Pucci, A;
Tymoszuk, U;
Cheung, WH;
Makaronidis, JM;
Scholes, S;
Tharakan, G;
Elkalaawy, M;
... Batterham, RL; + view all
(2018)
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.
Diabetic Medicine
, 35
(3)
pp. 360-367.
10.1111/dme.13532.
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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.pdf - Published Version Download (197kB) | Preview |
Abstract
AIMS: The 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 Type 2 diabetes remission prediction score uses HbA1c , age and Type 2 diabetes medications but not Type 2 diabetes duration. The aim of this study was to compare the predictive value of the DiaRem score with the DiaBetter score that includes Type 2 diabetes duration, upon combined (complete plus partial) 2-year post-surgery Type 2 diabetes remission in people following RYGB and sleeve gastrectomy, and to investigate the relationship between weight loss and Type 2 diabetes remission. METHODS: A retrospective single-centre cohort study of obese people with Type 2 diabetes who underwent RYGB (107) or sleeve gastrectomy (103) and a separate validation cohort study (173) were undertaken. Type 2 diabetes remission, per cent weight loss, DiaRem, DiaBetter scores and areas under receiving operator characteristic (ROC) curves were calculated. The relationship between per cent weight loss and Type 2 diabetes remission was investigated using logistic regression with multivariate adjustments. RESULTS: The proportion of people achieving Type 2 diabetes remission was highest for those with the lowest DiaBetter and DiaRem scores, and lowest in those with the highest 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 per cent 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 Type 2 diabetes CR compared with sleeve gastrectomy [OR 2.51 (95% CI: 1.12-5.60), P = 0.025]. This association became non-significant when adjusted for per cent weight loss. CONCLUSION: DiaBetter and DiaRem scores predict Type 2 diabetes remission following RYGB and sleeve gastrectomy. Two-year per cent weight loss plays a key role in determining Type 2 diabetes remission. This article is protected by copyright. All rights reserved.
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