Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec City, Quebec, Canada; Faculté de médecine, Université Laval, Quebec City, Quebec, Canada; École de nutrition, Université Laval, Quebec City, Quebec, Canada.
Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec City, Quebec, Canada; Faculté de médecine, Université Laval, Quebec City, Quebec, Canada.
Surg Obes Relat Dis. 2024 Jun;20(6):507-514. doi: 10.1016/j.soard.2023.11.006. Epub 2023 Nov 25.
Many patients achieve short-term type 2 diabetes (T2D) remission after bariatric surgery, but relapses are common. Diabetes outcomes after bariatric surgery vary across procedures and populations. T2D remission scores are simple clinical tools developed to predict remission after bariatric surgery. However, they have never been tested after Biliopancreatic diversion with duodenal switch (BPD-DS).
The aim of this study was to compare the predictive value of T2D remission scores and preoperative diabetes characteristics in predicting T2D remission after BPD-DS.
Quebec Heart and Lung Institute - Laval University.
We retrospectively identified 918 patients with preoperative T2D who had undergone BPD-DS. Retrospective chart review was performed and variables used to calculate predictive scores were captured. T2D status was assessed annually for up to 10 years postop. Predictive values for each score (DiarRem, Ad Diarem, and Diabetter) and single preoperative diabetes characteristics used to construct these algorithms were evaluated by area under receiver operating characteristic curves (AUC).
Diabetter showed greater performance for prediction of durable diabetes remission than other algorithms with acceptable discriminative ability (AUC between .69 and .79), but was not superior to T2D duration as a single predictor (P = .24 and P = .18). At 10 years, T2D duration had a better discriminative ability for the prediction of T2D remission than all 3 predictive models (AUC = .85, P < .05).
Better chances for T2D remission following BPD-DS are associated with a shorter duration or T2D before surgery. Duration of T2D alone offers an excellent predictive ability and is a convenient alternative to diabetes remission scores to estimate chances of long-term diabetes remission after BPD-DS.
许多患者在接受减重手术后短期内 2 型糖尿病（T2D）得到缓解，但缓解后易复发。减重手术对不同手术和人群的糖尿病结局影响各异。T2D 缓解评分是一种简单的临床工具，用于预测减重手术后的缓解。然而，它们从未在胆胰分流十二指肠转位术（BPD-DS）后进行过测试。
本研究旨在比较 T2D 缓解评分和术前糖尿病特征在预测 BPD-DS 后 T2D 缓解中的预测价值。
魁北克心脏和肺研究所-拉瓦尔大学。
我们回顾性地确定了 918 例术前患有 T2D 的患者，这些患者接受了 BPD-DS。进行了回顾性病历审查，并捕获了用于计算预测评分的变量。在术后 10 年内每年评估 T2D 状态。通过接受者操作特征曲线下面积（AUC）评估每个评分（DiarRem、Ad Diarem 和 Diabetter）和用于构建这些算法的单个术前糖尿病特征的预测值。
与其他算法相比，DiarRem 显示出对持久糖尿病缓解的预测具有更好的性能，且具有可接受的鉴别能力（AUC 在.69 和.79 之间），但并不优于作为单一预测因子的 T2D 持续时间（P =.24 和 P =.18）。在 10 年时，T2D 持续时间对 T2D 缓解的预测具有更好的鉴别能力，优于所有 3 种预测模型（AUC =.85，P <.05）。
BPD-DS 后 T2D 缓解的机会更好与手术前 T2D 的持续时间较短有关。T2D 持续时间本身具有出色的预测能力，是替代 T2D 缓解评分来估计 BPD-DS 后长期糖尿病缓解机会的便捷替代方法。
