Comparison of four scoring systems for predicting the effect of hypoglycemia after metabolic surgery

doi:10.3877/cma.j.issn.1674-6899.2020.03.012

Abstract

Abstract:

Objective

To screen out the more suitable prediction model of preoperative accurate assessment of gastric bypass (GBP) for the treatment of type 2 diabetes mellitus (T2DM) in mainland China by comparing several scoring systems of predicting T2DM after metabolic surgery.

Methods

The data of patients with T2DM who received GBP was retrospectively collected, and all the patients were seen from Apr.2012 to Dec. 2015 in Beijing Tian Tan Hospital, compared changes of related clinical indicators before and one year after surgery. We compared the predictive accuracy by ROC curve for T2DM complete remission after GBP between ABCD, DiaRem, IMS, and Tian Tan predictive scoring systems.

Results

A total of 101 patients (58 women) were enrolled in our study. Complete remission rate of T2DM after GBP was 70.3% (71/101). Mean age of the T2DM patients was (45.3±11.1)years, mean BMI was (30.3±5.5)kg/m², mean HbA1c and disease duration were (8.5±1.7)% and (7.1±4.8 )years, respectively. BMI, TCHO, TG, LDL, FPG, HbA1c, fasting C-peptide, fasting insulin, HOMA-IR and serum ferritin were significantly lower than those before operation (P<0.05). The AUC values of IMS, Tian Tan, DiaRem, and ABCD scoring systems were 0.833, 0.825, 0.764, and 0.724 respectively.

Conclusions

The IMS and Tian Tan scoring systems were accurate estimate of T2DM complete remission of patients after GBP, allowing metabolic surgeon to optimized treatment plan based on individualized risk prediction.

Key words: Metabolic surgery, Bariatric, Gastric bypass, Type 2 diabetes mellitus, Predictor, Models

Wenmao Yan, Tianlei Xu, Youguo Li, Jun Xu, Zhiqiang Zhong, Rixing Bai. Comparison of four scoring systems for predicting the effect of hypoglycemia after metabolic surgery[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2020, 13(03): 182-187.

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Figures/Tables 7

References 26

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项目	ABCD	DiaRem	IMS^*	天坛预测评分系统
预测因素	年龄(岁，0～1分) <40岁，1分 ≥40岁，0分	年龄(岁，0～3分) <40岁，0分 40～49岁，1分 50～59岁，2分 ≥60岁，3分	HbA1c(%，分) <7%, 0分	HbA1c(%，0～1分) <9%，1分 ≥9%，0分
?	BMI(kg/m²，0～3分) <27 kg/m²，0分 27～34.9 kg/m²，1分 35～41.9 kg/m²，2分 ≥42 kg/m²，3分	HbA1c(%，0～6分) <6.5%，0分 6.5%～6.9%，2分 7.0%～8.9%，4分 ≥9.0%，6分	是否用降糖口服药未服药，0分口服药种类越多，得分越高	C-肽(ng/ml，0～1分) ≥1 ng/ ml ，1分 <1 ng/ ml , 0分
?	C-肽(ng/ml，0～3分) <2 ng/ml，0分 2～2.9 ng/ml，1分 3～4.9 ng/ml, 2分 ≥5 ng/ml，3分	是否用降糖口服药(0～3分) 口服除二甲双胍外的非磺脲类或增加胰岛素敏感性的降糖药，0分口服除二甲双胍外的磺脲类或增加胰岛素敏感性的降糖药，3分	是否用胰岛素未使用胰岛素，0分	是否用胰岛素(0～1分) 未使用胰岛素，1分使用胰岛素，0分
?	T2DM病程(年，0～3分) >8年，0分 4～8年，1分 1～3.9年，2分 <1年，3分	是否用胰岛素(0～10分) 未使用胰岛素，0分使用胰岛素，10分	T2DM病程(年) 病程越短，得分越低；最低0分	T2DM病程(年，0～1分) <10年，1分 ≥10年，0分
总分	10分	22分	≤25分(轻度) 25分>且≤95分(中度) >95分(重度)	4分

项目	ABCD	DiaRem	IMS^*	天坛预测评分系统
预测因素	年龄(岁，0～1分) <40岁，1分 ≥40岁，0分	年龄(岁，0～3分) <40岁，0分 40～49岁，1分 50～59岁，2分 ≥60岁，3分	HbA1c(%，分) <7%, 0分	HbA1c(%，0～1分) <9%，1分 ≥9%，0分
?	BMI(kg/m²，0～3分) <27 kg/m²，0分 27～34.9 kg/m²，1分 35～41.9 kg/m²，2分 ≥42 kg/m²，3分	HbA1c(%，0～6分) <6.5%，0分 6.5%～6.9%，2分 7.0%～8.9%，4分 ≥9.0%，6分	是否用降糖口服药未服药，0分口服药种类越多，得分越高	C-肽(ng/ml，0～1分) ≥1 ng/ ml ，1分 <1 ng/ ml , 0分
?	C-肽(ng/ml，0～3分) <2 ng/ml，0分 2～2.9 ng/ml，1分 3～4.9 ng/ml, 2分 ≥5 ng/ml，3分	是否用降糖口服药(0～3分) 口服除二甲双胍外的非磺脲类或增加胰岛素敏感性的降糖药，0分口服除二甲双胍外的磺脲类或增加胰岛素敏感性的降糖药，3分	是否用胰岛素未使用胰岛素，0分	是否用胰岛素(0～1分) 未使用胰岛素，1分使用胰岛素，0分
?	T2DM病程(年，0～3分) >8年，0分 4～8年，1分 1～3.9年，2分 <1年，3分	是否用胰岛素(0～10分) 未使用胰岛素，0分使用胰岛素，10分	T2DM病程(年) 病程越短，得分越低；最低0分	T2DM病程(年，0～1分) <10年，1分 ≥10年，0分
总分	10分	22分	≤25分(轻度) 25分>且≤95分(中度) >95分(重度)	4分

相关指标	术前	术后1年	P值
BMI(kg/m²)	30.3±5.5	23.7±4.1	<0.000
体质量(kg)	83.7±17.2	65.9±13.9	<0.000
AST (U/L)	21.5±8.8	25.2±12.4	0.038
ALT (U/L)	31.4±18.6	30.6±18.1	0.667
GGT(U/L)	28.7±16.7	24.9±17.0	0.078
TCHO (mmol/L)	4.7±0.9	4.3±0.7	0.010
TG (mmol/L)	2.0±1.7	1.1±0.6	<0.000
HDL (mmol/L)	1.1±0.2	1.3±0.3	<0.000
LDL (mmol/L)	2.9±0.7	2.5±0.6	0.001
Cr (μmol/L)	51.9±15.0	52.0±15.0	0.804
BUN (mmol/L)	6.3±8.9	6.0±6.0	0.760
UA(μmol/L)	310.6±112.2	298.7±99.5	0.497
FBG (mmol/L)	7.8±3.2	6.0±1.2	<0.000
HbA1c (%)	8.5±1.7	5.8±0.7	<0.000
空腹C-肽(ng/ml)	1.6±0.9	1.2±0.5	0.003
空腹胰岛素(U/ml)	19.4±13.9	8.5±6.3	<0.000
HOMA-IR	6.8±6.3	2.2±1.9	<0.000
Ca(mmol/L)	2.3±0.1	2.4±0.3	0.210
铁蛋白(ng/ml)	213.6±166.4	170.8±144.9	0.037
维生素B₁₂(pg/ml)	452.3±184.7	495.1±315.8	0.876
Hb(g/L)	136.8±10.8	134.8±14.0	0.751

相关指标	术前	术后1年	P值
BMI(kg/m²)	30.3±5.5	23.7±4.1	<0.000
体质量(kg)	83.7±17.2	65.9±13.9	<0.000
AST (U/L)	21.5±8.8	25.2±12.4	0.038
ALT (U/L)	31.4±18.6	30.6±18.1	0.667
GGT(U/L)	28.7±16.7	24.9±17.0	0.078
TCHO (mmol/L)	4.7±0.9	4.3±0.7	0.010
TG (mmol/L)	2.0±1.7	1.1±0.6	<0.000
HDL (mmol/L)	1.1±0.2	1.3±0.3	<0.000
LDL (mmol/L)	2.9±0.7	2.5±0.6	0.001
Cr (μmol/L)	51.9±15.0	52.0±15.0	0.804
BUN (mmol/L)	6.3±8.9	6.0±6.0	0.760
UA(μmol/L)	310.6±112.2	298.7±99.5	0.497
FBG (mmol/L)	7.8±3.2	6.0±1.2	<0.000
HbA1c (%)	8.5±1.7	5.8±0.7	<0.000
空腹C-肽(ng/ml)	1.6±0.9	1.2±0.5	0.003
空腹胰岛素(U/ml)	19.4±13.9	8.5±6.3	<0.000
HOMA-IR	6.8±6.3	2.2±1.9	<0.000
Ca(mmol/L)	2.3±0.1	2.4±0.3	0.210
铁蛋白(ng/ml)	213.6±166.4	170.8±144.9	0.037
维生素B₁₂(pg/ml)	452.3±184.7	495.1±315.8	0.876
Hb(g/L)	136.8±10.8	134.8±14.0	0.751

分数	原始文献结果		本中心数据结果
分数	比例	术后缓解率	比例	术后缓解率
10	2%	100%	0%	-
9	7%	100%	0%	-
8	9%	100%	0%	-
7	13%	87%	2%	100%
6	13%	83%	5%	100%
5	8%	57%	8%	88%
4	10%	41%	15%	80%
3	14%	46%	13%	77%
2	17%	43%	34%	74%
1	5%	33%	18%	50%
0	2%	33%	6%	17%
总体	?	65%	?	70%

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