External validation of predictive scores for diabetes remission after metabolic surgery

Abstract

Purpose Bariatric surgery has proven to be the most efficient treatment for obesity and type 2 diabetes mellitus (T2DM). Despite detailed qualification, desirable outcome after an intervention is not achieved by every patient. Various risk prediction models of diabetes remission after metabolic surgery have been established to facilitate the decision-making process. The purpose of the study is to validate the performance of available risk prediction scores for diabetes remission a year after surgical treatment and to determine the optimal model. Methods A retrospective analysis comprised 252 patients who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2009 and 2017 and completed 1-year follow-up. The literature review revealed 5 models, which were subsequently explored in our study. Each score relationship with diabetes remission was assessed using logistic regression. Discrimination was evaluated by area under the receiver operating characteristic (AUROC) curve, whereas calibration by the Hosmer–Lemeshow test and predicted versus observed remission ratio. Results One year after surgery, 68.7% partial and 21.8% complete diabetes remission and 53.4% excessive weight loss were observed. DiaBetter demonstrated the best predictive performance (AUROC 0.81; 95% confidence interval (CI) 0.71–0.90; p-value > 0.05 in the Hosmer–Lemeshow test; predicted-to-observed ratio 1.09). The majority of models showed acceptable discrimination power. In calibration, only the DiaBetter score did not lose goodness-of-fit in all analyzed groups. Conclusion The DiaBetter score seems to be the most appropriate tool to predict diabetes remission after metabolic surgery since it presents adequate accuracy and is convenient to use in clinical practice. There are no accurate models to predict T2DM remission in a patient with advanced diabetes.

How Good is Stratification and Prediction Model Analysis Between Primary and Revisional Roux-en-Y Gastric Bypass Surgery? A Multi-center Study and Narrative Review

“…In total, 10 (52.6%) studies performed an internal validation [ 18 , 19 , 23 – 26 , 28 , 32 , 34 , 36 ], and 10 (52.6%) performed an external validation [ 18 , 20 – 22 , 27 , 29 – 31 , 33 , 35 ] of the prediction model. One study tested internal and external validation.…”

Effect of Banded Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy on Diabetes Remission at 5 Years Among Patients With Obesity and Type 2 Diabetes: A Blinded Randomized Clinical Trial

“…Our study used stratified randomization to prevent imbalance between treatment groups for known factors that influence the likelihood of type 2 diabetes remission, such as age, BMI, duration of diabetes, insulin treatment, and ethnicity. Most of these variables are used in clinical scoring tools to predict the likelihood of diabetes remission after surgery ( 37 ).…”

Towards precision medicine in bariatric surgery prescription

“…Based on the evidence of the most robust patient-related pre-operative determinants for T2D remission, predictive scores such as DiaBetter (HbA1c, T2D duration and type antidiabetic drugs) [ 68 ], DiaRem (Age, HbA1c and type of antidiabetic drugs) [ 69 ] and Ad-DiaRem (Age, HbA1c, T2D duration, number and type of antidiabetic) have been developed [ 70 ]. These models were demonstrated to have comparable accuracies for predictiving T2D remission in the short-term, with an area under the Receiver Operating Characteristic (ROC) curve (AUC) ranging 0.75 – 0.90 for RYBG [ 68 , 70 , 71 ]. More recently, the 5y-Ad-DiaRem score was proposed to predict medium-term T2D remission, including not only preoperative factors (HbA1c, number of antidiabetic drugs usaded, T2D duration) but also weight loss and T2D status, 1-year after surgery [ 72 ].…”