Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Diabetes Res Clin Pract. 2024 Feb;208:111091. doi: 10.1016/j.diabres.2024.111091. Epub 2024 Jan 13.
Metabolic and bariatric surgery (MBS) is considered one of the most effective interventions for weight loss and associated type-2 diabetes mellitus (T2DM) remission. Multiple scores including the Individualized Metabolic Surgery (IMS), DiaRem, advanced DiaRem, and Robert et al. scores, have been developed predict T2DM remission after MBS. We aim to validate each of these scores in our cohort of patients undergoing MBS with long-term follow-up and assess their efficacy based on procedure type and preoperative BMI.
We conducted a multicenter cohort study including patients with T2DM undergoing either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Areas under the receiver operating characteristics (ROC) curve (AUC) were calculated to assess the discriminatory ability of the four models to detect T2DM remission.
A total of 503 patients (67 % females, mean age 53.5 [11] years, BMI 46.2 [8.8] kg/m) with T2DM were included. The majority (78 %) underwent RYGB, while the rest (28 %) had SG. All four scores predicted T2DM remission in our cohort with an ROC AUC of 0.79 for IMS, 0.78 for both DiaRem and advanced-DiaRem, and 0.75 for Robert et al. score. Specific subgroups for each of these scores demonstrated higher T2DM remission rates after RYGB compared to SG.
We demonstrate the ability of the IMS, DiaRem, advanced-DiaRem and Robert et al. scores to predict T2DM remission in patients undergoing MBS. T2DM remission rates was demonstrated to decrease with more severe IMS, DiaRem and advanced-DiaRem scores and lower Robert et al. scores.
代谢和减重手术（MBS）被认为是减肥和相关 2 型糖尿病（T2DM）缓解最有效的干预措施之一。已经开发了多种评分系统，包括个体化代谢手术（IMS）、DiaRem、高级 DiaRem 和 Robert 等人的评分系统，以预测 MBS 后 T2DM 的缓解情况。我们旨在通过长期随访验证这些评分系统在我们接受 MBS 的患者队列中的有效性，并根据手术类型和术前 BMI 评估它们的疗效。
我们进行了一项多中心队列研究，纳入了接受 Roux-en-Y 胃旁路术（RYGB）或袖状胃切除术（SG）的 T2DM 患者。计算接受者操作特征曲线（ROC）下的面积（AUC）以评估四个模型识别 T2DM 缓解的能力。
共有 503 名 T2DM 患者（78%为女性，平均年龄 53.5[11]岁，BMI 46.2[8.8]kg/m）纳入研究。大多数患者（78%）接受了 RYGB，其余患者（28%）接受了 SG。所有四个评分系统在我们的队列中都能预测 T2DM 的缓解，IMS 的 ROC AUC 为 0.79，DiaRem 和高级 DiaRem 的 ROC AUC 为 0.78，Robert 等人的评分的 ROC AUC 为 0.75。这些评分系统的特定亚组在 RYGB 后显示出比 SG 更高的 T2DM 缓解率。
我们证明了 IMS、DiaRem、高级 DiaRem 和 Robert 等人的评分系统能够预测接受 MBS 的患者 T2DM 的缓解情况。T2DM 的缓解率随着 IMS、DiaRem 和高级 DiaRem 评分的增加和 Robert 等人评分的降低而降低。
