title: Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan. wjlee_obessurg_tw@yahoo.com.tw
authors.forename: Wei-Jei
authors.initials: WJ
authors.lastname: Lee
authors.forename: Kyung Yul
authors.initials: KY
authors.lastname: Hur
authors.forename: Muffazal
authors.initials: M
authors.lastname: Lakadawala
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kasama
authors.forename: Simon K H
authors.initials: SK
authors.lastname: Wong
authors.forename: Shu-Chun
authors.initials: SC
authors.lastname: Chen
authors.forename: Yi-Chih
authors.initials: YC
authors.lastname: Lee
authors.forename: Kong-Han
authors.initials: KH
authors.lastname: Ser
mesh_terms: D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D002096:C-Peptide / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass / Q000379:methods*; D005763:Gastroenterostomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009767:Obesity, Morbid / Q000097:blood / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D002096:C-Peptide