A Simple Scoring Model for Mid-term Remission of Type 2 Diabetes Mellitus After Sleeve Gastrectomy in Chinese Patients.

Abstract

Background: Metabolic bariatric surgery is the most effective treatment for obesity and related type 2 diabetes mellitus (T2DM), but T2DM remission post-surgery is heterogeneous. Existing prediction models were developed largely in Western populations, often for gastric bypass and short-term outcomes, limiting applicability to Chinese patients undergoing laparoscopic sleeve gastrectomy (LSG). We aimed to develop a preoperative model for predicting mid-term T2DM remission after LSG.

Methods: We performed a retrospective cohort study of Chinese patients with obesity and T2DM who underwent primary LSG between 2017 and 2023. Mid-term remission was assessed over 2-7 years of follow-up. Candidate preoperative variables were screened by univariate analysis and LASSO regression, followed by multivariable logistic regression and 2,000-bootstrap internal validation. The final model was simplified into a scoring system.

Results: Among 221 patients included (median baseline HbA1c 7.20%), 81.4% achieved T2DM remission at a mean follow-up of 3.60 ± 1.49 years, with median HbA1c decreasing to 5.60%. The final model retained three predictors: number of hypoglycemic agents, insulin use, and 2-hour plasma C-peptide, and showed strong discrimination (AUC 0.876). Bootstrap validation confirmed robust performance (mean AUC 0.878, 95% CI 0.809-0.935). The simplified score (2-hour plasma C-peptide-5 × number of hypoglycemic agents - insulin use score [11/0]) showed the same AUC, and higher scores indicated greater remission probability.

Conclusions: We developed and internally validated a preoperative model for predicting mid-term T2DM remission after LSG in Chinese patients with obesity and T2DM. The model was translated into a simple scoring system that may support individualized management and decision-making.