Fatima Farhat, Hjelmesæth Jøran, Hertel Jens Kristoffer, Svanevik Marius, Sandbu Rune, Småstuen Milada Cvancarova, Hofsø Dag
Morbid Obesity Centre, Department of Medicine, Vestfold Hospital Trust, Boks 2168, 3103, Tønsberg, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318, Oslo, Norway.
Obes Surg. 2022 Mar;32(3):801-809. doi: 10.1007/s11695-021-05856-2. Epub 2022 Jan 4.
Prediction of type 2 diabetes (T2DM) remission is an important part of risk-benefit assessment before bariatric surgery.
Advanced-DiaRem (Ad-DiaRem) and ABCD diabetes remission scores for sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) were calculated using baseline data. Differences in model discrimination using area under the curve of receiver operating curve (AUC-ROC) and model calibration were tested for complete remission (HbA1c ≤ 6.0% without antidiabetic medications) in the two groups. Optimal cutoff scores were calculated using the Youden index.
We randomized 109 patients to either SG or RYGB. With one patient lost to follow-up in each group, the scores were calculated for 54 patients in the SG group and 53 patients in the RYGB group. Both models showed moderate predictive power without any significant difference between the groups: AUC-ROCs (95% CI) for the Ad-DiaRem score (SG versus RYGB) were 0.872 (0.780-0.964) versus 0.843 (0.733-0.954), p = 0.69, and for the ABCD score 0.849 (0.752-0.946) versus 0.750 (0.580-0.920), p = 0.32, respectively. Using optimal cutoff points derived from the whole study population, the actual proportion of diabetes remission was significantly higher than predicted for both the Ad-DiaRem and ABCD scores in the RYGB group. Diabetes duration and glycated haemoglobin predicted diabetes remission in the entire Oseberg population.
Both the Ad-DiaRem and ABCD scores showed moderate ability to discriminate between those who achieved remission of T2DM and those who did not after SG and RYGB. Larger studies are needed for the identification of procedure-specific optimal cutoffs. Trial Registration ClinicalTrials.gov Identifier: NCT01778738.
2型糖尿病（T2DM）缓解的预测是减肥手术前风险效益评估的重要组成部分。
使用基线数据计算袖状胃切除术（SG）和Roux-en-Y胃旁路术（RYGB）的Advanced-DiaRem（Ad-DiaRem）和ABCD糖尿病缓解评分。使用受试者工作特征曲线下面积（AUC-ROC）测试两组完全缓解（糖化血红蛋白[HbA1c]≤6.0%且未使用抗糖尿病药物）时模型区分度的差异，并测试模型校准情况。使用约登指数计算最佳截断分数。
我们将109例患者随机分为SG组或RYGB组。每组各有1例患者失访，为SG组的54例患者和RYGB组的53例患者计算评分。两种模型均显示出中等预测能力，两组之间无显著差异：Ad-DiaRem评分的AUC-ROC（95%CI）（SG组与RYGB组）分别为0.872（0.780 - 0.964）和0.843（0.733 - 0.954），p = 0.69；ABCD评分的AUC-ROC分别为0.849（0.752 - 0.946）和0.750（0.580 - 0.920），p = 0.32。使用从整个研究人群得出的最佳截断点，RYGB组中糖尿病缓解的实际比例显著高于Ad-DiaRem和ABCD评分的预测值。糖尿病病程和糖化血红蛋白可预测整个奥塞贝格人群中的糖尿病缓解情况。
Ad-DiaRem和ABCD评分在区分SG和RYGB术后实现T2DM缓解的患者与未实现缓解的患者方面均显示出中等能力。需要开展更大规模的研究以确定特定手术的最佳截断值。试验注册ClinicalTrials.gov标识符：NCT01778738。
