Aminian et al reported the Individualized Metabolic Surgery Score (IMSS) for evaluating a patient prior to metabolic surgery. This can help to decide which type of surgery to perform. The authors are from multiple institutions in the United States, Spain, Malaysia, and Thailand.
Patient selection: obese, prior to metabolic surgery
Parameters:
(1) number of diabetes medications taken prior to surgery, up to 5 drugs
(2) preoperative insulin therapy
(3) duration of diabetes prior to surgery, in years
(4) preoperative hemoglobin A1c (as an indicator of diabetic control)
points for number of diabetic drugs =
= 12.64 * (number of drugs)
|
Duration
|
Points
|
|
<= 10 years
|
(-0.1619 * ((years)^2)) + (6.364 * (years)) - 0.285
|
|
> 10 years
|
(1.726 * (years)) + 31.42
|
|
Parameter
|
Finding
|
Points
|
|
preoperative insulin use
|
no
|
0
|
|
|
yes
|
18.4
|
|
hemoglobin A1c
|
< 7%
|
0
|
|
|
>= 7%
|
16
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 197.6
|
Score
|
Diabetes Severity
|
RYGB vs SG
|
|
<= 25
|
mild
|
RYGB but SG also effective
|
|
26 to 95
|
moderate
|
RYGB
|
|
> 95
|
severity
|
SG (but both less effective)
|
RYGB = Rou-en-Y; SG = sleeve gastrectomy
where:
• To achieve a mild rating the patient either has (a) no drug, no insulin, duration less than 4.5 years and low HgbA1c or (2) 1 drug, no insulin, duration less than 2.2 years and low HgbA1c.
