bariatric surgery

New Evaluation Tool May Help in Procedure Selection for Patients With Diabetes




Researchers have created the first validated tool that can help clinicians select bariatric surgery options for the treatment of type 2 diabetes mellitus (T2DM).

The research team from the United States, Canada, and Spain presented their tool at the American Surgical Association’s Annual Meeting on April 22.


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To create the tool, the researchers analyzed 659 patients with diabetes who had undergone Roux-en-Y gastric bypass (RYGB)—which involves dividing the stomach into a smaller pouch—or sleeve gastrectomy (SG)—which involves removing up to 80% of the stomach—at an academic center in the United States and who had a minimum 5-year follow-up.

Diabetes remission was defined as an HbA1c level of less than 6.5% off medications.

Number of diabetes medications before surgery, insulin use before surgery, duration (in years) of diabetes before surgery, and glycemic control before surgery were considered as independent predictors of long-term remission. Using these factors, the researchers created the Individualized Metabolic Surgery (IMS) Score. Then they categorized patients into 3 stages of diabetes severity and provided procedure recommendations.

An IMS score of 0 to 25 was considered mild, and RYGB was suggested; a score of 26 to 95 was considered moderate, and RYGB was highly recommended; and a score of 96 to 180 was considered severe, and SG was suggested.

After a median follow-up of 7 years after surgery, 49% of patients who had undergone RYGB and 28% of those who had undergone SG were in remission.

For patients with mild diabetes, 92% of patients who had RYGB and 74% of those who had SG were in remission at follow-up. For patients with severe diabetes, both procedures had low efficacy rates (12% vs 12%, respectively).

However, for patients with moderate diabetes, RYGB was much more effective than SG (60% vs 25%, respectively).

These findings were validated using an external dataset of 241 patients from Spain.

“This is the largest reported cohort (n=900) with long-term postoperative glycemic follow-up, which for the first time categorizes T2DM into three validated stages for evidence-based procedure selection,” the researchers wrote.

—Amanda Balbi

Aminian A, Brethauer SA, Andalib A, et al. Individualized metabolic surgery score: procedure selection based on diabetes severity. Paper presented at: American Surgical Association’s 137th Annual Meeting; April 20-22, 2017; Philadelphia, PA. Accessed April 18, 2017.