Bariatric surgery has evolved from surgical treatment of morbidly obese to treating metabolic syndrome type 2 diabetes mellitus (t2DM). Despite the significant improvements the bariatric and metabolic surgery has in diabetes patients, not all individuals attain the most desirable outcomes. A new scoring system will allow doctors to carefully identify patients that are good candidates for diabetes remission after metabolic surgery, like gastric bypass surgery.

diabetes type 2 - insulin resistance

The scoring system is based on four different variables,

  • age
  • types of anti-diabetic drugs
  • insulin use
  • HbA1C concentration

A patient can score up to 22 points. The study was released by the Geisinger Health System and the National Institutes of Health.*

The study found that 88% of patients had zero to two scores, while just 2% of patients had scored 18 to 22 at the high end of the scoring system. The research shows that diabetes remission is influenced by insulin use, age, glycated hemoglobin, and combination therapy with insulin sensitizers.

The researchers found that baseline insulin use was the strongest predictor of remission in patients, as those who did not use insulin before the surgery had a remission rate of 70.6% compared to 10.3% of those who did take insulin before gastric bypass surgery.

Learn More: What Does Sugar Do To Your Body?

Scoring System Helps to Predict Gastric Bypass Patients’ Chances of Diabetes RemissionFuture of Diabetes Scoring System for Gastric Bypass Patients

“The DiaRem score is the first pre-operative way to predict diabetes remission after RYGB surgery and is calculated with four readily obtainable clinical variables,” the researchers said. For example, an individual with a body mass index (BMI) of 39 kg/m2 and a DiaRem score of 22 could benefit from RYGB in terms of weight loss but would have a low probability of diabetes remission and could, therefore, opt to make intensive lifestyle changes or use incretin mimetics before surgery, which appears to improve the odds of remission for individuals taking insulin.”

The study also reports that nearly 60% of obese diabetic patients experience a remission of diabetes after weight loss surgery. Many believe this statistic suggests that surgery should be used to achieve diabetes remission in patients who have dangerous cases of diabetes due to their morbid obesity.

About the Study

The authors of the study agree that patients and their doctors can benefit from a system that allows them to predict their likelihood of remission before enduring weight loss surgery (gastric bypass). The researchers were determined to find an effective and easy to understand way to predict diabetes remission.

Patients achieved this by studying nearly 2,300 patients who understand gastric bypass at their health system (Geisinger Health System) from 2004 to 2011. They identified the patients studied by ensuring that they met the American Diabetes Association criteria for type 2 diabetes before enduring surgery. They also used the American Diabetes Association definition of remission to define it in this study.

Learn More: The Outcome for Bariatric Surgery is Better After 15 Years

Takeaway

NIH Scoring System Type II Diabetes - Mexico Bariatric Center

Researchers separated patients into two groups according to their individual insulin use at the time of surgery. From there, patients were divided into groups further by studying when remission occurred (if at all), whether within 2 months before surgery or 2 months after surgery.

The study looked at 2,300 patients with 690 patients with type 2 diabetes before surgery, and 436 achieving partial remission and 340 achieving complete remission. According to the study, patients were separated into five categories – 0 to 2, 3 to 7, 8 to 12, 13 to 17, and 18 to 22. The conclusion is simple: gastric bypass surgery had a profound impact on type 2 diabetes remission.

More Information & Links

* Reference: Scoring System and Procedure