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

Abstract

AimsThe comparative efficacy of Roux‐en‐Y gastric bypass (RYGB) and sleeve gastrectomy on Type 2 diabetes remission and the role of weight loss are unclear. The DiaRem diabetes remission prediction score uses HbA1c, age and diabetes medications but not diabetes duration. The aim of this study was to compare the DiaRem with the DiaBetter score that includes diabetes duration, upon combined (complete plus partial) 2‐year post‐surgery diabetes remission in people following RYGB and sleeve gastrectomy, and to investigate the relationship between weight loss and diabetes remission.MethodsA retrospective single‐centre cohort study of obese people with diabetes who underwent RYGB (107) or sleeve gastrectomy (103) and a validation cohort study (173) were undertaken. Diabetes remission, % weight loss, DiaRem, DiaBetter scores and areas under receiving operator characteristic (ROC) curves were calculated. The relationship between % weight loss and diabetes remission was investigated using logistic regression.ResultsThe proportion of people achieving diabetes remission was highest for those with the lowest DiaBetter and DiaRem scores. Areas under the ROC curves were comparable [DiaBetter: 0.867 (95%CI: 0.817–0.916); DiaRem: 0.865 (95%CI: 0.814–0.915), P=0.856]. Two‐year % weight loss was higher post RYGB [26.6 (95%CI: 24.8–28.4)] vs post‐sleeve gastrectomy [20.6 (95%CI: 18.3–22.8), P<0.001]. RYGB had 151% higher odds of diabetes remission [OR 2.51 (95%CI: 1.12–5.60), P=0.025]. This association became non‐significant when adjusted for % weight loss.ConclusionDiaBetter and DiaRem scores predict diabetes remission following both procedures. Two‐year % weight loss plays a key role in determining diabetes remission.

Is Pre-operation Social Connectedness Associated with Weight Loss up to 2 Years Post Bariatric Surgery?

“…Differences of such magnitude are also clinically significant, as a previous study reports a 7% increase in the odds of type 2 diabetes remission for every 1% weight loss [36]. This finding is in partial agreement with a prospective study which reported a borderline positive association between number of confidants and %EWL [22].…”

A meta-analysis of the medium- and long-term effects of laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass

“…To determine the effect of fasting insulin and glucose reduction, the degree of %EWL was more significant than the type of surgery. This may be the reason why LRYGB was more effective than LSG as T2DM treatment [16].…”

“…Moreover, conclusions of studies that compared LRYGB with LSG in the remission of complications remained controversial. Some studies indicated that LRYGB was superior to LSG [5,15,16] in the remission of T2DM, while other studies suggested that the remission rates were similar in both groups [17]. Previous studies had shown an advantage for LRYGB in the remission of hypertension [18][19][20].…”

Impact of bariatric surgery on type 2 diabetes: contribution of inflammation and gut microbiome?

“…Since DR following BS is not universal, there has been progress in developing scoring systems (DiaRem 56 , ABCD score 57 , Ad-DiaRem 58 and DiaBetter 59 ) to predict patients' likelihood to achieve DR one year following surgery. These scores use several routine clinical parameters demonstrated to be involved with DR or non-DR.…”