Lancet Diabetes Endocrinol. 2014 Jan;2(1):38-45. doi: 10.1016/S2213-8587(13)70070-6.
About 60% of patients with type 2 diabetes achieve remission after Roux-en-Y gastric bypass (RYGB) surgery. No accurate method is available to preoperatively predict the probability of remission. Our goal was to develop a way to predict probability of diabetes remission after RYGB surgery on the basis of preoperative clinical criteria.
In a retrospective cohort study, we identified individuals with type 2 diabetes for whom electronic medical records were available from a primary cohort of 2300 patients who underwent RYGB surgery at the Geisinger Health System (Danville, PA, USA) between Jan 1, 2004, and Feb 15, 2011. Partial and complete remission were defined according to the American Diabetes Association criteria. We examined 259 clinical variables for our algorithm and used multiple logistic regression models to identify independent predictors of early remission (beginning within first 2 months after surgery and lasting at least 12 months) or late remission (beginning more than 2 months after surgery and lasting at least 12 months). We assessed a final Cox regression model with a consistent subset of variables that predicted remission, and used the resulting hazard ratios (HRs) to guide creation of a weighting system to produce a score (DiaRem) to predict probability of diabetes remission within 5 years. We assessed the validity of the DiaRem score with data from two additional cohorts.
Electronic medical records were available for 690 patients in the primary cohort, of whom 463 (63%) had achieved partial or complete remission. Four preoperative clinical variables were included in the final Cox regression model: insulin use, age, HbA1c concentration, and type of antidiabetic drugs. We developed a DiaRem score that ranges from 0 to 22, with the greatest weight given to insulin use before surgery (adding ten to the score; HR 5·90, 95% CI 4·41–7·90; p<0·0001). Kaplan-Meier analysis showed that 88% (95% CI 83–92%) of patients who scored 0–2, 64% (58–71%) of those who scored 3–7, 23% (13–33%) of those who scored 8–12, 11% (6–16%) of those who scored 13–17, and 2% (0–5%) of those who scored 18–22 achieved early remission (partial or complete). As in the primary cohort, the proportion of patients achieving remission in the replication cohorts was highest for the lowest scores, and lowest for the highest scores.
The DiaRem score is a novel preoperative method to predict the probability of remission of type 2 diabetes after RYGB surgery.
Geisinger Health System and the US National Institutes of Health.
大约 60%的 2 型糖尿病患者在接受 Roux-en-Y 胃旁路手术（RYGB）后可实现缓解。目前尚无准确的方法可在术前预测缓解的概率。我们的目标是基于术前临床标准，开发一种预测 RYGB 手术后糖尿病缓解概率的方法。
在一项回顾性队列研究中，我们从接受过 RYGB 手术的 2300 例患者的主要队列中确定了可获取电子病历的 2 型糖尿病患者。这些患者的手术时间在 2004 年 1 月 1 日至 2011 年 2 月 15 日之间。根据美国糖尿病协会的标准，将部分缓解和完全缓解定义为缓解。我们对 259 个临床变量进行了分析，并使用多因素逻辑回归模型确定了早期缓解（术后 2 个月内开始，持续至少 12 个月）或晚期缓解（术后 2 个月后开始，持续至少 12 个月）的独立预测因子。我们评估了一个包含能够预测缓解的一致变量子集的最终 Cox 回归模型，并使用由此产生的风险比（HR）来指导创建一个加权系统，以产生一个评分（DiaRem），用于预测术后 5 年内糖尿病缓解的概率。我们使用来自两个额外队列的数据评估了 DiaRem 评分的有效性。
主要队列中共有 690 名患者可获取电子病历，其中 463 名患者（63%）实现了部分或完全缓解。最终 Cox 回归模型纳入了 4 个术前临床变量：胰岛素使用、年龄、糖化血红蛋白浓度和抗糖尿病药物类型。我们开发了一个 DiaRem 评分，范围为 0 至 22 分，其中手术前胰岛素使用的权重最大（加 10 分；HR 5.90，95%CI 4.41-7.90；p<0.0001）。Kaplan-Meier 分析显示，评分 0-2 分的患者中 88%（95%CI 83%-92%）、评分 3-7 分的患者中 64%（58%-71%）、评分 8-12 分的患者中 23%（13%-33%）、评分 13-17 分的患者中 11%（6%-16%）和评分 18-22 分的患者中 2%（0%-5%）实现了早期缓解（部分缓解或完全缓解）。与主要队列一样，在复制队列中，缓解率最高的是评分最低的患者，最低的是评分最高的患者。
DiaRem 评分是一种新的术前方法，可预测 2 型糖尿病患者接受 RYGB 手术后缓解的概率。
Geisinger 健康系统和美国国立卫生研究院。
