Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, 200233, China.
Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
Obes Surg. 2020 Jun;30(6):2147-2157. doi: 10.1007/s11695-019-04371-9.
Roux-en-Y gastric bypass (RYGB) is a major type of bariatric surgery. Various models have been established for facilitating clinical decision-making and predicting outcomes after RYGB; the ABCD, DiaRem, advanced-DiaRem (Ad-DiaRem), and DiaBetter scores are among the most commonly used risk prediction models. However, these models were primarily developed based on retrospective analyses of patients from Western countries at 1 year after RYGB. The present study was to assess the performance of these models and identify the optimal model, for predicting postoperative diabetes remission in diabetic Chinese patients.
The present study included a total of 253 RYGB patients; 214 completed a 1-year follow-up and 131 completed a 3-year follow-up. The assessments and comparisons of the predictive performance of the four models were based on both discrimination and calibration measures. Discrimination was assessed according to the area under the receiver operating characteristic curve (AUC), and calibration was evaluated by Hosmer-Lemeshow goodness-of-fit tests and predicted-to-observed ratios.
One hundred thirteen (52.8%) in the 1-year follow-up group and 59 (45.0%) in the 3-year follow-up group achieved complete diabetes remission. Although all models showed similar discriminatory capacity and good calibration, the DiaBetter model exhibited the best predictive performance (1-year follow-up, AUC 0.760, 95% confidence interval [CI] 0.697-0.815, predicted-to-observed ratio 1.04; 3-year follow-up, AUC 0.804, 95% CI 0.726-0.868, predicted-to-observed ratio 0.95).
The present results indicated that the DiaBetter model is the optimal model for predicting postoperative diabetes remission in diabetic Chinese individuals, due to its excellent predictive accuracy and ready availability for use in clinical practice.
Roux-en-Y 胃旁路术（RYGB）是一种主要的减重手术。已经建立了各种模型来促进临床决策并预测 RYGB 后的结果；ABCD、DiaRem、高级-DiaRem（Ad-DiaRem）和 DiaBetter 评分是最常用的风险预测模型之一。然而，这些模型主要是基于西方国家 RYGB 术后 1 年的患者回顾性分析建立的。本研究旨在评估这些模型的性能，并确定预测中国糖尿病患者术后糖尿病缓解的最佳模型。
本研究共纳入 253 例 RYGB 患者；214 例完成 1 年随访，131 例完成 3 年随访。基于区分度和校准度评估了四个模型的预测性能。区分度根据接受者操作特征曲线下的面积（AUC）进行评估，校准通过 Hosmer-Lemeshow 拟合优度检验和预测值与实际值的比值进行评估。
1 年随访组中有 113 例（52.8%），3 年随访组中有 59 例（45.0%）达到完全糖尿病缓解。虽然所有模型均表现出相似的区分能力和良好的校准度，但 DiaBetter 模型表现出最佳的预测性能（1 年随访，AUC 为 0.760，95%置信区间 [CI] 为 0.697-0.815，预测值与实际值的比值为 1.04；3 年随访，AUC 为 0.804，95%CI 为 0.726-0.868，预测值与实际值的比值为 0.95）。
本研究结果表明，DiaBetter 模型是预测中国糖尿病个体术后糖尿病缓解的最佳模型，因为它具有出色的预测准确性，并且易于在临床实践中使用。
