Ann Surg Treat Res.  2019 Dec;97(6):309-318. 10.4174/astr.2019.97.6.309.

Discordance in prediction for prognosis of type 2 diabetes after metabolic surgery: comparison of the ABCD, DiaRem, and individualized metabolic surgery models

• Ha J
• Kwon Y
• Kim NH
• Park S
• Menzo EL
• Rosenthal

• KMID: 2464787
• DOI: http://doi.org/10.4174/astr.2019.97.6.309

Abstract

PURPOSE
Metabolic surgery has been performed as a treatment option for uncontrolled type 2 diabetes (T2D), and several scoring systems for predicting postoperative T2D remission have been proposed. This study was designed to assess consistency of 3 existing scoring systems in patients with T2D duration <1 year.
METHODS
This study included 186 patients with T2D enrolled in a university hospital prospective database between 2011 and 2013. Externally validated scoring systems for predicting T2D prognosis after metabolic surgery were identified and selected through systematic literature search. We assessed concordance between ABCD, DiaRem, and individualized metabolic surgery (IMS) scores in participants using kappa statistical analysis and 1-way analysis of variance.
RESULTS
Of the participants, 52 and 82 patients were expected to have favorable T2D remission after metabolic surgery with ABCD score of 10-5 and DiaRem score of 0-7, respectively, and a slight-to-fair concordance was shown between the 2 scoring systems (kappa measure, 0.07; standard error [SE], 0.05 and kappa measure, 0.25; SE, 0.19, respectively). The DiaRem score increased with T2D severity determined by IMS score (P < 0.001), while the ABCD score showed no significant association with IMS score.
CONCLUSION
ABCD and DiaRem scores showed significant discordance when applied to potential metabolic surgery candidates in whom postoperative T2D remission rate was highly expected. The IMS score showed a dose-response association with DiaRem score but had no significant association with the ABCD score.

Keyword

Bariatric surgery; Prognosis; Scores; Type 2 diabetes mellitus

MeSH Terms

Bariatric Surgery*
Diabetes Mellitus, Type 2
Humans
Prognosis*
Prospective Studies

Figure

• 

  Fig. 1 Distribution of ABCD, DiaRem, and individualized metabolic surgery (IMS) scores in all participants. The total score of each scoring system is calculated by adding the points for each of the 4 variables (left panel). The cutoff values for each variable are shown. A, B, and C in the right panel indicate distribution of ABCD, DiaRem, and IMS scores in all participants, respectively. Intervals are 1 in ABCD score (A), 1 in DiaRem score (B), and 10 in IMS score (C). Subgroups with highly expected diabetes remission (>67%) are marked in panels A and B. BMI, body mass index; T2D, type 2 diabetes; SG, sleeve gastrectomy; RYGB, Roux-en-Y gastric bypass.

• 

  Fig. 2 Distribution of DiaRem (A) and ABCD (B) scores among patients in whom diabetes remission was highly expected according to the other system scores calculated by the other scoring system 52 and 82 patients were selected based on the ABCD and DiaRem scores, respectively. Patients with high expected remission rate with ABCD score show wide distribution of DiaRem score and vice versa, implying inconsistency between 2 scoring systems.

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