Honarmand K, Chetty K, Vanniyasingam T, Anvari M, Chetty V T
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Faculty of Medicine, University of Queensland, Brisbane, Australia.
Clin Obes. 2017 Jun;7(3):176-182. doi: 10.1111/cob.12189. Epub 2017 Mar 28.
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.
Roux-en-Y胃旁路术（RYGB）与2型糖尿病（DM）的缓解相关。有多种评分系统可用于预测减肥手术后2型糖尿病的缓解率；然而，经过外部验证的相对较少。DiaRem评分由四个术前变量（年龄、糖化血红蛋白[HbA1c]、磺脲类和胰岛素增敏剂使用情况以及胰岛素使用情况）组成，可用于识别RYGB术后最有可能实现糖尿病缓解的患者。我们的主要目标是确定RYGB术后1年糖尿病缓解的预测变量，确定DiaRem评分对RYGB术后1年糖尿病缓解的预测效果，并确定最佳的DiaRem评分临界值。该研究基于加拿大安大略省多个中心开展的RYGB手术结果，由汉密尔顿的外科发明与创新中心监督，并在安大略减肥网络的指导下进行。采用回归分析来确定人口统计学和临床变量以及DiaRem评分的预测价值。使用敏感性和特异性分析来确定最佳的DiaRem临界评分。在2010年1月至2015年2月期间安大略减肥登记处的3874名患者中，915名有完整的1年随访数据。其中，15名在基线时未被归类为患有糖尿病，被排除在外。在其余900名患有2型糖尿病并接受RYGB手术的患者中，333名（37.0%）在1年随访时有糖尿病缓解。除了使用任何降糖药物外，四个DiaRem变量中的三个（年龄、HbA1c、胰岛素使用情况）与糖尿病缓解相关。DiaRem评分具有中等预测价值。DiaRem评分临界值<5时，敏感性为71.8%，特异性为71.3%。本研究为临床医生使用DiaRem评分提供指导，以指导患者的选择和优先级确定，确保最可能受益的患者能及时接受减肥手术。
