Simple test predicts diabetes remission following weight loss surgery

November 21, 2017, University College London

A new simple test that helps predicts which people with type 2 diabetes will benefit most from weight loss surgery has been developed by a UCL-led team.

The study, published today in Diabetic Medicine, also reports that keeping the weight off after is more important than which type of weight loss operation was done. Taken together, the findings should help maximise the health benefits obtained from .

"Over 2 million people in the UK are eligible for assessment for bariatric , and yet only 6,000 undergo the procedure each year. Given the limited access to surgery it's vital that we ensure it's offered to those who will benefit the most, and that they're well supported long after the surgery," said the study's lead author, Professor Rachel Batterham (UCL Centre for Obesity Research and UCLH Bariatric Centre for Weight Management and Metabolic Surgery).

Type 2 diabetes (T2D) is currently estimated to cause close to 25,000 preventable deaths a year in the UK, and the main driver for its increased prevalence is rising obesity rates. Sustained weight loss improves control in people with established T2D; however, maintaining sustained weight loss is difficult due to biological compensatory mechanisms.

Bariatric surgery alters the hormones that control blood glucose, lowering glucose levels and reducing the long-term complications of T2D such as eye and kidney damage. Many people with T2D are able to stop all of their diabetes medications after surgery. Bariatric surgery is now recognised as a treatment option for people with T2D with a BMI of 35 or above.

"Bariatric surgery can be highly beneficial, yet the results are highly variable, so we set out to devise a better way of identifying which people with T2D will benefit most," explained Professor Batterham, who also leads the Obesity research theme at the University College London Hospitals Biomedical Research Centre.

The study was a retrospective cohort study of people with T2D who had undergone Roux-en-Y surgery (107 people) or sleeve gastrectomy (103 people), with two-year follow-up data, plus a further 173 people in a separate study to validate the results. The researchers employed two scoring systems designed to predict T2D remission post-surgery: the established DiaRem score, as well as the novel, more accessible DiaBetter score designed by the research team.

The DiaBetter score is calculated from three factors: the drugs a person is currently taking, their HbA1c level (a simple blood test used to monitor blood glucose in all people with diabetes) and how long ago their diabetes was diagnosed.

People with low DiaRem scores were significantly more likely to achieve T2D remission than those with higher scores. Remission rates among those in the lowest quintile of DiaBetter scores were 98% compared to 19% in the highest quintile.

The researchers also found that percentage weight loss two years post-surgery was a stronger predictor of T2D remission than whether the patient underwent gastric bypass or sleeve gastrectomy, as there wasn't a significant difference between the two surgeries after adjusting for weight loss.

For every 5% weight loss, the odds of T2D remission increased by 54%. It was the first time the significance of loss to remission was established in people who had undergone sleeve gastrectomy; while it's the most common type of bariatric surgery globally, it's much newer than gastric bypass so there are gaps in the research.

"Access to bariatric surgery is very carefully controlled, yet post-surgery support is often lacking. We've added to the evidence that it's vital to support people in maintaining their long-term, to make sure that the surgery is effective," said Dr Andrea Pucci (UCL Centre for Obesity Research and UCLH Bariatric Centre for Weight Management and Metabolic Surgery), the study's first author.

"As roughly one in five people don't have positive results from bariatric surgery, we hope that clinicians will begin using DiaBetter right away to adequately weigh the benefits and risks, and ensure that only the most suitable candidates have the surgery," said Professor Batterham.

Explore further: Delaying bariatric surgery until higher weight may result in poorer outcomes

More information: A. Pucci et al, Type 2 diabetes remission 2 years post Roux-en-Y gastric bypass and sleeve gastrectomy: the role of the weight loss and comparison of DiaRem and DiaBetter scores, Diabetic Medicine (2017). DOI: 10.1111/dme.13532

Related Stories

Delaying bariatric surgery until higher weight may result in poorer outcomes

July 26, 2017
Obese patients who underwent bariatric surgery were more like to achieve a body mass index (BMI) of less than 30 one year after surgery if they had a BMI of less than 40 before surgery, according to a study published by JAMA ...

Long-term weight loss, T2DM remission for roux-en-Y surgery

September 21, 2017
(HealthDay)—For patients with severe obesity, Roux-en-Y gastric bypass is associated with lasting benefits, according to a study published in the Sept. 21 issue of the New England Journal of Medicine.

Bariatric surgery tied to T2DM resolution in obese patients

February 16, 2017
(HealthDay)—Five years after bariatric surgery, patients with type 2 diabetes who have the procedure show better improvements in quality of life and overall health, compared with those who only take diabetes medications, ...

Patients with higher thyroid hormone levels lose more weight after bariatric surgery

April 3, 2017
Patients who have higher levels of the thyroid hormone triiodothyronine (T3) lose more weight after bariatric surgery, new research from Portugal reports. The study results will be presented in a poster Monday, April 3, at ...

Weight-loss surgery cuts risk of developing serious heart problems

December 22, 2015
Bariatric (weight-loss) surgery can reduce the risk of developing serious health conditions such as heart attacks and type 2 diabetes, as well improve existing conditions, according to a new study published in PLOS Medicine.

In mildly obese patients, sleeve-it surgery may increase weight loss and glycemic control

April 1, 2016
In mildly obese ("class I") patients, sleeve with ileal transposition (sleeve-IT) surgery results in better glycemic control than either gastric bypass or clinical treatment, a new study from Brazil suggests. The results ...

Recommended for you

A novel insulin accelerant

October 17, 2018
Insulin levels rise after eating a meal, signaling uptake of circulating glucose by skeletal muscle. In individuals with diabetes this process is often impaired—a condition known as insulin resistance.

Fat tissue may play a crucial role in the progression of diabetes, challenging long established notions

October 12, 2018
A new study by Australian researchers, out today, is challenging what we know about the causes of diabetes. The new research points to fat tissue as a source of disease, and widens our understanding beyond the traditional ...

Does breastfeeding hormone protect against type 2 diabetes?

October 12, 2018
(HealthDay)—The hormone prolactin—most commonly associated with breastfeeding—may play a role in reducing the risk of type 2 diabetes, a new study suggests.

Markers of dairy fat consumption linked to lower risk of type two diabetes

October 10, 2018
Higher levels of biomarkers of dairy fat consumption are associated with a lower risk of developing type 2 diabetes, according to new research published today in PLOS Medicine. The study, in more than 60,000 adults, was undertaken ...

Planned intermittent fasting may help reverse type 2 diabetes, suggest doctors

October 10, 2018
Planned intermittent fasting may help to reverse type 2 diabetes, suggest doctors writing in the journal BMJ Case Reports after three patients in their care, who did this, were able to cut out the need for insulin treatment ...

New discovery restores insulin cell function in type 2 diabetes

October 8, 2018
By blocking a protein, VDAC1, in the insulin-producing beta cells, it is possible to restore their normal function in case of type 2 diabetes. In preclinical experiments, the researchers behind a new study have also shown ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.