Type 2 diabetes remission 2 years post Roux‐en‐Y gastric bypass and sleeve gastrectomy: the role of the weight loss and comparison of DiaRem and DiaBetter scores

• DOI: 10.1111/dme.13532
• Publication Date: 2017-10-21T15:36:39Z
• Authors: A. Pucci; U. Tymoszuk; W. H. Cheung; J. M. Makaronidis; S. Scholes; G. Tharakan; M. Elkalaawy; M. Guimaraes; M. Nora; M. Hashemi; A. Jenkinson; M. Adamo; M. P. Monteiro; N. Finer; R. L. Batterham
• Keywords: Glycated Hemoglobin; Male; 2. Zero hunger; Remission Induction; Gastric Bypass; Bariatric Surgery; Middle Aged; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Diabetes Mellitus, Type 2; Gastrectomy; Weight Loss; Humans; Female; Research Articles; Probability

AbstractAimsThe comparative efficacy of Roux‐en‐Y gastric bypass (RYGB) and sleeve gastrectomy on Type 2 diabetes remission and the role of weight loss are unclear. The DiaRem diabetes remission prediction score uses HbA1c, age and diabetes medications but not diabetes duration. The aim of this study was to compare the DiaRem with the DiaBetter score that includes diabetes duration, upon combined (complete plus partial) 2‐year post‐surgery diabetes remission in people following RYGB and sleeve gastrectomy, and to investigate the relationship between weight loss and diabetes remission.MethodsA retrospective single‐centre cohort study of obese people with diabetes who underwent RYGB (107) or sleeve gastrectomy (103) and a validation cohort study (173) were undertaken. Diabetes remission, % weight loss, DiaRem, DiaBetter scores and areas under receiving operator characteristic (ROC) curves were calculated. The relationship between % weight loss and diabetes remission was investigated using logistic regression.ResultsThe proportion of people achieving diabetes remission was highest for those with the lowest DiaBetter and DiaRem scores. Areas under the ROC curves were comparable [DiaBetter: 0.867 (95%CI: 0.817–0.916); DiaRem: 0.865 (95%CI: 0.814–0.915), P=0.856]. Two‐year % weight loss was higher post RYGB [26.6 (95%CI: 24.8–28.4)] vs post‐sleeve gastrectomy [20.6 (95%CI: 18.3–22.8), P<0.001]. RYGB had 151% higher odds of diabetes remission [OR 2.51 (95%CI: 1.12–5.60), P=0.025]. This association became non‐significant when adjusted for % weight loss.ConclusionDiaBetter and DiaRem scores predict diabetes remission following both procedures. Two‐year % weight loss plays a key role in determining diabetes remission.