Background:The effect of bariatric surgery on type 2 diabetes mellitus(T2DM)control can be assessed based on predictive models of T2DM remission.Various models have been externally verified internationally.However,lon...Background:The effect of bariatric surgery on type 2 diabetes mellitus(T2DM)control can be assessed based on predictive models of T2DM remission.Various models have been externally verified internationally.However,long-term validated results after laparoscopic sleeve gastrectomy(LSG)surgery are lacking.The best model for the Chinese population is also unknown.Methods:We retrospectively analyzed Chinese population data 5 years after LSG at Beijing Shijitan Hospital in China between March 2009 and December 2016.The independent t-test,Mann–Whitney U test,and chi-squared test were used to compare characteristics between T2DM remission and non-remission groups.We evaluated the predictive efficacy of each model for longterm T2DM remission after LSG by calculating the area under the curve(AUC),sensitivity,specificity,Youden index,positive predictive value(PPV),negative predictive value(NPV),and predicted-to-observed ratio,and performed calibration using Hosmer–Lemeshow test for 11 prediction models.Results:We enrolled 108 patients,including 44(40.7%)men,with a mean age of 35.5 years.The mean body mass index was 40.3±9.1 kg/m^(2),the percentage of excess weight loss(%EWL)was(75.9±30.4)%,and the percentage of total weight loss(%TWL)was(29.1±10.6)%.The mean glycated hemoglobin A1c(HbA1c)level was(7.3±1.8)%preoperatively and decreased to(5.9±1.0)%5 years after LSG.The 5-year postoperative complete and partial remission rates of T2DM were 50.9%[55/108]and 27.8%[30/108],respectively.Six models,i.e.,"ABCD",individualized metabolic surgery(IMS),advanced-DiaRem,DiaBetter,Dixon et al’s regression model,and Panunzi et al’s regression model,showed a good discrimination ability(all AUC>0.8).The"ABCD"(sensitivity,74%;specificity,80%;AUC,0.82[95%confidence interval[CI]:0.74–0.89]),IMS(sensitivity,78%;specificity,84%;AUC,0.82[95%CI:0.73–0.89]),and Panunzi et al’s regression models(sensitivity,78%;specificity,91%;AUC,0.86[95%CI:0.78–0.92])showed good discernibility.In the Hosmer–Lemeshow goodness-of-fit test,except for DiaRem(P<0.01),DiaBetter(P<0.01),Hayes et al(P=0.03),Park et al(P=0.02),and Ramos-Levi et al’s(P<0.01)models,all models had a satifactory fit results(P>0.05).The P values of calibration results of the"ABCD"and IMS were 0.07 and 0.14,respectively.The predicted-to-observed ratios of the"ABCD"and IMS were 0.87 and 0.89,respectively.Conclusion:The prediction model IMS was recommended for clinical use because of excellent predictive performance,good statistical test results,and simple and practical design features.展开更多
基金supported by Clinical Cooperation Ability Construction Project of Chinese and Western Medicine for Major and Difficult Diseases(Department of Medical Administration,National Administration of Traditional Chinese Medicine[2018]No.3)
文摘Background:The effect of bariatric surgery on type 2 diabetes mellitus(T2DM)control can be assessed based on predictive models of T2DM remission.Various models have been externally verified internationally.However,long-term validated results after laparoscopic sleeve gastrectomy(LSG)surgery are lacking.The best model for the Chinese population is also unknown.Methods:We retrospectively analyzed Chinese population data 5 years after LSG at Beijing Shijitan Hospital in China between March 2009 and December 2016.The independent t-test,Mann–Whitney U test,and chi-squared test were used to compare characteristics between T2DM remission and non-remission groups.We evaluated the predictive efficacy of each model for longterm T2DM remission after LSG by calculating the area under the curve(AUC),sensitivity,specificity,Youden index,positive predictive value(PPV),negative predictive value(NPV),and predicted-to-observed ratio,and performed calibration using Hosmer–Lemeshow test for 11 prediction models.Results:We enrolled 108 patients,including 44(40.7%)men,with a mean age of 35.5 years.The mean body mass index was 40.3±9.1 kg/m^(2),the percentage of excess weight loss(%EWL)was(75.9±30.4)%,and the percentage of total weight loss(%TWL)was(29.1±10.6)%.The mean glycated hemoglobin A1c(HbA1c)level was(7.3±1.8)%preoperatively and decreased to(5.9±1.0)%5 years after LSG.The 5-year postoperative complete and partial remission rates of T2DM were 50.9%[55/108]and 27.8%[30/108],respectively.Six models,i.e.,"ABCD",individualized metabolic surgery(IMS),advanced-DiaRem,DiaBetter,Dixon et al’s regression model,and Panunzi et al’s regression model,showed a good discrimination ability(all AUC>0.8).The"ABCD"(sensitivity,74%;specificity,80%;AUC,0.82[95%confidence interval[CI]:0.74–0.89]),IMS(sensitivity,78%;specificity,84%;AUC,0.82[95%CI:0.73–0.89]),and Panunzi et al’s regression models(sensitivity,78%;specificity,91%;AUC,0.86[95%CI:0.78–0.92])showed good discernibility.In the Hosmer–Lemeshow goodness-of-fit test,except for DiaRem(P<0.01),DiaBetter(P<0.01),Hayes et al(P=0.03),Park et al(P=0.02),and Ramos-Levi et al’s(P<0.01)models,all models had a satifactory fit results(P>0.05).The P values of calibration results of the"ABCD"and IMS were 0.07 and 0.14,respectively.The predicted-to-observed ratios of the"ABCD"and IMS were 0.87 and 0.89,respectively.Conclusion:The prediction model IMS was recommended for clinical use because of excellent predictive performance,good statistical test results,and simple and practical design features.
