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Cardiovascular and Metabolic Risk

Comparison of Preoperative Remission Scores and Diabetes Duration Alone as Predictors of Durable Type 2 Diabetes Remission and Risk of Diabetes Complications After Bariatric Surgery: A Post Hoc Analysis of Participants From the Swedish Obese Subjects Study

  1. Kajsa Sjöholm1⇑,
  2. Lena M.S. Carlsson1,
  3. Magdalena Taube1,
  4. Carel W. le Roux2,
  5. Per-Arne Svensson1,3 and
  6. Markku Peltonen4,5
  1. 1Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
  2. 2Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin, Ireland
  3. 3Institute of Health and Care Science, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
  4. 4Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
  5. 5Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
  1. Corresponding author: Kajsa Sjöholm, kajsa.sjoholm{at}medic.gu.se
Diabetes Care 2020 Nov; 43(11): 2804-2811. https://doi.org/10.2337/dc20-0157
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Abstract

OBJECTIVE Bariatric surgery is associated with diabetes remission and prevention of diabetes-related complications. The ABCD, DiaRem, Ad-DiaRem, DiaBetter, and individualized metabolic surgery scores were developed to predict short- to medium-term diabetes remission after bariatric surgery. However, they have not been tested for predicting durable remission nor the risk of diabetes complications, nor compared with diabetes duration alone.

RESEARCH DESIGN AND METHODS We identified 363 individuals from the surgically treated group in the prospective Swedish Obese Subjects study with preoperative type 2 diabetes and for whom data (preoperative age, BMI, C-peptide, HbA1c, oral diabetes medications, insulin use, and diabetes duration) were available for calculation of remission scores. Partial remission (after 2 and 10 years) was defined as blood glucose <6.1 mmol/L or HbA1c <6.5% (48 mmol/mol) and no diabetes medication. Information on diabetes complications (at baseline and over 15 years of follow-up) was obtained from national health registers. Discrimination was evaluated by area under receiver operating characteristic curves (AUROCs).

RESULTS For 2-year diabetes remission, AUROCs were between 0.79 and 0.88 for remission scores and 0.84 for diabetes duration alone. After 10 years, the predictive ability of scores decreased markedly (AUROCs between 0.70 and 0.76), and no score had higher predictive capacity than diabetes duration alone (AUROC = 0.73). For development of microvascular and macrovascular diabetes complications over 15 years, AUROCs for remission scores were 0.70–0.80 and 0.62–0.71, respectively, and AUROCs for diabetes duration alone were 0.77 and 0.66, respectively.

CONCLUSIONS Remission scores and diabetes duration are good predictors of short-term diabetes remission. However, for durable remission and risk of complications, remission scores and diabetes duration alone have limited predictive ability.

Footnotes

  • Clinical trial reg. no. NCT01479452, clinicaltrials.gov

  • This article contains supplementary material online at https://doi.org/10.2337/figshare.12765875.

  • Received January 23, 2020.
  • Accepted July 30, 2020.
  • © 2020 by the American Diabetes Association
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Diabetes Care: 43 (11)

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November 2020, 43(11)
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Comparison of Preoperative Remission Scores and Diabetes Duration Alone as Predictors of Durable Type 2 Diabetes Remission and Risk of Diabetes Complications After Bariatric Surgery: A Post Hoc Analysis of Participants From the Swedish Obese Subjects Study
Kajsa Sjöholm, Lena M.S. Carlsson, Magdalena Taube, Carel W. le Roux, Per-Arne Svensson, Markku Peltonen
Diabetes Care Nov 2020, 43 (11) 2804-2811; DOI: 10.2337/dc20-0157

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Comparison of Preoperative Remission Scores and Diabetes Duration Alone as Predictors of Durable Type 2 Diabetes Remission and Risk of Diabetes Complications After Bariatric Surgery: A Post Hoc Analysis of Participants From the Swedish Obese Subjects Study
Kajsa Sjöholm, Lena M.S. Carlsson, Magdalena Taube, Carel W. le Roux, Per-Arne Svensson, Markku Peltonen
Diabetes Care Nov 2020, 43 (11) 2804-2811; DOI: 10.2337/dc20-0157
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