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New scoring method predicts long-term diabetes remission after bariatric surgery

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August 16, 2018

Patients likely to experience long-term diabetes remission after Roux-en-Y gastric bypass surgery can be identified by a combination of presurgical and 1-year postsurgical parameters, according to findings published in Diabetes Care.

“Currently, there is a major concern in the mid- to long-term maintenance of glycemic control post-[bariatric surgery] because observational long-term follow-up studies and randomized controlled trials indicate a decreased rate of [diabetes remission] over time,” Jean Debédat, PhD, of Sorbonne University, INSERM, NutriOmics team, Paris, and colleagues wrote in the study background. “Nearly half of the patients experiencing [diabetes remission] at 1-year relapse 5 years post-[Roux-en-Y gastric bypass], with a decreased mean [diabetes remission] rate of 30%. These relapses are frequently concomitant with weight regain and the deterioration of lipid homeostasis after 1 year.”

Researchers evaluated data from a subgroup of 175 patients with severe obesity and type 2 diabetes from the Bariatric Surgery Cohort of Institute of Cardiometabolism and Nutrition study to develop and test a scoring system — the 5-year advanced-diabetes remission score — to predict long-term diabetes remission. Participants underwent Roux-en-Y gastric bypass surgery and had available data from baseline, 3, 6 and 12 months and 5 years after the procedure. Researchers developed the scoring method using machine-learning algorithms and validated it with three confirmation cohorts that included 124 similar participants.

At 1 year after surgery, 106 members of the study cohort experienced partial or complete diabetes remission. At 5 years, this dropped to 94 experiencing long-term remission and 27 participants who had diabetes remission at some point experiencing relapse during follow-up; the remaining 54 patients did not experience diabetes remission at any time.

Researchers found that scoring systems that predicted diabetes remission at 1 year were less accurate at predicting remission or relapse at 5 years.

Compared with patients without diabetes remission at 5 years, those with long-term remission had higher baseline body weight but had lost substantially more weight, total fat mass and trunk fat mass at 6 and 12 months, and they had improved body condition as shown by greater loss of limb fat mass and greater gains of limb fat-free mass. In contrast, those who experienced ultimate relapse of diabetes remission had less weight loss and less loss of total fat, limb fat and trunk fat vs. those who maintained diabetes remission at 5 years. Less weight loss within the first year of follow-up was more predictive of relapse vs. remission at 5 years (OR = 2.66; P < .05), but not vs. never experiencing diabetes remission (OR = 0.63; P = .13).

In terms of predicting diabetes remission at 5 years, the scoring system was highly effective (area under the receiver operating characteristic, 90%; accuracy, 85%) and accurately identified 13 of 39 patients who were wrongly categorized based on 1-year remission predictors alone.

“We propose to use the [5-year advanced-diabetes remission] score as an easily integrated tool to identify patients at risk for longer-term relapse during their 1-year follow-up assessments to propose strategies targeting optimized weight reduction and maintenance to maximize the length of their remission,” the researchers wrote. “Eventually, patients identified with the [5-year advanced-diabetes remission score] to remain in long-term [no diabetes remission] could also be proposed add-on strategies to further improve and control and prevent long-term complications.” – by Jennifer Byrne

Disclosures: The authors report no relevant financial disclosures.

 

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