title: Prediction of remission after metabolic surgery using a novel scoring system in type 2 diabetes - a retrospective cohort study.
abstract: BACKGROUND
  Remission of diabetes is seen in more than 60% of patients after bariatric surgery. There is extensive variability in the remission rates between different surgical procedures. We analyzed our database and aimed to develop an easy scoring system to predict the probability of diabetes remission after two surgical procedures i.e. Ileal Interposition coupled with Sleeve Gastrectomy (IISG) or Diverted Sleeve Gastrectomy (IIDSG).
  
  
  METHODS
  In this retrospective study, we analyzed records pertaining to patients who underwent IISG (n = 46) and IIDSG (n = 29). The primary outcome measure was diabetes remission (A1c <6.5% and not requiring hypoglycemic drugs). We identified seven preoperative clinical variables (age, duration of diabetes, body mass index, micro and macrovascular complications, use of insulin and stimulated C-peptide) based on our previous reports to be included in the diabetes remission score (DRS). The DRS score (7 - 14) was compared between the patients with and without remission in both the surgery groups.
  
  
  RESULTS
  Mean DRS in patients who underwent IISG was 9.2 ± 1.4. Twenty one (46%) had a remission in diabetes. DRS was significantly lower in patients with remission than patients without remission (8.1 ± 0.8 versus 10.2 ± 0.9, p < 0.0001). Mean DRS in patients who underwent IIDSG was 10.4 ± 1.3. Twenty one (72%) had a remission in diabetes. DRS was significantly lower in patients with remission than patients without remission (9.7 ± 0.8 versus 12.0 ± 0.5, p < 0.0001). Patients with a DRS ≥ 10 in IISG group and more than 12 in IIDSG group did not get into remission.
  
  
  CONCLUSIONS
  Preoperative DRS can be a useful tool to select the type of surgical procedure and to predict the postoperative diabetes remission.
  
  
  BACKGROUND
  NCT00834626.
authors.affiliation: Department of Advanced Laparoscopy and Metabolic Surgery, Kirloskar Hospital, Hyderabad, Andhra Pradesh India.
authors.forename: Surendra
authors.initials: S
authors.lastname: Ugale
authors.affiliation: Department of Advanced Laparoscopy and Metabolic Surgery, Kirloskar Hospital, Hyderabad, Andhra Pradesh India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Department of Endocrinology, Medwin Hospital, Hyderabad, AP India.
authors.forename: Kirtikumar D
authors.initials: KD
authors.lastname: Modi
authors.affiliation: Department of Endocrinology, Endocare Hospital, Vijayawada, AP India.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Kota
authors.affiliation: Department of Advanced Laparoscopy and Metabolic Surgery, Kirloskar Hospital, Hyderabad, Andhra Pradesh India.
authors.forename: Vasisht
authors.initials: V
authors.lastname: Satwalekar
authors.affiliation: Department of Advanced Laparoscopy and Metabolic Surgery, Kirloskar Hospital, Hyderabad, Andhra Pradesh India.
authors.forename: Vishwas
authors.initials: V
authors.lastname: Naik
authors.affiliation: Department of Advanced Laparoscopy and Metabolic Surgery, Kirloskar Hospital, Hyderabad, Andhra Pradesh India.
authors.forename: Modukuri
authors.initials: M
authors.lastname: Swapna
authors.affiliation: Department of Endocrinology, Command Hospital, Chandimandir, 134107 Haryana India.
authors.forename: Kvs Hari
authors.initials: KH
authors.lastname: Kumar
keywords: Diabetes remission; Ileal interposition; Metabolic surgery; Sleeve gastrectomy; Type 2 Diabetes