Abstract
PURPOSE: Many patients achieve type 2 diabetes (T2D) remission after bariatric surgery, but relapse after post-surgery remission is common. Scoring models accurately predict remission up to 5 years after surgery but have not been tested for prediction of long-term T2D relapse. The aim of this work was to test the ability of prediction models and single predictors to identify patients at risk of long-term relapse (10-15 years) after post-surgery T2D remission. METHODS: We identified 222 individuals with T2D from the surgically treated group in the prospective Swedish Obese Subjects study, who were in remission at the 2-year follow-up and had data available for prediction of long-term T2D relapse. T2D remission/relapse was assessed after 10 and 15 years. Model performance (discrimination) was evaluated by the area under the receiver operating characteristic (AUROC) curves. RESULTS: Preoperative prediction of relapse using scores DiaRem, Ad-DiaRem, and DiaBetter and T2D duration alone was poor, as indicated by AUROC curves between 0.61-0.64 at 10 years and 0.62-0.66 at 15 years. Likewise, the 5y-Ad-DiaRem score, which includes early postoperative measures, resulted in AUROC curves of 0.65 and 0.70 for relapse at 10 and 15 years, respectively. Two-year weight change alone had higher discriminatory capacity than the 5y-Ad-DiaRem model at 10 years (AUROC = 0.70; p = 0.036) and similar capacity at 15 years (AUROC = 0.78; p = 0.188). CONCLUSIONS: Predictive performance of all tested models is low for T2D relapse. By contrast, a single measure of 2-year weight change after surgery was associated with relapse, supporting a key role for initial weight reduction in long-term T2D control.