Abstract
Background
Roux-en-Y gastric bypass (RYGB) is a major type of bariatric surgery. Various models have been established for facilitating clinical decision-making and predicting outcomes after RYGB; the ABCD, DiaRem, advanced-DiaRem (Ad-DiaRem), and DiaBetter scores are among the most commonly used risk prediction models. However, these models were primarily developed based on retrospective analyses of patients from Western countries at 1 year after RYGB. The present study was to assess the performance of these models and identify the optimal model, for predicting postoperative diabetes remission in diabetic Chinese patients.
Methods
The present study included a total of 253 RYGB patients; 214 completed a 1-year follow-up and 131 completed a 3-year follow-up. The assessments and comparisons of the predictive performance of the four models were based on both discrimination and calibration measures. Discrimination was assessed according to the area under the receiver operating characteristic curve (AUC), and calibration was evaluated by Hosmer-Lemeshow goodness-of-fit tests and predicted-to-observed ratios.
Results
One hundred thirteen (52.8%) in the 1-year follow-up group and 59 (45.0%) in the 3-year follow-up group achieved complete diabetes remission. Although all models showed similar discriminatory capacity and good calibration, the DiaBetter model exhibited the best predictive performance (1-year follow-up, AUC 0.760, 95% confidence interval [CI] 0.697–0.815, predicted-to-observed ratio 1.04; 3-year follow-up, AUC 0.804, 95% CI 0.726–0.868, predicted-to-observed ratio 0.95).
Conclusions
The present results indicated that the DiaBetter model is the optimal model for predicting postoperative diabetes remission in diabetic Chinese individuals, due to its excellent predictive accuracy and ready availability for use in clinical practice.
Similar content being viewed by others
Abbreviations
- T2DM:
-
Type 2 diabetes mellitus
- RYGB:
-
Roux-en-Y gastric bypass
- Ad-DiaRem:
-
Advanced-DiaRem score
- SD:
-
Standard deviation
- IQR:
-
Interquartile range
- CI:
-
Confidence interval
- BMI:
-
Body mass index
- AST:
-
Aspartate aminotransferase
- ALT:
-
Alanine aminotransferase
- BUN:
-
Blood urea nitrogen
- TG:
-
Triglycerides
- TC:
-
Total cholesterol
- HDL-c:
-
High-density lipoprotein cholesterol
- LDL-c:
-
Low-density lipoprotein cholesterol
- FPG:
-
Fasting plasma glucose
- PPG:
-
Postprandial plasma glucose
- HbA1c:
-
Hemoglobin A1c
- HOMA-IR:
-
Homeostasis model of assessment for insulin resistance
- PPV:
-
Positive predictive value
- NPV:
-
Negative predictive value
- AUC:
-
Area under receiver operating characteristic curve
- ROC curve:
-
The receiver operating characteristic (ROC) curve
References
Wang L, Gao P, Zhang M, et al. Prevalence and ethnic pattern of diabetes and Prediabetes in China in 2013. JAMA. 2017;317(24):2515–23.
Professional Practice Committee: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S3.
Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016;39(6):861–77.
Lee WJ, Hur KY, Lakadawala M, et al. Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score. Surg Obes Relat Dis. 2013;9(3):379–84.
Still CD, Wood GC, Benotti P, et al. Preoperative prediction of type 2 diabetes remission after roux-en-Y gastric bypass surgery: a retrospective cohort study. Lancet Diabetes Endocrinol. 2014;2(1):38–45.
Aron-Wisnewsky J, Sokolovska N, Liu Y, et al. The advanced-DiaRem score improves prediction of diabetes remission 1 year post-roux-en-Y gastric bypass. Diabetologia. 2017;60(10):1892–902.
Pucci A, Tymoszuk U, Cheung WH, et al. 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. Diabet Med. 2018;35(3):360–7.
Zhang R, Borisenko O, Telegina I, et al. Systematic review of risk prediction models for diabetes after bariatric surgery. Br J Surg. 2016;103(11):1420–7.
Debedat J, Sokolovska N, Coupaye M, et al. Long-term relapse of type 2 diabetes after roux-en-Y gastric bypass: prediction and clinical relevance. Diabetes Care. 2018;41(10):2086–95.
Shen SC, Wang W, Tam KW, et al. Validating risk prediction models of diabetes remission after sleeve gastrectomy. Obes Surg. 2019;29(1):221–9.
Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes? Diabetes Care. 2009;32(11):2133–5.
Yu H, Li Q, Zhang M, et al. Decreased Leptin is associated with alterations in thyroid-stimulating hormone levels after roux-en-Y gastric bypass surgery in obese euthyroid patients with type 2 diabetes. Obes Facts. 2019;12(3):272–80.
Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29–36.
Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3(1):32–5.
Hosmer DW, Hosmer T, Le Cessie S, et al. A comparison of goodness-of-fit tests for the logistic regression model. Stat Med. 1997;16(9):965–80.
Chan J, Malik V, Jia W, et al. Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009;301(20):2129–40.
Lee WJ, Chong K, Chen SC, et al. Preoperative prediction of type 2 diabetes remission after gastric bypass surgery: a comparison of DiaRem scores and ABCD scores. Obes Surg. 2016;26(10):2418–24.
Cotillard A, Poitou C, Duchateau-Nguyen G, et al. Type 2 diabetes remission after gastric bypass: what is the best prediction tool for clinicians? Obes Surg. 2015;25(7):1128–32.
Craig Wood G, Horwitz D, Still CD, et al. Performance of the DiaRem score for predicting diabetes remission in two health systems following bariatric surgery procedures in Hispanic and non-Hispanic white patients. Obes Surg. 2018;28(1):61–8.
Honarmand K, Chetty K, Vanniyasingam T, et al. Type 2 diabetes remission rates 1-year post-roux-en-Y gastric bypass and validation of the DiaRem score: the Ontario bariatric network experience. Clin Obes. 2017;7(3):176–82.
Stallard R, Sahai V, Drover JW, et al. Defining and using preoperative predictors of diabetic remission following bariatric surgery. JPEN J Parenter Enteral Nutr. 2018;42(3):573–80.
Dicker D, Golan R, Aron-Wisnewsky J, et al. Prediction of long-term diabetes remission after RYGB, sleeve gastrectomy, and adjustable gastric banding using DiaRem and advanced-DiaRem scores. Obes Surg. 2019;29(3):796–804.
Aminian A, Brethauer SA, Kashyap SR, et al. DiaRem score: external validation. Lancet Diabetes Endocrinol. 2014;2(1):12–3.
Sampaio-Neto J, Nassif LS, Branco-Filho AJ, et al. External validation of the Diarem score as remission predictor of diabetes mellitus type 2 in obese patients undergoing roux-en-Y gastric bypass. Arq Bras Cir Dig. 2015;28(Suppl 1):19–22.
Tharakan G, Scott R, Szepietowski O, et al. Limitations of the DiaRem score in predicting remission of diabetes following roux-en-Y gastric bypass (RYGB) in an ethnically diverse population from a single institution in the UK. Obes Surg. 2017;27(3):782–6.
Funding
This study was supported by grants from National Key Research and Development Project of China (2016YFA0502003), National Natural Science Foundation of China (81500625), and Municipal Natural Science Foundation of Shanghai (17ZR1421200).
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethnical Approval
This study was approved by the sixth People’s Hospital Ethics Committee of Shanghai Jiaotong University and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Statements of Ethics
According to the World Medical Association’s statement, this study was approved by the Sixth People’s Hospital Ethics Committee of Shanghai Jiaotong University and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. All participants received informed written consent before the study.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kam, H., Tu, Y., Pan, J. et al. Comparison of Four Risk Prediction Models for Diabetes Remission after Roux-en-Y Gastric Bypass Surgery in Obese Chinese Patients with Type 2 Diabetes Mellitus. OBES SURG 30, 2147–2157 (2020). https://doi.org/10.1007/s11695-019-04371-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-019-04371-9