Diabetes Remission Following Gastric Bypass: Does Diarem Stand the Test of Time?

J. Hunter Mehaffey, MD, Matthew G Mullen, MD, Rachel L Mehaffey, MD, Florence E Turrentine, PhD, RN, Steven K Malin, PhD, Bruce Schirmer, MD, Peter T Hallowell, MD. University of Virginia

Objective(s): Amelioration of type 2 diabetes mellitus (T2DM) is well-known to occur after Roux-en-Y Gastric Bypass (RYGB). Although the DiaREM score is a novel method for predicting T2DM resolution up to 1-year post-RYGB, no data exist for long-term validity. Therefore, we sought to determine the utility of this score on long-term RYGB effectiveness for T2DM resolution at 2 and 10 years respectively following RYGB.

Methods: T2DM patients (Age: 48, BMI: 46, HbA1C: 8.1) undergoing RYGB at the University of Virginia between 2004-2006 (n=42) and 2012-2014 (n=59) were evaluated prospectively to assess pre-operative DiaREM score, defined from insulin use, age, HbA1c and type of antidiabetic medication. T2DM partial remission status was based on the American Diabetes Association guidelines. Chi square test was used to compare patient’s T2DM status to their DiaREM probability of remission.

Results: Among RYGB patients with 2-year post-operative data, 2 were lost (n=1 no follow-up and n=1 died ) resulting in 57 patients for analysis. For the 10-year postoperative data, 11 were lost (n=6 no follow up and n=5 died) thereby resulting in only 31 patients for analysis. Table 1 displays patients stratified by preoperative DiaREM scores, with the probability of T2DM remission as well as the actual percent remission at 2- and 10-years. There was no statistical difference in the DiaREM predicted compared with actual T2DM remission rate at either time-point (all p>0.05).            

Conclusions: Pre-operative DiaREM scores are a good tool for predicting both short- and long-term T2DM remission following RYGB. This study represents the first evaluation of this model in T2DM patients up to 10 years after bariatric surgery. 

Table 1. Pre-operative DiaREM Score Validation of T2DM Remission at 2- and 10-years

DiaREM Score	Avg Probability  of Remission (%)	2-Year Remission (%)	2-Year    p-value	10-Year Remission (%)	10-Year  p-value
0-2	94	100	0.61	100	0.72
3-7	76	94	0.08	83	0.57
8-12	36	47	0.38	43	0.72
13-17	22	20	0.92	33	0.64
18-22	9	15	0.40	14	0.64