Obesity surgery · 2026
Comparative Performance of Preoperative Diabetes-Remission Scores Following Metabolic Bariatric Surgery: A Retrospective Cohort Study in a Malaysian Population.
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Mokhtar Abdul Rahman, Loo Guo Hou, Raduan Farhana, Mohamed Yusof Nursuhadah, Kosai Nik Ritza
Аннотация
INTRODUCTION: Preoperative scores predict type 2 diabetes mellitus (T2DM) remission after metabolic bariatric surgery (MBS). The original DiaRem score was refined by adding diabetes duration (DiaRem2), and separately by adding duration together with treatment burden and re-weighted penalties (advanced-DiaRem, Ad-DiaRem). Whether these refinements perform better in Asian, sleeve-predominant populations, and across classes of obesity, is unknown.
METHODS: We retrospectively studied patients with T2DM who underwent laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) at a Malaysian tertiary center between 2018 and 2022. DiaRem, DiaRem2 and Ad-DiaRem were calculated from their originally published scoring algorithms. Remission (complete or partial) followed American Society for Metabolic and Bariatric Surgery criteria. The primary analysis comprised patients with clinic-based glycemic follow-up (n = 204); a pre-specified sensitivity analysis additionally included patients followed by telephone (n = 256). Discrimination was compared using DeLong's test.
RESULTS: In the primary cohort (mean age 43.9 years; 72.1% female; 85.3% LSG), 141 patients (69.1%) achieved remission, declining across DiaRem2 groups (85.0%, 66.7%, 19.4%; trend p < 0.001). Ad-DiaRem discriminated best (area under the curve [AUC] 0.852, 95% CI 0.794-0.904), followed by DiaRem (0.807, 0.732-0.872) and DiaRem2 (0.781, 0.707-0.845). Ad-DiaRem outperformed DiaRem2 (p = 0.009) but not DiaRem (p = 0.115), and DiaRem did not differ from DiaRem2 (p = 0.259). In the larger sensitivity cohort, Ad-DiaRem also outperformed DiaRem (p = 0.036). The ordering held across obesity classes and procedures, with no score-by-procedure interaction.
CONCLUSION: In a predominantly Malay, sleeve-predominant cohort, all three scores predicted remission. Adding diabetes duration alone (DiaRem2) did not improve on the original DiaRem, whereas Ad-DiaRem, which also incorporates treatment burden and re-weighted penalties, discriminated best. Because the medication components were reconstructed retrospectively, and because the study was not powered to detect modest differences between scores, these comparisons require confirmation.
METHODS: We retrospectively studied patients with T2DM who underwent laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) at a Malaysian tertiary center between 2018 and 2022. DiaRem, DiaRem2 and Ad-DiaRem were calculated from their originally published scoring algorithms. Remission (complete or partial) followed American Society for Metabolic and Bariatric Surgery criteria. The primary analysis comprised patients with clinic-based glycemic follow-up (n = 204); a pre-specified sensitivity analysis additionally included patients followed by telephone (n = 256). Discrimination was compared using DeLong's test.
RESULTS: In the primary cohort (mean age 43.9 years; 72.1% female; 85.3% LSG), 141 patients (69.1%) achieved remission, declining across DiaRem2 groups (85.0%, 66.7%, 19.4%; trend p < 0.001). Ad-DiaRem discriminated best (area under the curve [AUC] 0.852, 95% CI 0.794-0.904), followed by DiaRem (0.807, 0.732-0.872) and DiaRem2 (0.781, 0.707-0.845). Ad-DiaRem outperformed DiaRem2 (p = 0.009) but not DiaRem (p = 0.115), and DiaRem did not differ from DiaRem2 (p = 0.259). In the larger sensitivity cohort, Ad-DiaRem also outperformed DiaRem (p = 0.036). The ordering held across obesity classes and procedures, with no score-by-procedure interaction.
CONCLUSION: In a predominantly Malay, sleeve-predominant cohort, all three scores predicted remission. Adding diabetes duration alone (DiaRem2) did not improve on the original DiaRem, whereas Ad-DiaRem, which also incorporates treatment burden and re-weighted penalties, discriminated best. Because the medication components were reconstructed retrospectively, and because the study was not powered to detect modest differences between scores, these comparisons require confirmation.