Systematic review of risk prediction models for diabetes after bariatric surgery

Zhang, R; Borisenko, O.; Telegina, I; Hargreaves, James; Ahmed, Amna; Santos, Raquel Sánchez; Pring, Christopher; Funch‐Jensen, Peter; Dillemans, B.; Hedenbro, Jan

doi:10.1002/bjs.10255

Cited by 32 publications

(16 citation statements)

References 36 publications

(93 reference statements)

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“…Both models were developed in patients who underwent RYGB; the ABCD model was initially verified in an Asian population, whereas the DiaRem score was verified in a USA, predominantly white cohort. A limited number of studies have directly compared the two scoring systems in terms of discrimination and calibration .…”

Section: Discussionmentioning

confidence: 99%

Type 2 diabetes remission rates 1‐year post‐Roux‐en‐Y gastric bypass and validation of the DiaRem score: the Ontario Bariatric Network experience

et al. 2017

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Roux-en-Y gastric bypass (RYGB) is associated with the remission of type 2 diabetes mellitus (DM). There are a number of scoring systems available that help predict type 2 diabetes remission rates after bariatric surgery; however, relatively few have been validated externally. The DiaRem score, comprised of four preoperative variables (age, haemoglobin A1c [HbA1c], sulfonylurea and insulin-sensitizing agent use and insulin use), allows for the identification of patients who are most likely to have DM remission following RYGB. Our primary objective was to determine the variables predictive of DM remission 1 year post-RYGB, determine how well the DiaRem score predicts DM remission 1 year post-RYGB and identify the optimal cut-off DiaRem score. The study is based on results of RYGB performed across multiple centres in Ontario, Canada, overseen by the Centre for Surgical Invention and Innovation in Hamilton, with direction from the Ontario Bariatric Network. Regression analysis was used to determine the predictive value of demographic and clinical variables and that of the DiaRem score. The optimal DiaRem cut-off score was determined using sensitivity and specificity analysis. Of 3874 patients in the Ontario Bariatric Registry between January 2010 and February 2015, 915 had complete 1-year follow-up data. Among these, 15 were not classified as having DM at baseline and were excluded. Of the remaining 900 patients with type 2 diabetes and who underwent RYGB surgery, 333 (37.0%) had DM remission at 1-year follow-up. Three of four DiaRem variables (age, HbA1c, insulin use), in addition to use of any hypoglycaemic agent, were associated with DM remission. DiaRem score had moderate predictive value. A DiaRem score cut-off of <5 had a sensitivity of 71.8% and specificity of 71.3%. This study provides guidance to clinicians in using the DiaRem score to inform the selection and prioritization of patients to ensure timely access to bariatric surgery for those who are likely to benefit the most.

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Section: Discussionmentioning

confidence: 99%

Type 2 diabetes remission rates 1‐year post‐Roux‐en‐Y gastric bypass and validation of the DiaRem score: the Ontario Bariatric Network experience

et al. 2017

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“…However, the exact physiological and molecular mechanisms behind diabetes remission after bariatric surgery remains incompletely understood[ 21 , 22 ]. (Figure 1 ) There are several reviews that looked at the role of bariatric surgery in managing diabetes mellitus[ 23 - 26 ] and the mechanism behind reversibility of type 2 diabetes mellitus[ 27 , 28 ] All agree that diabetes remission can be an important outcome to look at after bariatric surgery and there are many risk prediction models which can predict diabetes remission[ 29 ].…”

Section: Bariatric Surgerymentioning

confidence: 99%

Reversibility of diabetes mellitus: Narrative review of the evidence

Ang¹

2018

WJD

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The global disease burden of diabetes mellitus is high. It is well-established that prediabetes is reversible but it is unclear whether diabetes is reversible once it has been diagnosed. The objective of this narrative review is to review the evidence of reversibility of diabetes mellitus and stimulate interest in prolonged remission as a treatment target. The current evidence for bariatric surgery is stronger than intensive medical management and the evidence is stronger for type 2 diabetes patients compared with type 1 diabetes patients. It is also unclear whether non obese diabetes patients would benefit from such interventions and the duration of diabetes before diabetes become irreversible. Further research is needed in this area especially with regards to the subgroup of diabetes patient who will benefit from these interventions and the long term safety and efficacy remains unknown especially with intensive medical management.

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“…Even though bariatric surgery leads to the improvement of T2D, differences related to the resolution of the obesity-related conditions exist [11]. Therefore, the identification of prediction factors of T2D remission after bariatric surgery is an important topic [12,13]. Factors such as the preoperative duration of T2D, the use of insulin, as well as a high percentage of glycated hemoglobin (HbA1c) and lower weight loss after surgery can influence the remission of T2D [14,15].…”

Section: Introductionmentioning

confidence: 99%

Increase of the Adiponectin/Leptin Ratio in Patients with Obesity and Type 2 Diabetes after Roux-en-Y Gastric Bypass

et al. 2019

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Bariatric surgery remains the most effective option for achieving important and sustained weight loss. We explored the effects of Roux-en-Y gastric bypass (RYGB) on the circulating levels of adiponectin, leptin, and the adiponectin/leptin (Adpn/Lep) ratio in patients with obesity and type 2 diabetes (T2D). Twenty-five T2D volunteers undergoing RYGB were included in the study, and further subclassified as patients that responded or not to RYBG, regarding remission of T2D. Anthropometric and biochemical variables were evaluated before and after RYGB. Obese patients with T2D exhibited an increase (p < 0.0001) in the Adpn/Lep ratio after RYGB. Changes in the Adpn/Lep ratio correlated better with changes in anthropometric data (p < 0.001) than with the variations of adiponectin or leptin alone. Multiple regression analysis revealed that the change in the Adpn/Lep ratio in patients with T2D was an independent predictor of the changes in body mass index (p < 0.001) and body fat percentage (p = 0.022). However, the Adpn/Lep ratio did not differ between individuals with or without T2D remission after RYGB. In summary, the current study demonstrated that after weight and body fat loss following RYGB, the Adpn/Lep ratio increased in patients with obesity and T2D.

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Systematic review of risk prediction models for diabetes after bariatric surgery

Cited by 32 publications

References 36 publications

Type 2 diabetes remission rates 1‐year post‐Roux‐en‐Y gastric bypass and validation of the DiaRem score: the Ontario Bariatric Network experience

Type 2 diabetes remission rates 1‐year post‐Roux‐en‐Y gastric bypass and validation of the DiaRem score: the Ontario Bariatric Network experience

Reversibility of diabetes mellitus: Narrative review of the evidence

Increase of the Adiponectin/Leptin Ratio in Patients with Obesity and Type 2 Diabetes after Roux-en-Y Gastric Bypass

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