Roux-en-Y gastric bypass (RYGB) is associated with the remission of type 2 diabetes mellitus (DM). There are a number of scoring systems available that help predict type 2 diabetes remission rates after bariatric surgery; however, relatively few have been validated externally. The DiaRem score, comprised of four preoperative variables (age, haemoglobin Ale [HbAlc], sulfonylurea and insulin-sensitizing agent use and insulin use), allows for the identification of patients who are most likely to have DM remission following RYGB. Our primary objective was to determine the variables predictive of DM remission 1 year post-RYGB, determine how well the DiaRem score predicts DM remission 1 year post-RYGB and identify the optimal cut-off DiaRem score. The study is based on results of RYGB performed across multiple centres in Ontario, Canada, overseen by the Centre for Surgical Invention and Innovation in Hamilton, with direction from the Ontario Bariatric Network. Regression analysis was used to determine the predictive value of demographic and clinical variables and that of the DiaRem score. The optimal DiaRem cut-off score was determined using sensitivity and specificity analysis. Of 3874 patients in the Ontario Bariatric Registry between January 2010 and February 2015, 915 had complete 1-year follow-up data. Among these, 15 were not classified as having DM at baseline and were excluded. Of the remaining 900 patients with type 2 diabetes and who underwent RYGB surgery, 333 (37.0%) had DM remission at 1-year follow-up. Three of four DiaRem variables (age, HbAlc, insulin use), in addition to use of any hypoglycaemic agent, were associated with DM remission. DiaRem score had moderate predictive value. A DiaRem score cut-off of <5 had a sensitivity of 71.8% and specificity of 71.3%. This study provides guidance to clinicians in using the DiaRem score to inform the selection and prioritization of patients to ensure timely access to bariatric surgery for those who are likely to benefit the most.
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机译：roux - en - y胃旁路手术(RYGB)有关的缓解2型糖尿病(DM)。有许多可用的评分系统帮助预测2型糖尿病缓解率减肥手术后;外部验证。由四个术前变量(年龄、血红蛋白啤酒(HbAlc)磺酰脲类和insulin-sensitizing代理使用和胰岛素使用),允许病人的识别最有可能有DM RYGB后缓解。我们的主要目标是确定的变量预测的DM缓解1年post-RYGB,了解DiaRem得分预测DM post-RYGB和缓解期1年确定最优截止DiaRem得分。研究基于RYGB执行的结果跨多个中心在安大略省、加拿大、由外科中心的发明汉密尔顿,创新的方向安大略省减肥网络。被用来确定的预测价值人口统计学和临床变量的DiaRem分数。使用敏感性和得分决定特异性分析。安大略省减肥注册表2010年1月之间2015年2月,915年完成1年随访数据。分类在基线和DM排除在外。2糖尿病和RYGB手术,333在1年随访糖尿病缓解(37.0%)。三四个DiaRem变量(年龄、HbAlc胰岛素使用),除了使用的那些代理,与糖尿病有关缓解。价值。敏感性为71.8%,特异性为71.3%。本研究临床医生提供指导使用DiaRem分数通知选择和优先级的患者,以确保及时的访问为那些减肥手术可能受益最多。
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