Performance of the DiaRem Score for Predicting Diabetes Remission in Two Health Systems Following Bariatric Surgery Procedures in Hispanic and non-Hispanic White Patients.
G Craig Wood, Daniel Horwitz, Christopher D Still, Tooraj Mirshahi, Peter Benotti, Manish Parikh, Annemarie G Hirsch
Author Information
G Craig Wood: Geisinger Health System, Obesity Institute, Danville, PA, USA.
Daniel Horwitz: New York University School of Medicine/Bellevue Hospital Center, New York, NY, USA.
Christopher D Still: Geisinger Health System, Obesity Institute, Danville, PA, USA.
Tooraj Mirshahi: Geisinger Health System, Weis Center for Health Research, Danville, PA, USA.
Peter Benotti: Geisinger Health System, Obesity Institute, Danville, PA, USA.
Manish Parikh: New York University School of Medicine/Bellevue Hospital Center, New York, NY, USA.
Annemarie G Hirsch: Geisinger Health System, Department of Epidemiology and Health Services Research, Danville, PA, USA. aghirsch@geisinger.edu.
OBJECTIVE: The objective of this study was to determine whether the DiaRem, a score that predicts type 2 diabetes (T2D) remission following roux-en-y gastric bariatric surgery (RYGB), also predicts remission following laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) in white and Hispanic patients. BACKGROUND: While bariatric surgery is highly effective in reversing insulin resistance, there are patients for whom surgery will not lead to remission. To date, there is no score for predicting remission following LAGB or LSG surgery. Additionally, there is little known about how to predict whether Hispanic patients will experience remission. METHODS: We conducted a retrospective cohort study of white and Hispanic patients with T2D who received bariatric surgery. There were 361 white and 130 Hispanic patients among whom 328 had RYGB surgery, 107 had LSG surgery, and 56 had LAGB surgery. We used age, diabetes treatment, and hemoglobin A1c to calculate DiaRem scores. Mann-Whitney U test was used to determine the association between DiaRem scores and remission. Area under the receiver operant curve (AUC) was used to assess the ability of the DiaRem to discriminate between patients who did and did not remit. RESULTS: The DiaRem was associated with partial remission in all surgery types for white and Hispanic patients (Mann-Whitney, p < 0.001). The DiaRem had moderate to high discriminant ability (AUC > 0.70) for all surgical and racial/ethnic groups. CONCLUSIONS: The DiaRem distinguishes between patients likely and unlikely to experience remission, informing expectations of patients making T2D treatment decisions.
