Abstract

Introduction: Many risk prediction models of diabetes remission after bariatric and metabolic surgery have been proposed. Most models have been created using Roux-en-Y gastric bypass cohorts. However, validation of these models in sleeve gastrectomy (SG) is limited. The objective of our study is to validate the performance of risk prediction models of diabetes remission in obese patients with diabetes who underwent SG. Method: This retrospective cohort study included 128 patients who underwent SG with at least 1 year follow-up from Dec 2011 to Sep 2016 as the validation cohort. A literature review revealed total 11 models with 2 categories (scoring system and logistic regression), which were validated by our study dataset. Discrimination was evaluated by area under the receiver operating characteristic (AUC) while calibration by Hosmer–Lemeshow test and predicted versus observed remission ratio. Results: At 1 year after surgery, 71.9% diabetes remission (HbA1c < 6.0 off medication) and 61.4% excess weight loss were observed. Individual metabolic surgery, ABCD, DiaRem, Advanced-DiaRem, DiaBetter, Ana et al., and Dixon et al. models showed excellent discrimination power (AUC > 0.8). In calibration, all models overestimated diabetes remission from 5 to 30% but did not lose their goodness of fit. Conclusion: This is the first comprehensive external validation of current risk prediction models of diabetes remission at 1 year after SG. Seven models showed excellent predicting power, and scoring models were recommended more because of their easy utility. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
Original languageEnglish
JournalObesity Surgery
DOIs
Publication statusPublished - 2018

Fingerprint

Gastrectomy
Bariatric Surgery
Calibration
Gastric Bypass
ROC Curve
Area Under Curve
Cohort Studies
Retrospective Studies
Logistic Models

Keywords

  • Bariatric surgery
  • Diabetes remission
  • External validation
  • Metabolic surgery
  • Risk prediction models
  • Sleeve gastrectomy

Cite this

@article{5c5534759ec3486dac4fab399418da89,
title = "Validating Risk Prediction Models of Diabetes Remission After Sleeve Gastrectomy",
abstract = "Introduction: Many risk prediction models of diabetes remission after bariatric and metabolic surgery have been proposed. Most models have been created using Roux-en-Y gastric bypass cohorts. However, validation of these models in sleeve gastrectomy (SG) is limited. The objective of our study is to validate the performance of risk prediction models of diabetes remission in obese patients with diabetes who underwent SG. Method: This retrospective cohort study included 128 patients who underwent SG with at least 1 year follow-up from Dec 2011 to Sep 2016 as the validation cohort. A literature review revealed total 11 models with 2 categories (scoring system and logistic regression), which were validated by our study dataset. Discrimination was evaluated by area under the receiver operating characteristic (AUC) while calibration by Hosmer–Lemeshow test and predicted versus observed remission ratio. Results: At 1 year after surgery, 71.9{\%} diabetes remission (HbA1c < 6.0 off medication) and 61.4{\%} excess weight loss were observed. Individual metabolic surgery, ABCD, DiaRem, Advanced-DiaRem, DiaBetter, Ana et al., and Dixon et al. models showed excellent discrimination power (AUC > 0.8). In calibration, all models overestimated diabetes remission from 5 to 30{\%} but did not lose their goodness of fit. Conclusion: This is the first comprehensive external validation of current risk prediction models of diabetes remission at 1 year after SG. Seven models showed excellent predicting power, and scoring models were recommended more because of their easy utility. {\circledC} 2018, Springer Science+Business Media, LLC, part of Springer Nature.",
keywords = "Bariatric surgery, Diabetes remission, External validation, Metabolic surgery, Risk prediction models, Sleeve gastrectomy",
author = "S.-C. Shen and W. Wang and K.-W. Tam and H.-A. Chen and Y.-K. Lin and S.-Y. Wang and M.-T. Huang and Y.-H. Su",
note = "Export Date: 6 November 2018 Article in Press CODEN: OBSUE Correspondence Address: Su, Y.-H.; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical UniversityTaiwan; email: ntusyh@gmail.com References: Mingrone, G., Panunzi, S., De Gaetano, A., Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial (2015) Lancet, 386 (9997), pp. 964-973; Cummings, D.E., Arterburn, D.E., Westbrook, E.O., Kuzma, J.N., Stewart, S.D., Chan, C.P., Bock, S.N., Flum, D.R., Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial (2016) Diabetologia, 59 (5), pp. 945-953. , COI: 1:CAS:528:DC{\%}2BC28Xks1emsbw{\%}3D; Schauer, P.R., Bhatt, D.L., Kirwan, J.P., Wolski, K., Aminian, A., Brethauer, S.A., Navaneethan, S.D., Kashyap, S.R., Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes (2017) N Engl J Med, 376 (7), pp. 641-651; Ikramuddin, S., Korner, J., Lee, W., Lifestyle intervention and medical management with vs without Roux-en-Y gastric bypass and control of hemoglobin a1c, ldl cholesterol, and systolic blood pressure at 5 years in the diabetes surgery study (2018) JAMA, 319 (3), pp. 266-278; Vidal, P., Ram{\'o}n, J.M., Goday, A., Benaiges, D., Trillo, L., Parri, A., Gonz{\'a}lez, S., Grande, L., Laparoscopic gastric bypass versus laparoscopic sleeve gastrectomy as a definitive surgical procedure for morbid obesity. Mid-term results (2013) Obes Surg, 23 (3), pp. 292-299; Schauer, P.R., Bhatt, D.L., Kirwan, J.P., Wolski, K., Brethauer, S.A., Navaneethan, S.D., Aminian, A., Kashyap, S.R., Bariatric surgery versus intensive medical therapy for diabetes — 3-year outcomes (2014) N Engl J Med, 370 (21), pp. 2002-2013; Peterli, R., W{\"o}lnerhanssen, B.K., Vetter, D., Nett, P., Gass, M., Borb{\'e}ly, Y., Peters, T., Bueter, M., Laparoscopic sleeve gastrectomy versus Roux-Y-gastric bypass for morbid obesity—3-year outcomes of the prospective randomized Swiss Multicenter Bypass or Sleeve Study (SM-BOSS) (2017) Ann Surg, 265 (3), pp. 466-473; Weinstein, A.L., Marascalchi, B.J., Spiegel, M.A., Saunders, J.K., Fagerlin, A., Parikh, M., Patient preferences and bariatric surgery procedure selection; the need for shared decision-making (2014) Obes Surg, 24 (11), pp. 1933-1939; Aminian, A., Brethauer, S.A., Andalib, A., Punchai, S., Mackey, J., Rodriguez, J., Rogula, T., Schauer, P.R., Can sleeve gastrectomy “cure” diabetes? Long-term metabolic effects of sleeve gastrectomy in patients with type 2 diabetes (2016) Ann Surg, 264 (4), pp. 674-681; Coleman, K.J., Haneuse, S., Johnson, E., Bogart, A., Fisher, D., O’Connor, P.J., Sherwood, N.E., Arterburn, D., Long-term microvascular disease outcomes in patients with type 2 diabetes after bariatric surgery: evidence for the legacy effect of surgery (2016) Diabetes Care, 39 (8), pp. 1400-1407. , COI: 1:CAS:528:DC{\%}2BC2sXhsFeltb{\%}2FP; Rubino, F., Nathan, D.M., Eckel, R.H., Schauer, P.R., Alberti, K.G., Zimmet, P.Z., del Prato, S., Cummings, D.E., Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations (2016) Surg Obes Relat Dis, 12 (6), pp. 1144-1162; Wang, G.-F., Yan, Y.-X., Xu, N., Yin, D., Hui, Y., Zhang, J.P., Han, G.J., Yang, T., Predictive factors of type 2 diabetes mellitus remission following bariatric surgery: a meta-analysis (2015) Obes Surg, 25 (2), pp. 199-208; Fang, Y.-L., Lee, W.-J., Predictors for type 2 diabetes mellitus remission after metabolic/bariatric surgery (2017) Annals of Laparoscopic and Endoscopic Surgery, 2, p. 114; Adams, S., Salhab, M., Hussain, Z., Miller, G.V., Leveson, S.H., Preoperatively determinable factors predictive of diabetes mellitus remission following Roux-en-Y gastric bypass: a review of the literature (2013) Acta Diabetol, 50 (4), pp. 475-478. , COI: 1:CAS:528:DC{\%}2BC3sXhsVymu7vP; Zhang, R., Borisenko, O., Telegina, I., Hargreaves, J., Ahmed, A.R., Sanchez Santos, R., Pring, C., Hedenbro, J.L., Systematic review of risk prediction models for diabetes after bariatric surgery (2016) BJS, 103 (11), pp. 1420-1427. , COI: 1:STN:280:DC{\%}2BC2szjs1yjtA{\%}3D{\%}3D; Lee, W.-J., Hur, K.Y., Lakadawala, M., Kasama, K., Wong, S.K.H., Chen, S.C., Lee, Y.C., Ser, K.H., Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score (2013) Surg Obes Relat Dis, 9 (3), pp. 379-384; Panunzi, S., Carlsson, L., De Gaetano, A., (2015), et al,. Determinants of diabetes remission and glycemic control after bariatric surgery. 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(2009) Diabetes Care, 32 (11), pp. 2133-2135; Ugale, S., Gupta, N., Modi, K.D., Kota, S.K., Satwalekar, V., Naik, V., Swapna, M., Kumar, K.V.S.H., Prediction of remission after metabolic surgery using a novel scoring system in type 2 diabetes–a retrospective cohort study (2014) J Diabetes Metab Disord, 13 (1), p. 89; Alba, A.C., Agoritsas, T., Walsh, M., Hanna, S., Iorio, A., Devereaux, P.J., McGinn, T., Guyatt, G., Discrimination and calibration of clinical prediction models: users’ guides to the medical literature (2017) Jama, 318 (14), pp. 1377-1384; Moons, K.G., Kengne, A.P., Woodward, M., Risk prediction models: I. development, internal validation, and assessing the incremental value of a new (bio) marker (2012) Heart, 98 (9), pp. 683-690; Hosmer, D.W., Jr., Lemeshow, S., Sturdivant, R.X., Applied logistic regression. 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year = "2018",
doi = "10.1007/s11695-018-3510-7",
language = "English",
journal = "Obesity Surgery",
issn = "0960-8923",
publisher = "Springer New York LLC",

}

TY - JOUR

T1 - Validating Risk Prediction Models of Diabetes Remission After Sleeve Gastrectomy

AU - Shen, S.-C.

AU - Wang, W.

AU - Tam, K.-W.

AU - Chen, H.-A.

AU - Lin, Y.-K.

AU - Wang, S.-Y.

AU - Huang, M.-T.

AU - Su, Y.-H.

N1 - Export Date: 6 November 2018 Article in Press CODEN: OBSUE Correspondence Address: Su, Y.-H.; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical UniversityTaiwan; email: ntusyh@gmail.com References: Mingrone, G., Panunzi, S., De Gaetano, A., Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial (2015) Lancet, 386 (9997), pp. 964-973; Cummings, D.E., Arterburn, D.E., Westbrook, E.O., Kuzma, J.N., Stewart, S.D., Chan, C.P., Bock, S.N., Flum, D.R., Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial (2016) Diabetologia, 59 (5), pp. 945-953. , COI: 1:CAS:528:DC%2BC28Xks1emsbw%3D; Schauer, P.R., Bhatt, D.L., Kirwan, J.P., Wolski, K., Aminian, A., Brethauer, S.A., Navaneethan, S.D., Kashyap, S.R., Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes (2017) N Engl J Med, 376 (7), pp. 641-651; Ikramuddin, S., Korner, J., Lee, W., Lifestyle intervention and medical management with vs without Roux-en-Y gastric bypass and control of hemoglobin a1c, ldl cholesterol, and systolic blood pressure at 5 years in the diabetes surgery study (2018) JAMA, 319 (3), pp. 266-278; Vidal, P., Ramón, J.M., Goday, A., Benaiges, D., Trillo, L., Parri, A., González, S., Grande, L., Laparoscopic gastric bypass versus laparoscopic sleeve gastrectomy as a definitive surgical procedure for morbid obesity. Mid-term results (2013) Obes Surg, 23 (3), pp. 292-299; Schauer, P.R., Bhatt, D.L., Kirwan, J.P., Wolski, K., Brethauer, S.A., Navaneethan, S.D., Aminian, A., Kashyap, S.R., Bariatric surgery versus intensive medical therapy for diabetes — 3-year outcomes (2014) N Engl J Med, 370 (21), pp. 2002-2013; Peterli, R., Wölnerhanssen, B.K., Vetter, D., Nett, P., Gass, M., Borbély, Y., Peters, T., Bueter, M., Laparoscopic sleeve gastrectomy versus Roux-Y-gastric bypass for morbid obesity—3-year outcomes of the prospective randomized Swiss Multicenter Bypass or Sleeve Study (SM-BOSS) (2017) Ann Surg, 265 (3), pp. 466-473; Weinstein, A.L., Marascalchi, B.J., Spiegel, M.A., Saunders, J.K., Fagerlin, A., Parikh, M., Patient preferences and bariatric surgery procedure selection; the need for shared decision-making (2014) Obes Surg, 24 (11), pp. 1933-1939; Aminian, A., Brethauer, S.A., Andalib, A., Punchai, S., Mackey, J., Rodriguez, J., Rogula, T., Schauer, P.R., Can sleeve gastrectomy “cure” diabetes? Long-term metabolic effects of sleeve gastrectomy in patients with type 2 diabetes (2016) Ann Surg, 264 (4), pp. 674-681; Coleman, K.J., Haneuse, S., Johnson, E., Bogart, A., Fisher, D., O’Connor, P.J., Sherwood, N.E., Arterburn, D., Long-term microvascular disease outcomes in patients with type 2 diabetes after bariatric surgery: evidence for the legacy effect of surgery (2016) Diabetes Care, 39 (8), pp. 1400-1407. , COI: 1:CAS:528:DC%2BC2sXhsFeltb%2FP; Rubino, F., Nathan, D.M., Eckel, R.H., Schauer, P.R., Alberti, K.G., Zimmet, P.Z., del Prato, S., Cummings, D.E., Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations (2016) Surg Obes Relat Dis, 12 (6), pp. 1144-1162; Wang, G.-F., Yan, Y.-X., Xu, N., Yin, D., Hui, Y., Zhang, J.P., Han, G.J., Yang, T., Predictive factors of type 2 diabetes mellitus remission following bariatric surgery: a meta-analysis (2015) Obes Surg, 25 (2), pp. 199-208; Fang, Y.-L., Lee, W.-J., Predictors for type 2 diabetes mellitus remission after metabolic/bariatric surgery (2017) Annals of Laparoscopic and Endoscopic Surgery, 2, p. 114; Adams, S., Salhab, M., Hussain, Z., Miller, G.V., Leveson, S.H., Preoperatively determinable factors predictive of diabetes mellitus remission following Roux-en-Y gastric bypass: a review of the literature (2013) Acta Diabetol, 50 (4), pp. 475-478. , COI: 1:CAS:528:DC%2BC3sXhsVymu7vP; Zhang, R., Borisenko, O., Telegina, I., Hargreaves, J., Ahmed, A.R., Sanchez Santos, R., Pring, C., Hedenbro, J.L., Systematic review of risk prediction models for diabetes after bariatric surgery (2016) BJS, 103 (11), pp. 1420-1427. , COI: 1:STN:280:DC%2BC2szjs1yjtA%3D%3D; Lee, W.-J., Hur, K.Y., Lakadawala, M., Kasama, K., Wong, S.K.H., Chen, S.C., Lee, Y.C., Ser, K.H., Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score (2013) Surg Obes Relat Dis, 9 (3), pp. 379-384; Panunzi, S., Carlsson, L., De Gaetano, A., (2015), et al,. Determinants of diabetes remission and glycemic control after bariatric surgery. Diabetes Care,:dc150575; Khorgami, Z., Shoar, S., Andalib, A., Aminian, A., Brethauer, S.A., Schauer, P.R., Trends in utilization of bariatric surgery, 2010-2014: sleeve gastrectomy dominates (2017) Surg Obes Relat Dis, 13 (5), pp. 774-778; Angrisani, L., Santonicola, A., Iovino, P., Vitiello, A., Zundel, N., Buchwald, H., Scopinaro, N., Bariatric surgery and endoluminal procedures: IFSO Worldwide Survey 2014 (2017) Obes Surg, 27 (9), pp. 2279-2289. , COI: 1:STN:280:DC%2BC1cvnsVKhsA%3D%3D; Batterham, R.L., Cummings, D.E., Mechanisms of diabetes improvement following bariatric/metabolic surgery (2016) Diabetes Care, 39 (6), pp. 893-901; Cho, Y.M., A gut feeling to cure diabetes: potential mechanisms of diabetes remission after bariatric surgery (2014) Diabetes Metab J, 38 (6), pp. 406-415; Buse, J.B., Caprio, S., Cefalu, W.T., Ceriello, A., del Prato, S., Inzucchi, S.E., McLaughlin, S., Kirkman, M.S., How do we define cure of diabetes? (2009) Diabetes Care, 32 (11), pp. 2133-2135; Ugale, S., Gupta, N., Modi, K.D., Kota, S.K., Satwalekar, V., Naik, V., Swapna, M., Kumar, K.V.S.H., Prediction of remission after metabolic surgery using a novel scoring system in type 2 diabetes–a retrospective cohort study (2014) J Diabetes Metab Disord, 13 (1), p. 89; Alba, A.C., Agoritsas, T., Walsh, M., Hanna, S., Iorio, A., Devereaux, P.J., McGinn, T., Guyatt, G., Discrimination and calibration of clinical prediction models: users’ guides to the medical literature (2017) Jama, 318 (14), pp. 1377-1384; Moons, K.G., Kengne, A.P., Woodward, M., Risk prediction models: I. development, internal validation, and assessing the incremental value of a new (bio) marker (2012) Heart, 98 (9), pp. 683-690; Hosmer, D.W., Jr., Lemeshow, S., Sturdivant, R.X., Applied logistic regression. 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PY - 2018

Y1 - 2018

N2 - Introduction: Many risk prediction models of diabetes remission after bariatric and metabolic surgery have been proposed. Most models have been created using Roux-en-Y gastric bypass cohorts. However, validation of these models in sleeve gastrectomy (SG) is limited. The objective of our study is to validate the performance of risk prediction models of diabetes remission in obese patients with diabetes who underwent SG. Method: This retrospective cohort study included 128 patients who underwent SG with at least 1 year follow-up from Dec 2011 to Sep 2016 as the validation cohort. A literature review revealed total 11 models with 2 categories (scoring system and logistic regression), which were validated by our study dataset. Discrimination was evaluated by area under the receiver operating characteristic (AUC) while calibration by Hosmer–Lemeshow test and predicted versus observed remission ratio. Results: At 1 year after surgery, 71.9% diabetes remission (HbA1c < 6.0 off medication) and 61.4% excess weight loss were observed. Individual metabolic surgery, ABCD, DiaRem, Advanced-DiaRem, DiaBetter, Ana et al., and Dixon et al. models showed excellent discrimination power (AUC > 0.8). In calibration, all models overestimated diabetes remission from 5 to 30% but did not lose their goodness of fit. Conclusion: This is the first comprehensive external validation of current risk prediction models of diabetes remission at 1 year after SG. Seven models showed excellent predicting power, and scoring models were recommended more because of their easy utility. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.

AB - Introduction: Many risk prediction models of diabetes remission after bariatric and metabolic surgery have been proposed. Most models have been created using Roux-en-Y gastric bypass cohorts. However, validation of these models in sleeve gastrectomy (SG) is limited. The objective of our study is to validate the performance of risk prediction models of diabetes remission in obese patients with diabetes who underwent SG. Method: This retrospective cohort study included 128 patients who underwent SG with at least 1 year follow-up from Dec 2011 to Sep 2016 as the validation cohort. A literature review revealed total 11 models with 2 categories (scoring system and logistic regression), which were validated by our study dataset. Discrimination was evaluated by area under the receiver operating characteristic (AUC) while calibration by Hosmer–Lemeshow test and predicted versus observed remission ratio. Results: At 1 year after surgery, 71.9% diabetes remission (HbA1c < 6.0 off medication) and 61.4% excess weight loss were observed. Individual metabolic surgery, ABCD, DiaRem, Advanced-DiaRem, DiaBetter, Ana et al., and Dixon et al. models showed excellent discrimination power (AUC > 0.8). In calibration, all models overestimated diabetes remission from 5 to 30% but did not lose their goodness of fit. Conclusion: This is the first comprehensive external validation of current risk prediction models of diabetes remission at 1 year after SG. Seven models showed excellent predicting power, and scoring models were recommended more because of their easy utility. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.

KW - Bariatric surgery

KW - Diabetes remission

KW - External validation

KW - Metabolic surgery

KW - Risk prediction models

KW - Sleeve gastrectomy

U2 - 10.1007/s11695-018-3510-7

DO - 10.1007/s11695-018-3510-7

M3 - Article

JO - Obesity Surgery

JF - Obesity Surgery

SN - 0960-8923

ER -