Background

The appropriate selection of patients and surgical procedures is essential for better outcomes after metabolic surgery in patients with type 2 diabetes mellitus (T2DM) and morbid obesity. We validated the usefulness of an individualized metabolic surgery (IMS) score to guide procedure selection based on the severity of T2DM in Koreans.

Methods

This study analyzed 135 patients with T2DM (age 40±11 years, 76% female, body mass index (BMI) 39.0±6.3 kg/m2) who underwent sleeve gastrectomy (SG; n=19) or Roux-en-Y gastric bypass (RYGB; n=116). The mean duration of T2DM was 3.3±0.4 years and the mean HbA1c was 8.0±0.1%.

Results

At the 1-year follow-up, the mean BMI decreased to 28.6±4.6 kg/m2 and the mean percent total weight loss was 26.4±7.7%. The mean HbA1c decreased to 6.0±1.1% and T2DM remission (HbA1C<6.5%, off medication) was achieved in 88 (65.2%) patients. In patients with mild T2DM (IMS score ≤25), the diabetes remission rate did not differ significantly (P > 0.99) between the RYGB (88%) and SG (90%) groups. However, the remission rate was higher after RYGB in the moderate severity group (IMS score 25–95), although the difference was not significant (RYGB 70% vs. SG 38%, P = 0.11). In patients with severe T2DM (IMS score > 95), the remission rate was low in both surgical groups (RYGB 6% vs. SG 0%, P > 0.99).

Conclusions

This study validated the ability of the IMS score to predict the remission of diabetes and recommends surgical procedures in Koreans with T2DM and morbid obesity.