Discordance in prediction for prognosis of type 2 diabetes after metabolic surgery: comparison of the ABCD, DiaRem, and individualized metabolic surgery models

PURPOSE: Metabolic surgery has been performed as a treatment option for uncontrolled type 2 diabetes (T2D), and several scoring systems for predicting postoperative T2D remission have been proposed. This study was designed to assess consistency of 3 existing scoring systems in patients with T2D duration <1 year. METHODS: This study included 186 patients with T2D enrolled in a university hospital prospective database between 2011 and 2013. Externally validated scoring systems for predicting T2D prognosis after metabolic surgery were identified and selected through systematic literature search. We assessed concordance between ABCD, DiaRem, and individualized metabolic surgery (IMS) scores in participants using kappa statistical analysis and 1-way analysis of variance. RESULTS: Of the participants, 52 and 82 patients were expected to have favorable T2D remission after metabolic surgery with ABCD score of 10–5 and DiaRem score of 0–7, respectively, and a slight-to-fair concordance was shown between the 2 scoring systems (kappa measure, 0.07; standard error [SE], 0.05 and kappa measure, 0.25; SE, 0.19, respectively). The DiaRem score increased with T2D severity determined by IMS score (P < 0.001), while the ABCD score showed no significant association with IMS score. CONCLUSION: ABCD and DiaRem scores showed significant discordance when applied to potential metabolic surgery candidates in whom postoperative T2D remission rate was highly expected. The IMS score showed a dose-response association with DiaRem score but had no significant association with the ABCD score.

Efficacy of laparoscopic sleeve gastrectomy on morbidly obese patients with type 2 diabetes mellitus / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy of laparoscopic sleeve gastrectomy(LSG) on improving glycemic control of morbidly obese patients with type 2 diabetes mellitus.</p><p><b>METHODS</b>Prospective study of 30 type 2 diabetes mellitus(T2DM) patients with BMI > or = 35 undergone LSG was carried out. Pre- and post-operative clinical parameters associated with diabetes mellitus 6 months after operation were evaluated. Data collected included demographics, weight loss(BMI, EWL%), diabetes control (FPG, HbA1C) and ghrelin.</p><p><b>RESULTS</b>Fasting plasma glucose and glycosylated hemoglobin concentration tests and clinical outcomes suggested LSG resulted in significant improvement or resolution of T2DM in all the 30 patients with CR 63%(19/30) and PR 37%(11/30).</p><p><b>CONCLUSIONS</b>LSG can lead to significant changes in controlling glycemia on morbidly obese patients with T2DM in 6 months. Long-term efficacy needs further follow-up.</p>

Application of laparoscopic compression anastomosis clip for laparoscopic gastrointestinal anastomosis / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of laparoscopic compression anastomosis clip (LapCAC) for laparoscopic gastrointestinal anastomosis.</p><p><b>METHODS</b>In March, 2007, three gastric cancer patients undergone total gastrectomy (1 case) and distal gastrectomy (2 cases) received laparoscopic gastrointestinal anastomosis with LapCAC. The gastrointestinal anastomotic complications, first post-operational flatus, bowel movement and extrusion of clip device were observed.</p><p><b>RESULTS</b>No anastomotic complications such as leakage or obstruction were found. The clip was expelled with stool within 12-18 days. All the patients had good results in recovery of bowel function.</p><p><b>CONCLUSION</b>LapCAC is safe and simple for laparoscopic gastrointestinal anastomosis.</p>