The advanced-DiaRem score improves prediction of diabetes remission 1 year post-Roux-en-Y gastric bypass
The advanced-DiaRem score improves prediction of diabetes remission 1 year post-Roux-en-Y gastric bypass
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DOI：
10.1007/s00125-017-4371-7
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发表时间：
2017-10-01
期刊：
影响因子：
8.2
通讯作者：
Clement, Karine
中科院分区：
文献类型：
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作者：
Aron-Wisnewsky, Judith;Sokolovska, Nataliya;Clement, Karine
目的/假设并非所有接受减肥手术的2型糖尿病患者都能达到糖尿病缓解。因此，它是至关重要的，以开发适用于临床实践的预测结果的方法。DiaRem评分与预测Roux-en-Y胃旁路术（RYGB）后糖尿病缓解相关，但在整个评分范围内，它对所有个体都不准确。我们的目的是开发一种改进的评分系统，预测糖尿病缓解后RYGB（先进的DiaRem [Ad-DiaRem]）。方法我们使用了一个回顾性的法国队列（n = 1866），其中包括352例2型糖尿病患者随访1年后RYGB。我们开发了Ad-DiaRemin测试队列（n = 213），并在来自法国（n = 134）和以色列（n = 99）的独立队列中检查其准确性。结果在原始DiaRem中添加两个临床变量（糖尿病持续时间和降糖药物数量），并修改每个类别的罚分，从而提高了Ad-DiaRem的预测性能。与DiaRem相比，Ad-DiaRem显示出受试者工作特征曲线下面积和预测准确度的改善（分别为0.911 vs 0.856和0.841 vs 0.789; p = 0.03）;因此，对8%最初被DiaRem错误分类的患者进行了分类纠正。使用Ad-DiaRem，对中等分数的个人的错误分类也较少。这种改善的预测性能被证实在独立cohols.Conclusions/解释我们提出的广告-DiaRem，其中包括两个额外的临床变量，作为一个优化的工具，提高了准确性，预测糖尿病缓解1年后RYGB。当在常规护理中考虑减肥手术时，该工具可能有助于糖尿病患者的个性化管理，最终有助于精准医学。
Aims/hypothesis Not all people with type 2 diabetes who undergo bariatric surgery achieve diabetes remission. Thus it is critical to develop methods for predicting outcomes that are applicable for clinical practice. The DiaRem score is relevant for predicting diabetes remission post-Roux-en-Y gastric bypass (RYGB), but it is not accurate for all individuals across the entire spectrum of scores. We aimed to develop an improved scoring system for predicting diabetes remission following RYGB (the Advanced-DiaRem [Ad-DiaRem]).Methods We used a retrospective French cohort (n = 1866) that included 352 individuals with type 2 diabetes followed for 1 year post-RYGB. We developed the Ad-DiaRemin a test cohort (n = 213) and examined its accuracy in independent cohorts from France (n = 134) and Israel (n = 99).Results Adding two clinical variables (diabetes duration and number of glucose-lowering agents) to the original DiaRem and modifying the penalties for each category led to improved predictive performance for Ad-DiaRem. Ad-DiaRem displayed improved area under the receiver operating characteristic curve and predictive accuracy compared with DiaRem (0.911 vs 0.856 and 0.841 vs 0.789, respectively; p = 0.03); thus correcting classification for 8% of those initially misclassified with DiaRem. With Ad-DiaRem, there were also fewer misclassifications of individuals with mid-range scores. This improved predictive performance was confirmed in independent cohorts.Conclusions/interpretation We propose the Ad-DiaRem, which includes two additional clinical variables, as an optimised tool with improved accuracy to predict diabetes remission 1 year post-RYGB. This tool might be helpful for personalised management of individuals with diabetes when considering bariatric surgery in routine care, ultimately contributing to precision medicine.