Type 2 diabetes remission following gastric bypass: does diarem stand the test of time?

OBJECTIVE(S): Roux-en-Y Gastric Bypass (RYGB) is well known to ameliorate type 2 diabetes mellitus (T2DM), and recent work suggests that the preoperative DiaREM model predicts successful remission up to 1 year post-RYGB. However, 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.

METHODS: T2DM patients (Age: 48, BMI: 49, 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 preoperative 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 (HbA1C  < 6.5 % and fasting glycemia <125 mg/dL, and no anti-diabetic medications). Chi-square test was used to compare patient's T2DM status to their DiaREM probability of remission.

RESULTS: Among RYGB patients with 2-year postoperative 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. Patients were distributed by DiaREM score to correlate with the predicted probability of remission as follows: 0-2 (Predicted 94 %, 2-year 100 % p = 0.61, 10-year 100 % p = 0.72), 3-7 (Predicted 76 %, 2-year 94 % p = 0.08, 10-year 83 % p = 0.57), 8-12 (Predicted 36 %, 2-year 47 % p = 0.38, 10-year 43 % p = 0.72), 13-17 (Predicted 22 %, 2-year 20 % p = 0.92, 10-year 33 % p = 0.64), and 18-22 (Predicted 9 %, 2-year 15 % p = 0.40, 10-year 14 % p = 0.64).

CONCLUSIONS: Preoperative DiaREM scores are a good tool for predicting both short- and long-term T2DM remissions following RYGB. This study highlights the need to identify strategies that improve T2DM remission in those at highest risk.