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T2DM remission

Test predicts diabetes remission following bariatric surgery

The researchers employed two scoring systems - the established DiaRem score and the DiaBetter score

A new simple test that helps predicts which people with type 2 diabetes mellitus (T2DM) will benefit most from bariatric surgery has been developed by a University College London led researchers. The researchers also found that percentage weight loss two years post-surgery was a stronger predictor of T2DM remission, than whether the patient underwent gastric bypass or sleeve gastrectomy, as there wasn't a significant difference between the two surgeries after adjusting for weight loss. The findings should help maximise the health benefits obtained from bariatric surgery. The paper, ‘Type 2 diabetes remission 2 years post Roux-en-Y gastric bypass and sleeve gastrectomy: the role of the weight loss and comparison of DiaRem and DiaBetter scores,’ was published in Diabetic Medicine.

Rachel Batterham

"Over 2 million people in the UK are eligible for assessment for bariatric surgery, and yet only 6,000 undergo the procedure each year,” said the study's lead author, Professor Rachel Batterham, UCL Centre for Obesity Research and UCLH Bariatric Centre for Weight Management and Metabolic Surgery. “Given the limited access to surgery it's vital that we ensure it's offered to those who will benefit the most, and that they're well supported long after the surgery."

T2DM is currently estimated to cause close to 25,000 preventable deaths a year in the UK, and the main driver for its increased prevalence is rising obesity rates. Sustained weight loss improves blood glucose control in people with established T2DM; however, maintaining sustained weight loss is difficult due to biological compensatory mechanisms.

It is known that bariatric surgery alters the hormones that control blood glucose, lowering glucose levels and reducing the long-term complications of T2DM such as eye and kidney damage. Many people with T2DM are able to stop all of their diabetes medications after surgery.

"Bariatric surgery can be highly beneficial, yet the results are highly variable, so we set out to devise a better way of identifying which people with T2D will benefit most," explained Professor Batterham, who also leads the Obesity research theme at the University College London Hospitals Biomedical Research Centre.

The study was a retrospective cohort study of people with T2DM who had undergone Roux-en-Y gastric bypass surgery (n=107) or sleeve gastrectomy (n=103), with two-year follow-up data, plus a further 173 people in a separate study to validate the results. The researchers employed two scoring systems designed to predict T2DM remission post-surgery: the established DiaRem score, as well as the novel, more accessible DiaBetter score designed by the research team.

The DiaRem diabetes remission prediction score uses HbA1c, age and diabetes medications but not diabetes duration. The DiaBetter score is calculated from three factors: the drugs a person is currently taking, their HbA1c level and how long ago their diabetes was diagnosed.

The investigators reported that the proportion of people achieving diabetes remission was highest for those with the lowest DiaBetter and DiaRem scores. Remission rates among those in the lowest quintile of DiaBetter scores were 98% compared to 19% in the highest quintile.

The researchers also found that percentage weight loss two years post-surgery was a stronger predictor of T2DM remission than whether the patient underwent gastric bypass or sleeve gastrectomy, as there wasn't a significant difference between the two surgeries after adjusting for weight loss. For every 5% weight loss, the odds of T2DM remission increased by 54%.

"Access to bariatric surgery is very carefully controlled, yet post-surgery support is often lacking,” said Dr Andrea Pucci, UCL Centre for Obesity Research and UCLH Bariatric Centre for Weight Management and Metabolic Surgery, the study's first author. “We've added to the evidence that it's vital to support people in maintaining their weight loss long-term, to make sure that the surgery is effective."

The researchers noted that this was the first time the significance of weight loss to remission has been established in people who had undergone sleeve gastrectomy; while it's the most common type of bariatric surgery globally, it's much newer than gastric bypass so there are gaps in the research.

"As roughly one in five people don't have positive results from bariatric surgery, we hope that clinicians will begin using DiaBetter right away to adequately weigh the benefits and risks, and ensure that only the most suitable candidates have the surgery," said Professor Batterham.

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