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A new score chart may help obese patients with type 2 diabetes determine beforehand if gastric bypass surgery will - or will not - be an effective way to send their diabetes into remission, better determining if such a drastic surgery is the right choice to make in treating the disease.
The four-part method of evaluation - a system called DiaRem - looks at age, insulin use, A1c, and drugs taken to control diabetes, and uses the results to generate a score determining whether or not Roux-en-Y gastric bypass* could be an effective tool to treat diabetes.
The study came about due to the 60 percent rate of diabetes remission seen after morbidly obese patients had gastric bypass for weight loss, raising interest that the surgery may also offer a way to control type 2 diabetes for those who are less severely overweight.
In an effort to determine if there were other reasons for the diabetes remission, researchers from the Geisinger Health System in Danville, Penn.,analyzed hundreds of factors to determine which ones played a role in predicting the possibility of remission, and ultimately narrowed them down to four.
The scoring system was then tested on 400 patients, according to the study, which appeared in the journal The Lancet Diabetes & Endocrinology.
Those with a higher score were less likely to see their diabetes go into remission five years after gastric bypass surgery than those with higher scores, according to the results of the study.
"It will give patients and physicians a scientifically valid way of assessing the merits of gastric bypass surgery for treating diabetes and deciding whether additional measures should be taken to improve the odds of remission," said lead author George Argyropoulosin a news release.
More research is required, though, wrote the authors of text that accompanied the study, before the guidelines regarding gastric bypass and which patients are best suited for the surgery are revised.
"The DiaRem score could help with selection of appropriate treatment and management of expectations held by both the patient and the multidisciplinary team involved in the patient's care," added Dimitri Pournaras and Carel le Roux, from Imperial College London, in England.
"However, further prospective studies are needed to validate these potential uses. Future research in this area will increase the accuracy of outcome predictions in different populations, age groups and interventional approaches. This research could even challenge present guidelines for provision of weight-loss surgery."
* The Roux-en-Y gastric bypass procedure involves creating a stomach pouch out of a small portion of the stomach and attaching it directly to the small intestine, bypassing a large part of the stomach and duodenum.
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