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Comparison of preoperative remission scores and diabetes duration alone as predictors of durable type 2 diabetes remission and risk of diabetes complications after bariatric surgery: a post-hoc analysis of participants from the Swedish Obese Subjects study

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posted on 01.09.2020 by Kajsa Sjöholm, Lena MS Carlsson, Magdalena Taube, Carel W le Roux, Per-Arne Svensson, Markku Peltonen
Objective Bariatric surgery is associated with diabetes remission and prevention of diabetes-related complications. The scores ABCD, DiaRem, Ad-DiaRem, DiaBetter and IMS were developed to predict short to medium-term diabetes remission after bariatric surgery. However, they have not been tested for predicting durable remission nor the risk of diabetes complications, nor compared with diabetes duration alone.

Research Design and Methods We identified 363 individuals from the surgically treated group in the prospective Swedish Obese Subjects (SOS) study with preoperative type 2 diabetes and for whom data (preoperative age, BMI, C-peptide, HbA1c, oral diabetes medication(s), insulin use, and diabetes duration) were available for calculation of remission scores. Partial remission (after 2 and 10 years) was defined as blood glucose <6.1 mmol/L or HbA1c <6.5% (48 mmol/mol) and no diabetes medication. Information on diabetes complications (at baseline and over 15 years of follow-up) was obtained from national health registers. Discrimination was evaluated by area under receiving operator characteristic curves (AUROCs).

Results For 2-year diabetes remission, AUROCs were between 0.79 and 0.88 for remission scores and 0.84 for diabetes duration alone. After 10 years, the predictive ability of scores decreased markedly (AUROCs between 0.70-0.76) and no score had higher predictive capacity than diabetes duration alone (AUROC=0.73). For development of microvascular and macrovascular diabetes complications over 15 years, AUROCs for remission scores were 0.70-0.80 and 0.62-0.71, respectively, and AUROCs for diabetes duration alone were 0.77 and 0.66, respectively.

Conclusions Remission scores and diabetes duration are good predictors of short-term diabetes remission. However, for durable remission and risk of complications, remission scores and diabetes duration alone have limited predictive ability.

Funding

Research reported in this publication was supported by the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (ALFGBG-717881 and ALFGBG-717891), the Swedish Research Council (2017-01707), the Swedish Diabetes Foundation (2019-417), and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (Award Number R01DK105948). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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