Comparative Performance of Preoperative Diabetes-Remission Scores Following Metabolic Bariatric Surgery: A Retrospective Cohort Study in a Malaysian Population
In brief
About 69% achieved diabetes remission; a refined score ranked risk best
Among 204 Malaysian patients who had bariatric surgery, 69% achieved diabetes remission. The advanced DiaRem score best distinguished who would remit, but in the primary analysis it significantly outperformed DiaRem2, not the original DiaRem; adding diabetes duration alone did not improve prediction. Retrospective medication data and limited power mean the score's advantage needs confirmation.
- Journal
- Obesity surgery (Q1)
- Published
- 2 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Abdul Rahman Mokhtar, Guo Hou Loo, Farhana Raduan, Nursuhadah Mohamed Yusof, Nik Ritza Kosai
- PMID
- 42827212
- DOI
- 10.1007/s11695-026-08963-0
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (paper of the day, 5 October 2026): Ad‑DiaRem outperformed DiaRem2, AUC 0.852
Abstract
INTRODUCTION: Preoperative scores predict type 2 diabetes mellitus (T2DM) remission after metabolic bariatric surgery (MBS). The original DiaRem score was refined by adding diabetes duration (DiaRem2), and separately by adding duration together with treatment burden and re-weighted penalties (advanced-DiaRem, Ad-DiaRem). Whether these refinements perform better in Asian, sleeve-predominant populations, and across classes of obesity, is unknown. METHODS: We retrospectively studied patients with T2DM who underwent laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (RYGB) at a Malaysian tertiary center between 2018 and 2022. DiaRem, DiaRem2 and Ad-DiaRem were calculated from their originally published scoring algorithms. Remission (complete or partial) followed American Society for Metabolic and Bariatric Surgery criteria. The primary analysis comprised patients with clinic-based glycemic follow-up (n = 204); a pre-specified sensitivity analysis additionally included patients followed by telephone (n = 256). Discrimination was compared using DeLong's test. RESULTS: In the primary cohort (mean age 43.9 years; 72.1% female; 85.3% LSG), 141 patients (69.1%) achieved remission, declining across DiaRem2 groups (85.0%, 66.7%, 19.4%; trend p < 0.001). Ad-DiaRem discriminated best (area under the curve [AUC] 0.852, 95% CI 0.794-0.904), followed by DiaRem (0.807, 0.732-0.872) and DiaRem2 (0.781, 0.707-0.845). Ad-DiaRem outperformed DiaRem2 (p = 0.009) but not DiaRem (p = 0.115), and DiaRem did not differ from DiaRem2 (p = 0.259). In the larger sensitivity cohort, Ad-DiaRem also outperformed DiaRem (p = 0.036). The ordering held across obesity classes and procedures, with no score-by-procedure interaction. CONCLUSION: In a predominantly Malay, sleeve-predominant cohort, all three scores predicted remission. Adding diabetes duration alone (DiaRem2) did not improve on the original DiaRem, whereas Ad-DiaRem, which also incorporates treatment burden and re-weighted penalties, discriminated best. Because the medication components were reconstructed retrospectively, and because the study was not powered to detect modest differences between scores, these comparisons require confirmation.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.