American Surgical Association
ASA Main Home Current Meeting Home Final Program Past & Future Meetings

Search Meeting

Back to 2017 Program

Individualized Metabolic Surgery Score: Procedure Selection Based on Diabetes Severity
Ali Aminian1, Stacy A Brethauer1, Amin Andalib2, Amy S Nowacki1, Amanda Jimenez3, Ricard Corcelles3, Zubaidah NorHanipah1, Suriya Punchai1, Antonio M Lacy*3, Bartolome Burguera1, Josep Vidal3, Philip R Schauer1
1Cleveland Clinic, Cleveland, OH;2McGill University, Montreal, QC, Canada3Hospital Clínic Universitari, Barcelona, Spain

OBJECTIVE(S): Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) account for >95% of bariatric procedures in US in patients with type-2 diabetes (T2DM). While both procedures significantly improve T2DM in short-term, 30-50% of patients experience long-term relapse. To aid evidence-based selection of surgery for T2DM we have developed the first validated model.
METHODS:659 patients with T2DM who underwent RYGB and SG at an academic center in US and had a minimum 5-year follow-up (2005-2011) were analyzed to generate the model. Validation dataset included 241 patients from Spain.
RESULTS:At median postoperative follow-up of 7 years (range: 5-12), diabetes remission (HbA1c<6.5% off medications) was observed in 49% after RYGB and 28% after SG (P<0.001). Four independent predictors of long-term remission were used to develop the Individualized Metabolic Surgery (IMS) Score (Nomogram). Patients were then categorized into three stages of T2DM severity and procedure recommendations were provided (Figure). Findings were externally validated.
CONCLUSIONS:This is the largest reported cohort (n=900) with long-term postoperative glycemic follow-up, which for the first time categorizes T2DM into three validated stages for evidence-based procedure selection. In mild T2DM (IMS Score≤25), both procedures significantly improve diabetes. In severe T2DM (IMS Score>95), when there is limited beta-cell reserve/function, both procedures have similarly low efficacy. There is an intermediate group, however, in which RYGB is significantly more effective than SG, likely related to its more pronounced neurohormonal effects.

Back to 2017 Program

Philly Skyline Love Park Betsy Ross Tribute Love Statue