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Evaluation of Prediction Models for Type 2 Diabetes Relapse After Post-bariatric Surgery Remission: a Post hoc Analysis of 15-Year Follow-up Data from the Swedish Obese Subjects (SOS) Study.

ABSTRACT: PURPOSE:Many patients achieve type 2 diabetes (T2D) remission after bariatric surgery, but relapse after post-surgery remission is common. Scoring models accurately predict remission up to 5 years after surgery but have not been tested for prediction of long-term T2D relapse. The aim of this work was to test the ability of prediction models and single predictors to identify patients at risk of long-term relapse (10-15 years) after post-surgery T2D remission. METHODS:We identified 222 individuals with T2D from the surgically treated group in the prospective Swedish Obese Subjects study, who were in remission at the 2-year follow-up and had data available for prediction of long-term T2D relapse. T2D remission/relapse was assessed after 10 and 15 years. Model performance (discrimination) was evaluated by the area under the receiver operating characteristic (AUROC) curves. RESULTS:Preoperative prediction of relapse using scores DiaRem, Ad-DiaRem, and DiaBetter and T2D duration alone was poor, as indicated by AUROC curves between 0.61-0.64 at 10 years and 0.62-0.66 at 15 years. Likewise, the 5y-Ad-DiaRem score, which includes early postoperative measures, resulted in AUROC curves of 0.65 and 0.70 for relapse at 10 and 15 years, respectively. Two-year weight change alone had higher discriminatory capacity than the 5y-Ad-DiaRem model at 10 years (AUROC?=?0.70; p?=?0.036) and similar capacity at 15 years (AUROC?=?0.78; p?=?0.188). CONCLUSIONS:Predictive performance of all tested models is low for T2D relapse. By contrast, a single measure of 2-year weight change after surgery was associated with relapse, supporting a key role for initial weight reduction in long-term T2D control.

SUBMITTER: Sjoholm K

PROVIDER: S-EPMC7467912 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Evaluation of Prediction Models for Type 2 Diabetes Relapse After Post-bariatric Surgery Remission: a Post hoc Analysis of 15-Year Follow-up Data from the Swedish Obese Subjects (SOS) Study.

Sjöholm Kajsa K Svensson Per-Arne PA Taube Magdalena M Jacobson Peter P Andersson-Assarsson Johanna C JC Carlsson Lena M S LMS Peltonen Markku M

Obesity surgery 20200613 10

<h4>Purpose</h4>Many patients achieve type 2 diabetes (T2D) remission after bariatric surgery, but relapse after post-surgery remission is common. Scoring models accurately predict remission up to 5 years after surgery but have not been tested for prediction of long-term T2D relapse. The aim of this work was to test the ability of prediction models and single predictors to identify patients at risk of long-term relapse (10-15 years) after post-surgery T2D remission.<h4>Methods</h4>We identified ...[more]

PMID: 32535782

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Project description:BackgroundBariatric surgery reduces incidence of albuminuria and end-stage renal disease in patients with obesity. Effects of bariatric surgery on long-term remission and progression of pre-existing obesity-related renal damage are mainly unexplored. Here we investigate the long-term effects of bariatric surgery compared with conventional obesity care on remission and progression of albuminuria.Methods4047 patients were included in the Swedish Obese Subjects study. Inclusion criteria were age 37-60 years, BMI ≥ 34 kg/m2 in men and BMI ≥ 38 kg/m2 in women. Our analysis comprised 803 patients (19.8% of total population, 357 control, 446 surgery) with pre-existing albuminuria including 693 patients (312 control, 381 surgery) with microalbuminuria, and 110 patients (45 control, 65 surgery) with macroalbuminuria. Surgery patients were treated with banding, vertical banded gastroplasty, or gastric bypass. Control patients received conventional obesity care.ResultsTotal urinary albumin excretion was 36.5% lower in all patients with albuminuria after 15 years, 44.5% lower in patients with microalbuminuria after 15 years, and 27.8% lower in patients with macroalbuminuria after 2 years following bariatric surgery compared with conventional care. In surgery patients with microalbuminuria, remission to normoalbuminuria was higher (OR, 5.9, 2.2, 3.2, p < 0.001) and progression to macroalbuminuria was lower (OR, 0.28, 0.26, 0.25, p ≤ 0.02) at 2, 10, and 15 years, respectively, compared with control patients. In surgery patients with macroalbuminuria remission to normo- or microalbuminuria was higher (OR, 3.67, p = 0.003) after 2 years. No differences between surgery and control patients with macroalbuminuria were observed after 10 and 15 years. Surgery slowed progression of eGFR decline after 2 years in patients with microalbuminuria and macroalbuminuria (treatment effect: 1.0 ml/min/1.73 m2/year, p = 0.001 and 1.4 ml/min/1.73 m2/year, p = 0.047, respectively).ConclusionBariatric surgery had better effects than conventional obesity care on remission of albuminuria and prevention of eGFR decline, indicating that patients with obesity-related renal damage benefit from bariatric surgery.

Project description:BackgroundObesity shortens life expectancy. Bariatric surgery is known to reduce the long-term relative risk of death, but its effect on life expectancy is unclear.MethodsWe used the Gompertz proportional hazards regression model to compare mortality and life expectancy among patients treated with either bariatric surgery (surgery group) or usual obesity care (control group) in the prospective, controlled Swedish Obese Subjects (SOS) study and participants in the SOS reference study (reference cohort), a random sample from the general population.ResultsIn total, 2007 and 2040 patients were included in the surgery group and the control group, respectively, and 1135 participants were included in the reference cohort. At the time of the analysis (December 31, 2018), the median duration of follow-up for mortality was 24 years (interquartile range, 22 to 27) in the surgery group and 22 years (interquartile range, 21 to 27) in the control group; data on mortality were available for 99.9% of patients in the study. In the SOS reference cohort, the median duration of follow-up was 20 years (interquartile range, 19 to 21), and data on mortality were available for 100% of participants. In total, 457 patients (22.8%) in the surgery group and 539 patients (26.4%) in the control group died (hazard ratio, 0.77; 95% confidence interval [CI], 0.68 to 0.87; P<0.001). The corresponding hazard ratio was 0.70 (95% CI, 0.57 to 0.85) for death from cardiovascular disease and 0.77 (95% CI, 0.61 to 0.96) for death from cancer. The adjusted median life expectancy in the surgery group was 3.0 years (95% CI, 1.8 to 4.2) longer than in the control group but 5.5 years shorter than in the general population. The 90-day postoperative mortality was 0.2%, and 2.9% of the patients in the surgery group underwent repeat surgery.ConclusionsAmong patients with obesity, bariatric surgery was associated with longer life expectancy than usual obesity care. Mortality remained higher in both groups than in the general population. (Funded by the Swedish Research Council and others; SOS ClinicalTrials.gov number, NCT01479452.).

Project description:BackgroundBariatric surgery prevents and induces remission of type 2 diabetes in many patients. The effect of preoperative glucose status on long-term health-care costs is unknown. We aimed to assess health-care costs over 15 years for patients with obesity treated conventionally or with bariatric surgery and who had either euglycaemia, prediabetes, or type 2 diabetes before intervention.MethodsThe Swedish Obese Subjects (SOS) study is a prospective study of adults who had bariatric surgery and contemporaneously matched controls who were treated conventionally (age 37-60 years; BMI of ≥34 in men and ≥38 in women) recruited from 25 Swedish surgical departments and 480 primary health-care centres. Exclusion criteria were identical for both study groups, and were previous gastric or bariatric surgery, recent malignancy or myocardial infarction, selected psychiatric disorders, and other contraindicating disorders to bariatric surgery. Conventional treatment ranged from no treatment to lifestyle intervention and behaviour modification. In this study, we retrieved prescription drug costs for the patients in the SOS study via questionnaires and the nationwide Swedish Prescribed Drug Register. We retrieved data for inpatient and outpatient visits from the Swedish National Patient Register. We followed up the sample linked to register data for up to 15 years. We adjusted mean differences for baseline characteristics. Analyses were by intention to treat. The SOS study is registered with ClinicalTrials.gov, number NCT01479452.FindingsBetween Sept 1, 1987, and Jan 31, 2001, 2010 adults who had bariatric surgery and 2037 who were treated conventionally were enrolled into the SOS study. In this study, we followed up 4030 patients (2836 who were euglycaemic; 591 who had prediabetes; 603 who had diabetes). Drug costs did not differ between the surgery and conventional treatment groups in the euglycaemic subgroup (surgery US$10,511 vs conventional treatment $10,680; adjusted mean difference -$225 [95% CI -2080 to 1631]; p=0·812), but were lower in the surgery group in the prediabetes ($10,194 vs $13,186; -$3329 [-5722 to -937]; p=0·007) and diabetes ($14,346 vs $19,511; -$5487 [-7925 to -3049]; p<0·0001) subgroups than in the conventional treatment group. Compared with the conventional treatment group, we noted greater inpatient costs in the surgery group for the euglycaemic ($51,225 vs $25,313; $22,931 [19,001-26,861]; p<0·0001), prediabetes ($58,699 vs $32,861; $27,152 [18,736-35,568]; p<0·0001), and diabetes ($61,569 vs $47,569; 18,697 [9992-27,402]; p<0·0001) subgroups. We noted no differences in outpatient costs. Total health-care costs were higher in the surgery group in the euglycaemic ($71,059 vs $45,542; $22,390 [17,358-27,423]; p<0·0001) and prediabetes ($78,151 vs $54,864; $26,292 [16,738-35,845]; p<0·0001) subgroups than in the conventional treatment group, whereas we detected no difference between treatment groups in patients with diabetes ($88,572 vs $79,967; $9081 [-1419 to 19,581]; p=0·090).InterpretationTotal health-care costs were higher for patients with euglycaemia or prediabetes in the surgery group than in the conventional treatment group, but we detected no difference between the surgery and conventional treatment groups for patients with diabetes. Long-term health-care cost results support prioritisation of patients with obesity and type 2 diabetes for bariatric surgery.FundingAFA Försäkring and Swedish Scientific Research Council.

Dataset Information

Evaluation of Prediction Models for Type 2 Diabetes Relapse After Post-bariatric Surgery Remission: a Post hoc Analysis of 15-Year Follow-up Data from the Swedish Obese Subjects (SOS) Study.

Publications

Evaluation of Prediction Models for Type 2 Diabetes Relapse After Post-bariatric Surgery Remission: a Post hoc Analysis of 15-Year Follow-up Data from the Swedish Obese Subjects (SOS) Study.

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