Simple Score Predicts Bariatric-Surgery–Related Diabetes Cure

Marlene Busko

April 21, 2016

A new tool, based on four simple clinical measures, called the DiaRem score, may help identify which obese patients with type 2 diabetes who have bariatric surgery are likely to be "cured" from their diabetes afterward.

These findings, by G Craig Wood, of the Obesity Institute, Geisinger Health System, Danville, Pennsylvania, and colleagues, were published online April 20 in a research letter in JAMA Surgery.

Specifically, the researchers looked at the predictive power of the DiaRem score — which is based on age, HbA1c, insulin utilization, and use of other antiglycemic agents — in 407 obese diabetic patients who had Roux-en-Y gastric-bypass surgery.

After undergoing this surgery, half of the 100 patients with the best DiaRem scores (0 to 2) but none of the 33 patients with the worst scores (18 to 22) were cured of their diabetes — where cure is defined as HbA1c <5.7% (complete remission) for at least 5 years, with no antiglycemic-agent use in the past year.

"Bariatric surgery is currently the most effective treatment in reversing insulin resistance in [obese] patients with type 2 diabetes, and now a simple tool based on information that is found in medical records can provide insight into which patients might be cured from their diabetes following this surgery," senior author Annemarie G Hirsch, PhD, MPH, also of Geisinger Health System, told Medscape Medical News in an email.

DiaRem Score Inversely Correlates With Diabetes Cure

As previously reported, the group developed the DiaRem tool to predict diabetes remission in bariatric surgery by whittling 259 potential variables down to four, which they verified in three cohorts, as published in 2013.

This tool was "designed to be easily implemented, using a simple calculation based on four data elements readily available to doctors treating patients with diabetes," Dr Hirsch explained.

In the current study, the researchers analyzed up to 8 years of follow-up data from patients who had gastric-bypass surgery at their center between 2001 and 2010, to see whether the tool could predict diabetes cure.

The patients had a mean age of 51; 75% were women, and on average, they were followed for 7.1 years. They had a preoperative HbA1c of 7.4% and a mean body mass index (BMI) of 48.5.

About three-quarters of the patients (77%) were receiving metformin and more than a third (37%) were using insulin; others were using a sulfonylurea (31%) or a nonmetformin insulin-sensitizing agent (31%).

The patients had very diverse DiaRem scores: 0 to 2 (25% of patients); 3 to 7 (31%); 8 to 12 (11%); 13 to 17 (26%); and 18 to 22 (8%).

A total of 35% experienced 1 or more years of complete remission of diabetes (HbA1c <5.7%); a quarter had partial remission of diabetes for at least a year (HbA1c <6.5%); and a quarter had prolonged partial remission of diabetes for at least 5 years.

One in five patients no longer had diabetes.

The proportion of patients who achieved diabetes remission or cure decreased as the DiaRem scores increased.

A total of 82% of the patients with a DiaRem score of 0 to 2, but none of the patients with DiaRem scores of 18 to 22 attained prolonged partial remission of diabetes.

Doctors Already Have the Information to Calculate DiaRem

Mr Wood and colleagues go on to say that clinicians already have sufficient data in electronic health records to help make more individualized treatment decisions.

The current study shows how a simple algorithm based only on age, antiglycemic-medication use, and HbA1c levels can help predict which patients will likely be cured of diabetes following bariatric surgery, and this can be used to help guide treatment decisions, reiterated Dr Hirsch.

How to Calculate the DiaRem Score

Factor Score (points)
Age (y)
<40 0
40–49 1
50–59 2
>60 3
HbA1c (%)
<6.5 0
6.5–6.9 2
7.0–8.9 4
>9.0 6
Noninsulin antiglycemic drug use
Metformin 0
Other noninsulin drug 3
Use of insulin 10
The scores range from 0 (best) to 22 (worst)

This work was supported the Geisinger Clinic. The authors have no relevant financial relationships.

JAMA Surg. Published online April 20, 2016. Article

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