Rafael Ramos Vecchio, MD, David Gutierrez Blanco, MD, David Romero Funes, MD, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS, Samuel Szomstein, MD, FACS, FASMBS, Raul Rosenthal, MD, FACS, FASMBS. Cleveland Clinic Florida
Background: For the past decade, the bariatric surgeons have been seeking a practical and consistent tool to predict the metabolic improvement after a bariatric surgery. We evaluate the utility of the DiaRem score in predicting Type 2 Diabetes Mellitus (T2D) remission after bariatric surgery.
Methods: From our bariatric population we retrospectively reviewed all patients with diagnosis of T2D who have had a Laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric by-pass (LRYGB), between 2010 and 2014. Patients that met the criteria were included, and using simple clinical data (age, HbA1c, antidiabetic medication and use of insulin), we calculated the DiaRem. The post-operative T2D remission was calculated applying the American Diabetes Association criteria and compared to the DiaRem to assess its value as a predictive tool.
Results: From 1129 bariatric patients, 87 met the criteria for the DiaRem Score calculation and remission evaluation. The population had an age mean of 54.25±11.67 years, sex distribution of 62.06% females and 77.60% were Caucasian. LSG was the most prevalent surgery 65.5% (N=57), followed by LRYGB 34.5% (N=30). The DiaRem score was distributed as follows: 0 to 2: 9.2% (N=8), 3 to 7: 23% (N=20), 8 to 12: 12.6% (N=11), 13 to 17: 39% (N=34), 18 to 22: 16.2% (N=14). The Score Mean was 11.51±6.14. The remission (partial and complete) was achieved in 39.08% (N=34) of the cases with a relative outcome of 82% (N=28) complete and 18% (N=6) Partial. As we separated the data by group we found a remission of 87.50% (N=7) in the group from 0 to 2(p=0.0023); 70% (N=14) remission in the 3 to 7 group (p=0.01); 45% (N=5) remission in the 8 to 12 group(p=0.66); 11.76% (N=4) remission in the 13 to 17 group(p=<0.001); 28.5% (N=4)remission in the 18 to 22 group(p=0.02). Regarding the type of surgery we found for LSG 73% (N=17) remission within scores from 0 to 7 vs. 26% (N=6) within scores from 8 to 22. For LRYGB 36.3% (N=4) remission within scores from 0 to 7 vs. 63% (N=7) within scores from 8 to 22. The percentage of remission was 40.34% in LSG vs. 36.60% in LRYGB(p=0.73).
Conclusion: The DiaRem score demonstrated to be a useful tool to predict pot-operative remission of T2D both after LSG and LRYGB. Further prospective and larger studies are needed to better asses this correlation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80151
Program Number: P533
Presentation Session: Poster (Non CME)
Presentation Type: Poster