Predicting Type 2 Diabetes Remission Following Bariatric Surgery

Identifying patients who will achieve remission of type 2 diabetes (T2D) following bariatric surgery is challenging, but prediction models such as the ABCD (Age, BMI, C-peptide, and Duration) and Diabetes Remission score (DiaRem) models seem to be the most accurate, according to research findings published in Diabetes Care.

A team of UK investigators reviewed T2D remission prediction models and compared their performance and applicability in clinical practice. They identified 16 model development studies and 22 validation studies (a combined total of 38) out of 4165 studies published in MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases over a 15-year period.

Eleven of the 16 model development studies produced scoring systems, and 5 were logistic regression prediction models. In the model development studies, researchers said 10 showed “excellent discrimination” (defined as the ability to distinguish between post-bariatric surgery patients who did [or did not] achieve T2D remission, with an area under the receiver operating characteristic curve [AUC] of ≥0.800).  The study authors categorized an AUC score of 0.700-0.799 as “acceptable” discrimination, 0.800-0.899 as “excellent” discrimination, and 0.900-1.000 as “outstanding” discrimination.

Two prediction models–ABCD and DiaRem–were externally validated in a large variety of patient populations who had undergone different bariatric procedures and achieved both short- and long-term T2D remission. The ABCD and DiaRem models were primarily developed for the prediction of T2D remission at 1-year follow-up after bariatric surgery, the researchers noted, but said they have since “been validated in studies predicting long-term [T2D] remission.”

While newer prediction models showed “excellent” discrimination in test studies, many of them (several of which were published in the literature within the last 3 to 4 years) had limited external validation studies, according to the researchers.

The researchers noted that “a large proportion” of the studies selected in their review had small cohorts and short follow-up durations, which may have limited overall findings.

In the study authors’ opinion, their review identified the ABCD and DiaRem as “the two most widely validated models to predict [T2D] remission following bariatric surgery.”

“More external validation studies are needed for assessing the performance and clinical applicability of the new prediction models,” they concluded. “Future studies should also examine these models in real-world clinical settings to assess the impact on patient outcomes.”

Disclosure: Multiple study authors declared affiliations with pharmaceutical companies. . Please refer to the original article for a full list of disclosures.

Reference

Singh P, Adderley NJ, Hazlehurst J, et al. Prognostic models for predicting remission of diabetes following bariatric surgery: A systematic review and meta-analysis. Diabetes Care. 2021;44(11):2626-2641. doi:10.2337/dc21-0166