Still et al developed the DiaRem score to predict the chances that a patient will have remission from Type 2 diabetes following Roux-en-Y gastric bypass (RYGB) surgery. The authors are from Geisinger Health System, Scottsdale Healthcare Bariatric Center in Scottsdale, University of Arizona and Pennsylvania State University.
Patient selection: Type 2 diabetic undergoing RYGB surgery
Outcome: diabetes remission over 5 years
Complete remission of diabetes was a fasting glucose less than 100 mg/dL, a hemoglobin A1c less than 6% and no use of antidiabetic medicines.
Partial remission was a fasting blood glucose 100 to 124 mg/dL, hemaoglobin A1c less than 6%, and no antibiatic medicines.
Parameters:
(1) age in years
(2) preoperative hemoglobin A1c in percent
(3) pre-operative insulin therapy
(4) pre-operative non-insulin therapy
Parameter
Finding
Points
age in years
< 40 years of age
0
40 to 50 years of age
1
50 to 60 years of age
2
> 60 years of age
3
pre-operative HgbA1c
< 6.5%
0
6.5 to 6.9%
2
7.0 to 8.9%
4
>= 9.0%
6
pre-operative insulin
no
0
yes
10
pre-opreative other therapy
insulin-sensitizing agent other than metformin plus sulfonylurea
3
other
0
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 22
• The higher the score the less likely that the patient will have remission of diabetes after surgery.
Score
Percent Remission
0 to 2
88 to 99%
3 to 7
64 to 88%
8 to 12
23 to 49%
13 to 17
11 to 33%
18 to 22
2 to 16%
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