Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score

Surg Obes Relat Dis. May-Jun 2013;9(3):379-84. doi: 10.1016/j.soard.2012.07.015. Epub 2012 Aug 6.

Abstract

Background: Surgery is the most effective treatment of morbid obesity and leads to dramatic improvements in type 2 diabetes mellitus (T2DM). Gastrointestinal metabolic surgery has been proposed as a treatment option for T2DM. However, a grading system to categorize and predict the outcome of metabolic surgery is lacking. The study setting was a tertiary referral hospital (Taoyuan City, Taoyuan County, Taiwan).

Methods: We first evaluated 63 patients and identified 4 factors that predicted the success of T2DM remission after bariatric surgery in this cohort: body mass index, C-peptide level, T2DM duration, and patient age. We used these variables to construct the Diabetes Surgery Score, a multidimensional 10-point scale along which greater scores indicate a better chance of T2DM remission. We then validated the index in a prospective collected cohort of 176 patients, using remission of T2DM at 1 year after surgery as the outcome variable.

Results: A total of 48 T2DM remissions occurred among the 63 patients and 115 remissions (65.3%) in the validation cohort. Patients with T2DM remission after surgery had a greater Diabetes Surgery Score than those without (8 ± 4 versus 4 ± 4, P < .05). Patients with a greater Diabetes Surgery Score also had a greater rate of success with T2DM remission (from 33% at score 0 to 100% at score 10); A 1-point increase in the Diabetes Surgery Score translated to an absolute 6.7% in the success rate.

Conclusion: The Diabetes Surgery Score is a simple multidimensional grading system that can predict the success of T2DM treatment using bariatric surgery among patients with inadequately controlled T2DM.

Publication types

  • Evaluation Study
  • Validation Study

MeSH terms

  • Adult
  • Age Factors
  • Body Mass Index
  • C-Peptide / metabolism
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / surgery*
  • Female
  • Gastric Bypass / methods*
  • Gastroenterostomy / methods
  • Humans
  • Laparoscopy / methods*
  • Male
  • Obesity, Morbid / blood
  • Obesity, Morbid / complications
  • Obesity, Morbid / surgery*
  • Prospective Studies
  • Severity of Illness Index*
  • Treatment Outcome

Substances

  • C-Peptide