Aminian A, et al. - Authors sought to develop and validate a scoring system for evidence-based selection of bariatric and metabolic surgery procedures according to severity of type 2 diabetes (T2DM). They identified this as the largest reported cohort (n = 900) with long-term postoperative glycemic follow-up, which, for the first time, categorizes T2DM into 3 validated severity stages for evidence-based procedure selection.

Methods

• Authors analyzed a total of 659 patients with T2DM who underwent RYGB and SG at an academic center in the United States and had a minimum 5-year follow-up (2005–2011) to generate the model.
• In this work, the validation dataset was comprised of 241 patients from an academic center in Spain where similar criteria were applied.

Results

• Diabetes remission (HbA1C<6.5% off medications) was observed in 49% after RYGB and 28% after SG (P < 0.001) at median postoperative follow-up of 7 years (range 5–12).
• Four independent predictors of long-term remission included preoperative duration of T2DM (P < 0.0001), preoperative number of diabetes medications (P < 0.0001), insulin use (P = 0.002), and glycemic control (HbA1C < 7%) (P = 0.002); authors used these predictors were used to develop the Individualized Metabolic Surgery (IMS) score using a nomogram.
• Categorization of patients into 3 stages of diabetes severity was performed.
• In mild T2DM (IMS score ≤25), both procedures resulted in significant improvement in T2DM.
• In severe T2DM (IMS score >95), when clinical features suggest limited functional β-cell reserve, both procedures indicated comparable low efficacy for diabetes remission.
• There was an intermediate group, however, in which RYGB proved markedly more efficacious than SG, likely related to its more pronounced neurohormonal effects.
• They noticed that for each severity stage, findings were externally validated and procedure recommendations were provided.