Surendra Ugale, MS, FALS. Kirloskar Hospital, Bashir Bagh, Hyderabad 500063.
Diabetes Severity Score (DSS) : A Useful Tool To Assess The Severity of Diabetes, Select the Appropriate Surgical Procedure and Predict The
Remission of Diabetes
We felt a great need for a Scoring System, as there too many choices of procedures that are advocated for diabetic control in morbidly obese and also obese patients; there are varying results for the same procedure in different series globally; we need a simple way to quantify the diabetic severity, to judge the efficacy of a particular procedure in a specific Grade / Severity / Stage of T2DM; and also choose the most appropriate procedure.
We used our experience with Laparoscopic Jejunal or Duodenal Ileal Interposition (JII or DII) with sleeve gastrectomy (SG), which are types of modified bariatric surgery focused mainly for diabetes remission, to identify the important factors to be used for a scoring system that is simple enough to be used in a surgical clinic. DII+SG is preferred over JII+SG in patients with less favorable metabolic profile. Due to variable remission response in our patients who underwent these procedures, retrospectively we devised a novel score ‘DSS’. Now it helps us to select the type of procedure and to predict the diabetes remission before surgery
Forty six patients underwent JII+SG and 200 for DII+SG. DSS was calculated based on preoperative parameters. DSS of the subjects with and without remission (maintaining HbA1C < 6.5% without any medication) were compared
Mean DSS in patients who underwent JII+SG (n=46) was 9.2±1.4. Twenty one (46%) had remission in diabetes. In the same group, patients with BMI ≥ 35 kg/m2, DSS was 8.9 ± 1.7 and remission rate was 85%. DSS was significantly lower in patients with remission than patients without remission (8.1±0.8 versus 10.2 ±0.9, p<0.0001). Mean DSS in patients who underwent DII+SG (n=200) was 10.4±1.3 (significantly higher than II+SG group, p = 0.0004). 72% had remission in diabetes. DSS was significantly lower in patients with remission than patients without remission (9.7±0.8 versus 12.0 ±0.5, p<0.0001).
Preoperative DSS can be a useful tool, when planning surgical treatment for diabetic patients, to select the appropriate type of surgical procedure and to predict the post operative diabetes remission. It can be applied to other procedures retrospectively for further validation.