weight change alone had higher discriminatory capacity than the 5y-Ad-DiaRem model at 10 years (AUROC = 0.70; p = 0.036) and similar capacity at 15 years (AUROC = 0.78; p = 0.188). Conclusions Predictive performance of all tested models is low for T2D relapse. By contrast, a single measure of 2-year weight change after surgery was associated with relapse, supporting a key role for initial weight reduction in long-term T2D control.

Insulin use and new diabetes after acceptance for bariatric surgery: comparison of outcomes after completion of surgery or withdrawal from the program

“…For example, a recent US study found that 35% of those who had remission of diabetes after bariatric surgery had recurrence within 5 years, 1 and recently published data from the Swedish Obese Subjects study showed overall relapse rate of 54% at 10 years. 8 Risk factors for diabetes relapse after surgery include a longer duration of diabetes, preoperative insulin use, poor preoperative glycemic control, impaired β-cell function, greater preoperative weight and a lesser degree of postoperative weight loss. [1][2][3] However, even if diabetes relapses it often requires less medication 3 9 10 and a recent study…”

“…However, a recent study has shown low predictive performance of these models, and their use in clinical practice has been limited. 8 More data and a better understanding of diabetes trajectory following bariatric surgery are needed to identify those at highest risk of diabetes relapse and to allow for appropriate monitoring and timely institution of treatment. We have also analyzed data among those with pre-existing T2D who underwent surgery, to better understand the rates, time course and factors associated with remission and relapse.…”

Comparison of various prediction models in the effect of laparoscopic sleeve gastrectomy on type 2 diabetes mellitus in the Chinese population 5 years after surgery

“…[11,12] Many patients achieve T2DM remission after bariatric surgery, whereas some patients experience T2DM recur-rence years after surgery. [13,14] The effect of bariatric surgery on T2DM control can be assessed based on predictive models of T2DM remission. Currently, there are more than 10 models for predicting T2DM remission and those models are divided into two categories: scoring and logistic regression systems.…”

Accuracy of prediction models for long-term type 2 diabetes remission after gastric bypass

“…Bariatric surgery is the most effective treatment for severe obesity [ 1 ]. Roux-en-Y Gastric Bypass (RYGB) is a widely performed bariatric surgery procedure with a very favourable benefit-to-risk ratio.…”