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DiaRem score

DiaRem score may predict post-surgical T2DM resolution

The scoring system is based on four readily available preoperative patient characteristics; insulin use, age, haemoglobin A1c concentration (HbA1c) and type of anti-diabetic drugs

The DiaRem score could be used to predict which patients will benefit most from bariatric surgery in terms of resolving type 2 diabetes. The researchers from Geisinger Health System, Danville, PA, said that the score can be used to predict whether bariatric surgery will lead to short-term remission of diabetes. Their paper, ‘Association of DiaRem Score With Cure of Type 2 Diabetes Following Bariatric Surgery’, published in JAMA states that the scoring system is based on four readily available preoperative patient characteristics; insulin use, age, haemoglobin A1c concentration (HbA1c) and type of anti-diabetic drugs.

The researchers reviewed electronic health records up to eight years after Roux-en-y gastric bypass (RYGB) surgery for 407 patients with type 2 diabetes. The sample was a subset of patients from the original validation study of DiaRem who had at least five years of electronic health record data postoperatively. Complete remission was defined as return to normal glycaemic measures and no treatment for one year. Patients were classified as cured if complete remission lasted at least five years.

Of the 407 patients, 35 percent experienced one or more years of complete remission and another 24 percent had partial remission lasting at least one year. Cure of diabetes was found in 20 percent of patients, and another 25 percent had prolonged partial remission. For remissions of any duration, the proportion of patients achieving remission decreased as DiaRem scores increased. Among the 100 patients with a score from 0 to 2, 82 percent experienced prolonged partial remission compared with none of the 33 patients with a score of 18 or higher. Fifty of the 100 patients with a score of 0 to 2 were cured of diabetes compared with none of the 33 patients with a score of 18 or higher.

"We now show that the DiaRem score predicts who will be cured by surgery, defined as complete remission lasting at least five years. The recent efforts to build larger cohorts, gather more data, and develop new analytical capabilities do not preclude continued exploration into how existing data assets can be used to improve the precision of care today," the authors write.

Previous research from the 'Geisinger Health in 2013' showed that researchers found that patients with a low DiaRem score had the highest chance of remission after surgery, while those with a higher score were less likely to achieve remission.

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