title: Type 2 diabetes remission following gastric bypass: does diarem stand the test of time?
abstract: Roux-en-Y Gastric Bypass (RYGB) is well known to ameliorate type 2 diabetes mellitus (T2DM), and recent work suggests that the preoperative DiaREM model predicts successful remission up to 1 year post-RYGB. However, no data exist for long-term validity. Therefore, we sought to determine the utility of this score on long-term RYGB effectiveness for T2DM resolution at 2 and 10 years, respectively.
  
  
  
  T2DM patients (Age: 48, BMI: 49, HbA1C: 8.1) undergoing RYGB at the University of Virginia between 2004-2006 (n = 42) and 2012-2014 (n = 59) were evaluated prospectively to assess preoperative DiaREM score, defined from insulin use, age, HbA1C, and type of antidiabetic medication. T2DM partial remission status was based on the American Diabetes Association guidelines (HbA1C< 6.5 % and fasting glycemia <125 mg/dL, and no anti-diabetic medications). Chi-square test was used to compare patient's T2DM status to their DiaREM probability of remission.
  
  
  
  Among RYGB patients with 2-year postoperative data, 2 were lost (n = 1 no follow-up and n = 1 died) resulting in 57 patients for analysis. For the 10-year postoperative data, 11 were lost (n = 6 no follow-up and n = 5 died), thereby resulting in only 31 patients for analysis. Patients were distributed by DiaREM score to correlate with the predicted probability of remission as follows: 0-2 (Predicted 94 %, 2-year 100 % p = 0.61, 10-year 100 % p = 0.72), 3-7 (Predicted 76 %, 2-year 94 % p = 0.08, 10-year 83 % p = 0.57), 8-12 (Predicted 36 %, 2-year 47 % p = 0.38, 10-year 43 % p = 0.72), 13-17 (Predicted 22 %, 2-year 20 % p = 0.92, 10-year 33 % p = 0.64), and 18-22 (Predicted 9 %, 2-year 15 % p = 0.40, 10-year 14 % p = 0.64).
  
  
  
  Preoperative DiaREM scores are a good tool for predicting both short- and long-term T2DM remissions following RYGB. This study highlights the need to identify strategies that improve T2DM remission in those at highest risk.
authors.affiliation: Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA. jhm9t@virginia.edu.
authors.forename: J Hunter
authors.initials: JH
authors.lastname: Mehaffey
authors.affiliation: Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA.
authors.forename: Mathew G
authors.initials: MG
authors.lastname: Mullen
authors.affiliation: Department of Internal Medicine, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Mehaffey
authors.affiliation: Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA.
authors.forename: Florence E
authors.initials: FE
authors.lastname: Turrentine
authors.affiliation: Department of Kinesiology, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA.|Division of Endocrinology and Metabolism, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Malin
authors.affiliation: Department of Internal Medicine, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA.|Division of Endocrinology and Metabolism, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kirby
authors.affiliation: Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Schirmer
authors.affiliation: Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Hallowell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D003661:Decision Support Techniques; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bariatric surgery; DiaREM; Diabetes remission; Obesity