@article{fdi:010074020,
  title = {{L}ong-term relapse of type 2 diabetes after roux-en-y gastric bypass : prediction and clinical relevance},
  author = {{D}ebedat, {J}. and {S}okolovska, {N}. and {C}oupaye, {M}. and {P}anunzi, {S}. and {C}hakaroun, {R}. and {G}enser, {L}. and de {T}urenne, {G}. and {B}ouillot, {J}. {L}. and {P}oitou, {C}. and {O}ppert, {J}. {M}. and {B}luher, {M}. and {S}tumvoll, {M}. and {M}ingrone, {G}. and {L}edoux, {S}. and {Z}ucker, {J}ean-{D}aniel and {C}lement, {K}. and {A}ron-{W}isnewsky, {J}.},
  editor = {},
  language = {{ENG}},
  abstract = {{OBJECTIVE} {R}oux-en-{Y} gastric bypass ({RYGB}) induces type 2 diabetes remission ({DR}) in 60% of patients at 1 year, yet long-term relapse occurs in half of these patients. {S}coring methods to predict {DR} outcomes 1 year after surgery that include only baseline parameters cannot accurately predict 5-year {DR} (5y-{DR}). {W}e aimed to develop a new score to better predict 5y-{DR}. {RESEARCH} {DESIGN} {AND} {METHODS} {W}e retrospectively included 175 {RYGB} patients with type 2 diabetes with 5-year follow-up. {U}sing machine learning algorithms, we developed a scoring method, 5-year {A}dvanced-{D}iabetes {R}emission (5y-{A}d-{D}ia{R}em), predicting longer-term {DR} postsurgery by integrating medical history, bioclinical data, and antidiabetic treatments. {T}he scoring method was based on odds ratios and variables significantly different between groups. {T}his score was further validated in three independent {RYGB} cohorts from three {E}uropean countries. {RESULTS} {C}ompared with 5y-{DR} patients, patients who had relapsed after 5 years exhibited more severe type 2 diabetes at baseline, lost significantly less weight during the 1st year after {RYGB}, and regained more weight afterward. {T}he 5y-{A}d-{D}ia{R}em includes baseline (diabetes duration, number of antidiabetic treatments, and {H}b{A}(1c)) and 1-year follow-up parameters (glycemia, number of antidiabetic treatments, remission status, 1st-year weight loss). {T}he 5y-{A}d-{D}ia{R}em was accurate (area under the receiver operating characteristic curve [{AUROC}], 90%; accuracy, 85%) at predicting 5y-{DR}, performed better than the {D}iabetes {R}emission score ({D}ia{R}em) and the {A}dvanced-{D}ia{R}em ({AUROC}, 81% and 84%; accuracy, 79% and 78%, respectively), and correctly reclassified 13 of 39 patients misclassified with the {D}ia{R}em. {T}he 5y-{A}d-{D}ia{R}em robustness was confirmed in the independent cohorts. {CONCLUSIONS} {T}he 5y-{A}d-{D}ia{R}em accurately predicts 5y-{DR} and appears relevant to identify patients at risk for relapse. {U}sing this score could help personalize patient care after the 1st year post-{RYGB} to maximize weight loss, limit weight regains, and prevent relapse.},
  keywords = {{FRANCE} ; {ITALIE} ; {ALLEMAGNE}},
  booktitle = {},
  journal = {{D}iabetes {C}are},
  volume = {41},
  numero = {10},
  pages = {2086--2095},
  ISSN = {0149-5992},
  year = {2018},
  DOI = {10.2337/dc18-0567},
  URL = {https://www.documentation.ird.fr/hor/fdi:010074020},
}