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Prediction of Diabetes Remission after Bariatric or Metabolic Surgery
J Metab Bariatr Surg 2018;7(1):22-31
Published online June 30, 2018
© 2018 Korean Society of Acute Care Surgery.

Ji Yeon Park

Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
Correspondence to: Ji Yeon Park, Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, 807 Hoguk-ro, Buk-gu, Daegu 41404, Korea, Tel: 82-53-200-2711, Fax: 82-53-200-2027, E-mail: jybark99@hanmail.net
Received May 10, 2018; Revised May 28, 2018; Accepted May 28, 2018.
This is an open access journal distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Bariatric surgery has evolved from the surgical measure to treat morbid obesity into the epochal remedy to treat metabolic syndrome as a whole, which is represented by type 2 diabetes. Numerous clinical trials have unanimously advocated bariatric or metabolic surgery over the non-surgical interventions, demonstrating markedly superior metabolic outcomes not only in morbidly obese patients who satisfy traditional criteria for bariatric surgery (body mass index [BMI] >35kg/m2) but also in less obese or even in simply overweight patients. Nevertheless, not all the diabetic patients can achieve the most desirable outcomes, that is, diabetes remission, after metabolic surgery and candidates for metabolic surgery should be selected carefully based on the comprehensive preoperative assessment of the risk-benefit ratio. Predictors for diabetes remission after metabolic surgery can be largely classified into 2 groups based the mechanism of action; 1) indices for the preserved pancreatic beta-cell function, such as younger age, shorter duration of diabetes, and higher C-peptide level, and 2) those represent the potential reserve for reduction in insulin resistance, such as higher baseline BMI, and visceral fat area. Several prediction models for diabetes remission have been suggested by merging these predictors to guide clinicians and patients’ joint decision-making process. Among them, 3 models, DiaRem, ABCD, and Individualized Metabolic Surgery (IMS) scores provide intuitive scoring systems which can be simply utilized in the routine clinical practice and have been validated in the independent external cohort. These prediction models need further validation in the various different ethnicities to ensure the universal applicability.
Keywords : Metabolic surgery, Bariatric surgery, Diabetes, Remission, Predictor


June 2018, 7 (1)
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