Metabolic Surgery Assessment Score (MSAS): A useful tool to select the type of procedure and predict diabetes remission before modified bariatric surgery

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 660-676-Clinical Obesity Treatment
Clinical
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-669
Kirtikumar D Modi*1, Sunil Kumar Kota Sr.2, Suren Ugale3 and Neeraj Gupta4
1Medwin Hosp, HYDERABAD, India, 2Medwin Hospital, Hyderabad, India, 3Kirloskar Hospital, Hyderabad, India, Hyderabad, India, 4Kirloskar Hospital, Hyderabad, India, India
Background: Laparoscopic ileal interposition (II) with sleeve gastrectomy (SG) / diverted sleeve gastrectomy (DSG) are types of modified bariatric surgery focused mainly for diabetes remission. DSG is preferred over SG in patients with less favorable metabolic profile. Due to variable remission response in our patients who underwent these procedures, retrospectively we devised a novel score termed as metabolic surgery assessment score (MSAS). It helps to select the type of procedure and to predict the diabetes remission before surgery.

Methods: Forty six patients underwent II + SG and 29 for II + DSG. MSAS was calculated based on preoperative baseline parameters like age, body mass index,  duration of diabetes, associated micro or macro vascular complications, meal stimulated C-Peptide levels and mandatory insulin usage to control their diabetes. Remission in diabetes was defined as maintaining HbA1C < 6.5% without any medication. MSAS of the subjects with and without remission were compared.

Results: Patients subjected to II+SG had mean age of 48.3 ± 8.1 years, mean duration of  diabetes was 9.8 ± 7.6 years and had mean BMI of 32.1 ± 6.9 Kg/m2. All patients had poorly controlled diabetes with mean base line HbA1C 9.5 ± 2.2 %. Mean MSAS in patients who underwent II + SG (n=46) was 9.2 ±1.4. Twenty one (46%) had remission in diabetes. MSAS was significantly lower in patients with remission than patients without remission (8.1±0.8 versus 10.2 ±0.9, p<0.0001).  Patients with BMI ≥ 35 kg/m2 had remission in 85% of patients. Their mean MSAS was 8.9 ± 1.7 versus mean MSAS of 9.5 ± 1.1 in patients with BMI less than 35 (p = 0.07).

Patients subjected to II+DSG had mean age of 48.7 ± 7.8 years, DM duration of 13.1 ± 5.8 years and BMI 29.1 ± 6.7 Kg/m2. All patients had poorly controlled diabetes with HbA1C 9.8 ± 1.8 %. Mean MSAS in patients who underwent II + DSG (n=29) was 10.4±1.3 (significantly higher than II+SG group, p = 0.0004). Twenty one (72%) had remission in diabetes. MSAS was significantly lower in patients with remission than patients without remission (9.7±0.8 versus 12.0 ±0.5, p<0.0001).

Patients with MSAS ≥ 10 in II+SG group and MSAS ≥ 12 in II+DSG group did not get remission. MSAS was not significantly different (p = 0.1468) in patients without remission in II+SG (10.2 ±0.9) versus patients with remission in II+DSG (9.7±0.8). This indirectly suggests that DSG instead of SG would have helped them in achieving remission.

Conclusion: Preoperative MSAS can be a useful tool to select the type of surgical procedure and to predict the post operative diabetes remission.

Hari Kumar, M.D.,1 Surendra Ugale, M.S.,2 Neeraj Gupta, M.B.B.S.,2 Vishwas Naik, M.S.,2Pawan Kumar, M.D.,3 P. Bhaskar, M.D.,3 and K.D. Modi, M.D., D.M.1  Ileal Interposition with Sleeve Gastrectomyfor Control of Type 2 Diabetes K.V.S.  DIABETES TECHNOLOGY & THERAPEUTICSVolume 11, Number 12, 2009S K Kota, S Ugale, N Gupta, V Naik, K V S Hari Kumar, Kirtikumar D Modi. Remission of Type 2 Diabetes Mellitus by Ileal Interposition with Sleeve gastrectomy. International Journal of Endocrinology and Metabolism. 2011; 9 (3): 374-381Ileal interposition with sleeve gastrectomy fortreatment of type 2 diabetes mellitus Sunil Kumar Kota*, Surendra Ugale1*, Neeraj Gupta1, Vishwas Naik1, K. V. S. Hari Kumar2,Kirtikumar D. ModiDepartment of Endocrinology, Indian Journal of Endocrinology and Metabolism / Jul-Aug 2012 / Vol 16 | Issue 4

Nothing to Disclose: KDM, SKK Sr., SU, NG

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm