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Validation of Ad-DiaRem and ABCD Diabetes Remission Prediction Scores at 1-Year After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in the Randomized Controlled Oseberg Trial

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Abstract

Background

Prediction of type 2 diabetes (T2DM) remission is an important part of risk-benefit assessment before bariatric surgery.

Study Design

Advanced-DiaRem (Ad-DiaRem) and ABCD diabetes remission scores for sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) were calculated using baseline data. Differences in model discrimination using area under the curve of receiver operating curve (AUC-ROC) and model calibration were tested for complete remission (HbA1c ≤ 6.0% without antidiabetic medications) in the two groups. Optimal cutoff scores were calculated using the Youden index.

Results

We randomized 109 patients to either SG or RYGB. With one patient lost to follow-up in each group, the scores were calculated for 54 patients in the SG group and 53 patients in the RYGB group. Both models showed moderate predictive power without any significant difference between the groups: AUC-ROCs (95% CI) for the Ad-DiaRem score (SG versus RYGB) were 0.872 (0.780–0.964) versus 0.843 (0.733–0.954), p = 0.69, and for the ABCD score 0.849 (0.752–0.946) versus 0.750 (0.580–0.920), p = 0.32, respectively. Using optimal cutoff points derived from the whole study population, the actual proportion of diabetes remission was significantly higher than predicted for both the Ad-DiaRem and ABCD scores in the RYGB group. Diabetes duration and glycated haemoglobin predicted diabetes remission in the entire Oseberg population.

Conclusion

Both the Ad-DiaRem and ABCD scores showed moderate ability to discriminate between those who achieved remission of T2DM and those who did not after SG and RYGB. Larger studies are needed for the identification of procedure-specific optimal cutoffs.

Trial Registration

ClinicalTrials.gov Identifier: NCT01778738

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Acknowledgements

We thank the participants, the patient representative and all the study personnel. We particularly thank Linda Mathisen, Karina Bautz, Berit Mossing Bjørkås, Andreas Aarvik, Heidi Omre Fon, Hanna Lakso, Carina Rambo, Inger Mari Flakstad and Astrid Hillestad (Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway) for their continuous efforts, enthusiasm and patient care, thereby ensuring the collection of high-quality data in the Oseberg study. We also thank Matthew McGee (Morbid Obesity Center, Vestfold Hospital Trust) for proofreading the manuscript.

Author information

Authors and Affiliations

  1. Morbid Obesity Centre, Department of Medicine, Vestfold Hospital Trust, Boks 2168, 3103, Tønsberg, Norway

    Farhat Fatima, Jøran Hjelmesæth, Jens Kristoffer Hertel, Marius Svanevik, Rune Sandbu, Milada Cvancarova Småstuen & Dag Hofsø

  2. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318, Oslo, Norway

    Farhat Fatima

  3. Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, 0424, Oslo, Norway

    Jøran Hjelmesæth

  4. Department of Surgery, Vestfold Hospital Trust, 3103, Tønsberg, Norway

    Marius Svanevik & Rune Sandbu

  5. Department of Nutrition and Management, Oslo Metropolitan University, 0130, Oslo, Norway

    Milada Cvancarova Småstuen

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Contributions

D.H. and J.H. conceived the study and are the principal investigators. D.H., F.F., J.K.H., M.S., R.S. and J.H. contributed to the design and overlooked the study conduct. F.F., D.H. and J.H. wrote the manuscript. M.C.S. was responsible for the statistical analyses. All authors critically participated in the interpretation of the data, reviewed the manuscript for intellectual content and approved the final version of the manuscript. All authors had independent access to the data and took responsibility for data completeness and accuracy, as well as the fidelity of the trial to the protocol.

Corresponding author

Correspondence to Farhat Fatima.

Ethics declarations

Ethical Approval

All participants provided a written informed consent. The study protocol was approved by the Regional Committees for Medical and Health Research Ethics (ref: 2012/1427/REK sør-øst) and is in accordance with the Helsinki-II declaration.

Conflict of Interest

F.F. declares an educational grant (PhD) from South-Eastern Norway, Regional Health Authority during the conduct of the study. J.H. declares honoraria from Novo Nordisk, Boehringer Ingelheim and Navamedic, outside the submitted work. D.H. declares honoraria from Novo Nordisk, Lilly and Sanofi, outside the submitted work. Other authors have no conflict of interest.

Disclaimer

The funder of the study had no role in study design, data collection, data analyses, data interpretation or writing of the report. All authors had independent access to the data and took responsibility for data completeness and accuracy, and for the fidelity of the trial to the protocol. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

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Key points

1. Ad-DiaRem and ABCD scores predicted T2DM remission after SG and RYGB.

2. Observed diabetes remission was significantly higher than predicted in the RYGB group.

3. Larger studies are needed to identify procedure-specific optimal cutoffs.

Supplementary Information

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Supplementary file1 (DOCX 19 KB)

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Fatima, F., Hjelmesæth, J., Hertel, J.K. et al. Validation of Ad-DiaRem and ABCD Diabetes Remission Prediction Scores at 1-Year After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in the Randomized Controlled Oseberg Trial. OBES SURG 32, 801–809 (2022). https://doi.org/10.1007/s11695-021-05856-2

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