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Diabetes Remission After Weight-Loss Surgery

Scoring system could help determine if weight-loss procedure will help control disease in obese patients

WebMD News from HealthDay

By Robert Preidt

HealthDay Reporter

FRIDAY, Sept. 13 (HealthDay News) -- A simple scoring system can predict whether an obese patient might achieve diabetes remission within five years after weight-loss surgery, according to researchers.

The scoring system -- called DiaRem -- is based on four readily available pre-surgery patient characteristics: insulin use, age, hemoglobin A1c concentration (a measure of blood sugar) and type of diabetes drugs.

To develop their scoring system, the researchers analyzed the outcomes of nearly 700 obese people with type 2 diabetes who underwent weight-loss surgery between 2004 and 2011. Of those patients, 63 percent achieved partial or complete diabetes remission.

The researchers analyzed hundreds of factors in order to identify those that were independent predictors of remission. They eventually narrowed them down to the four used in the scoring system. Patient scores were determined by assigning a certain number of points to each of the four factors.

Patients with a low score had the highest chance of remission within five years after surgery, while those with a higher score were less likely to achieve remission. The scoring system's performance was then tested in nearly 400 patients, according to the study, which was published in the journal The Lancet Diabetes & Endocrinology.

"[The new scoring system] will give patients and physicians a scientifically valid way of assessing the merits of gastric bypass surgery for treating diabetes and deciding whether additional measures should be taken to improve the odds of remission," lead author George Argyropoulos, from the Geisinger Health System in Danville, Penn., said in a journal news release.

The authors of an accompanying commentary agreed. "The DiaRem score could help with selection of appropriate treatment and management of expectations held by both the patient and the multidisciplinary team involved in the patient's care," wrote Dimitri Pournaras and Carel le Roux, from Imperial College London, in England.

"Additionally, it could scientifically improve the comparison of different surgical procedures by allowing appropriate stratification of probability of remission," Pournaras and le Roux said.

"However, further prospective studies are needed to validate these potential uses," they said. "Future research in this area will increase the accuracy of outcome predictions in different populations, age groups and interventional approaches. This research could even challenge present guidelines for provision of weight-loss surgery, which mostly depends on [body-mass index]" -- a measurement of body fat based on height and weight.

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