Predictors for type 2 diabetes mellitus remission after metabolic/bariatric surgery

Type 2 diabetes mellitus (T2DM), fueled by an obesity epidemic, have emerged as a major health problem worldwide. Metabolic surgery, derived from bariatric surgery, is now proposed for the treatment of obese T2DM patients. Several randomized trials aimed at T2DM treatment have been performed and universally showed that metabolic surgery is more effective than medical treatment in glycemic control. However, not every T2DM patient benefit from metabolic surgery. An article review disclosed that pre-operative β-cell function, and its surrogates, including duration of diabetes and C-peptide, was the most important predictor of T2DM remission. Other factors were insulin use, HbA1c level, BMI, age, type of operation and miscellaneous ones. Some scoring systems, such as “ABCD” in the Diabetes surgery score (age, BMI, C-peptide and duration of T2DM), may help evaluate effectiveness of T2DM remission after surgery. In conclusion, metabolic surgery is a novel treatment option for obese T2DM patients but not all the patients are indicated. Pre-operative β-cell function (including duration of diabetes and C-peptide) are important predictor of the success of metabolic surgery. A scoring system is helpful for counseling patients and referring physicians, and may help to guide their expectations.