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DiaRem Score limitations

UK study finds DiaRem limited in high scoring patients

Whilst the DiaRem score is simple to calculate, it fails to take directly into account any of the postulated mechanisms of diabetes remission such as elevated gut hormone or bile acid secretion

Although the DiaRem score remains a useful tool to predict diabetes remission in those that have a low DiaRem score (high chance for remission) its is more limited in its predictive power in those with a high DiaRem score (least likely to have remission), according to a paper by researchers from Imperial College London and Brunel University, London, UK.

The study, ‘Limitations of the DiaRem Score in Predicting Remission of Diabetes Following Roux-En-Y Gastric Bypass (RYGB) in an ethnically Diverse Population from a Single Institution in the UK’, was published in Obesity Surgery.

The authors stated that although the DiaRem score has been validated in three different populations: USA, Taiwan and Brazil, no external validation has been performed in the UK population. Therefore, they performed a retrospective study within a tertiary bariatric service in London, UK, to determine the predictive power of the DiaRem score following Roux-en-Y gastric bypass to identify patients who would have diabetes remission at one year in an ethnically diverse population.

In total, 262 patients with T2DM and obesity underwent RYGB surgery at the Imperial Weight Centre between 2007 and 2014. There was a higher prevalence of female patients (59.9 %). The mean age (±SD) of the population was 51.0 ± 9.5 years and the mean (±SD) preoperative weight was 133.4±23.4kg. The most common ethnicity was Caucasian (61.1 %) followed by Asian (10.3 %). At one-year post-surgery, there were statistically significant reductions in both weight and HbA1c. Patients were divided into five groups by DiaRem score: group 1 (0–2), group 2 (3–7), group 3 (8–12), group 4 (13–17) and group 5 (18–22).

Outcomes

At one year, complete remission was seen in 85 patients (27.9 %) while partial remission was seen in a further 12 (4.6 %), 67.8 % of those with DiaRem score 0–2 had complete or partial remission, 38.5 % of those with score 3–7, 27.9 % of those with score 8–12, 9.5 % in those with score 13–17 and 22.9 % in those with score 18–22 (Table 2).

Table 1: Comparison of the DiaRem scores from the bariatric surgery population at Imperial Weight Centre (P < 0.0001 for trends in both CR/PR and PR, Cochran-Armitage test) and from Still et al ‘Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a retrospective cohort study’, Aminian et al ‘DiaRem score: external validation’, Lee et al ‘Preoperative prediction of type 2 diabetes remission after gastric bypass surgery: a comparison of DiaRem scores and ABCD scores’ and Sampaio-Neto et al ‘External validation of the diarem score as remission predictor of diabetes mellitus type 2 in obese patients undergoing roux-en-y gastric bypass’. Abbreviations: CR complete remission, PR partial remission

“… in our population, use of the DiaRem score may falsely deter patients with higher scores from surgery that would benefit a significant proportion,” they write. “These higher scoring DiaRem patients represent a subpopulation who have generally worse or more long-standing diabetes, and so potentially have the most to gain by undergoing surgery.”

The authors stated that whilst the DiaRem score is simple to calculate, it fails to take directly into account any of the postulated mechanisms of diabetes remission such as elevated gut hormone or bile acid secretion, and any future prospective studies could evaluate the predictive power of measurement of pre-surgical levels of these mediators as well as investigate different ethnic groups in larger numbers.

“The DiaRem score, a model used to predict diabetes remission following bariatric surgery, is less successful for the purposes of predicting remission in the patients treated in this single bariatric unit within the UK,” the authors concluded. “Specifically, it is less useful at predicting response in those who have higher DiaRem score. This may reflect differences in ethnic diversity in the studied populations, or differences in prescribing between countries.”

This is an open access article distributed under the terms of the Creative Commons Attribution License

To access this paper, please click here

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