减重手术治疗肥胖相关2型糖尿病临床预测模型研究进展

Advances in clinical prediction models for bariatric surgery in obesity-associated type 2 diabetes mellitus

摘要

肥胖是全球范围内最大的公共卫生难题, 与此伴随的是相关2型糖尿病(T2DM)患病率持续攀升。减重手术作为一种有效的治疗干预措施, 不仅能够显著降低患者的体质量, 还被证实可以改善血糖水平。然而, 术后糖尿病缓解存在个体异质性, 并非所有患者均能获得理想的降糖效果。本研究系统梳理了减重手术后T2DM缓解的预测模型, 探讨其预测因子、实用性与局限性, 并展望了未来研究方向, 为临床实践提供理论参考。

Abstract

Obesity represents one of the most critical global public health challenges, accompanied by a continuously rising prevalence of type 2 diabetes mellitus (T2DM). Bariatric surgery, as an effective therapeutic intervention, has been demonstrated to not only induce significant body mass decline but also improve glycemic control. However, postoperative diabetes remission exhibits considerable interindividual heterogeneity, and not all patients achieve optimal glycemic outcomes. This study systematically reviews predictive models for T2DM remission after bariatric surgery, explores their predictive factors, applicability, and limitations, and proposes future research directions, thereby providing a theoretical reference for clinical practice.

关键词

减重手术 / 2型糖尿病 / 肥胖症 / 预测模型 / 袖状胃切除术 / 列线图 / 临床实践 / 未来趋势

Key words

bariatric surgery / type 2 diabetes mellitus / obesity / prediction model / sleeve gastrectomy / nomogram / clinical practice / future trends

参考文献

[1] NCD RISK FACTOR COLLABORATION NCD-RISC. Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3 663 population-representative studies with 222 million children, adolescents, and adults[J]. Lancet, 2024, 403(10431): 1027-1050. DOI: 10.1016/S0140-6736(23)02750-2.

[2] WANG R F, MIJITI S, XU Q L, et al. The potential mechanism of remission in type 2 diabetes mellitus after vertical sleeve gastrectomy[J]. Obes Surg, 2024, 34(8): 3071-3083. DOI: 10.1007/s11695-024-07378-z.

[3] OGURTSOVA K, GUARIGUATA L, BARENGO N C, et al. IDF diabetes Atlas: global estimates of undiagnosed diabetes in adults for 2021[J]. Diabetes Res Clin Pract, 2022, 183: 109118. DOI: 10.1016/j.diabres.2021.109118.

[4] COURCOULAS A P, PATTI M E, HU B, et al. Long-term outcomes of medical management vs bariatric surgery in type 2 diabetes[J]. JAMA, 2024, 331(8): 654. DOI: 10.1001/jama.2024.0318.

[5] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2013年版)[J]. 中华糖尿病杂志, 2014, 6(7): 447-498. DOI: 10.3760/cma.j.issn.1674-5809.2014.07.004.

[6] SIMS E A, DANFORTH E Jr, HORTON E S, et al. Endocrine and metabolic effects of experimental obesity in man[J]. Recent Prog Horm Res, 1973, 29: 457-496. DOI: 10.1016/b978-0-12-571129-6.50016-6.

[7] 张鹏, 张忠涛. 从《肥胖症诊疗指南(2024年版)》看减重代谢外科的发展趋势[J]. 中国实用外科杂志, 2025, 45(10): 1104-1107. DOI: 10.19538/j.cjps.issn1005-2208.2025.10.05.

[8] PORIES W J, SWANSON M S, MACDONALD K G, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus[J]. Ann Surg, 1995, 222(3): 339-352. DOI: 10.1097/00000658-199509000-00011.

[9] AMERICAN DIABETES ASSOCIATION. Standards of medical care in diabetes: 2009[J]. Diabetes Care, 2009, 32(Suppl. 1): S13-S61. DOI: 10.2337/dc09-S013.

[10] SCHAUER P R, RUBINO F. International Diabetes Federation position statement on bariatric surgery for type 2 diabetes: implications for patients, physicians, and surgeons[J]. Surg Obes Relat Dis, 2011, 7(4): 448-451. DOI: 10.1016/j.soard.2011.05.015.

[11] 刘金刚, 郑成竹, 王勇. 中国肥胖和2型糖尿病外科治疗指南(2014)[J]. 中国实用外科杂志, 2014, 34(11): 1005-1010. DOI: 10.7504/CJPS.ISSN1005-2208.2014.11.01.

[12] HAYES M T, HUNT L A, FOO J, et al. A model for predicting the resolution of type 2 diabetes in severely obese subjects following Roux-en Y gastric bypass surgery[J]. Obes Surg, 2011, 21(7): 910-916. DOI: 10.1007/s11695-011-0370-9.

[13] LEE W J, HUR K Y, LAKADAWALA M, et al. Predicting success of metabolic surgery: age, body mass index, C-peptide, and duration score[J]. Surg Obes Relat Dis, 2013, 9(3): 379-384. DOI: 10.1016/j.soard.2012.07.015.

[14] ROBERT M, FERRAND-GAILLARD C, DISSE E, et al. Predictive factors of type 2 diabetes remission 1 year after bariatric surgery: impact of surgical techniques[J]. Obes Surg, 2013, 23(6): 770-775. DOI: 10.1007/s11695-013-0868-4.

[15] DIXON J B, CHUANG L M, CHONG K, et al. Predicting the glycemic response to gastric bypass surgery in patients with type 2 diabetes[J]. Diabetes Care, 2013, 36(1): 20-26. DOI: 10.2337/dc12-0779.

[16] STILL C D, WOOD G C, BENOTTI P, et al. Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a retrospective cohort study[J]. Lancet Diabetes Endocrinol, 2014, 2(1): 38-45. DOI: 10.1016/S2213-8587(13)70070-6.

[17] RAMOS-LEVI A M, MATIA P, CABRERIZO L, et al. Statistical models to predict type 2 diabetes remission after bariatric surgery[J]. J Diabetes, 2014, 6(5): 472-477. DOI: 10.1111/1753-0407.12127.

[18] UGALE S, GUPTA N, MODI K D, et al. Prediction of remission after metabolic surgery using a novel scoring system in type 2 diabetes-a retrospective cohort study[J]. J Diabetes Metab Disord, 2014, 13(1): 89. DOI: 10.1186/s40200-014-0089-y.

[19] ENGLISH T M, MALKANI S, KINNEY R L, et al. Predicting remission of diabetes after RYGB surgery following intensive management to optimize preoperative glucose control[J]. Obes Surg, 2015, 25(1): 1-6. DOI: 10.1007/s11695-014-1339-2.

[20] PARK J Y, KIM Y J. Prediction of diabetes remission in morbidly obese patients after Roux-en-Y gastric bypass[J]. Obes Surg, 2016, 26(4): 749-756. DOI: 10.1007/s11695-015-1823-3.

[21] PANUNZI S, CARLSSON L, DE GAETANO A, et al. Determinants of diabetes remission and glycemic control after bariatric surgery[J]. Diabetes Care, 2016, 39(1): 166-174. DOI: 10.2337/dc15-0575.

[22] AMINIAN A, BRETHAUER S A, ANDALIB A, et al. Individualized metabolic surgery score: procedure selection based on diabetes severity[J]. Ann Surg, 2017, 266(4): 650-657. DOI: 10.1097/SLA.0000000000002407.

[23] ARON-WISNEWSKY J, SOKOLOVSKA N, LIU Y J, et al. The advanced-DiaRem score improves prediction of diabetes remission 1 year post-Roux-en-Y gastric bypass[J]. Diabetologia, 2017, 60(10): 1892-1902. DOI: 10.1007/s00125-017-4371-7.

[24] SCOPINARO N, ADAMI G F, BRUZZI P, et al. Prediction of diabetes remission at long term following biliopancreatic diversion[J]. Obes Surg, 2017, 27(7): 1705-1708. DOI: 10.1007/s11695-017-2555-3.

[25] PUCCI A, TYMOSZUK U, CHEUNG W H, et al. Type 2 diabetes remission 2 years post Roux-en-Y gastric bypass and sleeve gastrectomy: the role of the weight loss and comparison of DiaRem and DiaBetter scores[J]. Diabet Med, 2018, 35(3): 360-367. DOI: 10.1111/dme.13532.

[26] DEBÉDAT J, SOKOLOVSKA N, COUPAYE M, et al. Long-term relapse of type 2 diabetes after Roux-en-Y gastric bypass: prediction and clinical relevance[J]. Diabetes Care, 2018, 41(10): 2086-2095. DOI: 10.2337/dc18-0567.

[27] STALLARD R, SAHAI V, DROVER J W, et al. Defining and using preoperative predictors of diabetic remission following bariatric surgery[J]. J Parenter Enteral Nutr, 2018, 42(3): 573-580. DOI: 10.1177/0148607117697934.

[28] MADSEN L R, BAGGESEN L M, RICHELSEN B, et al. Effect of Roux-en-Y gastric bypass surgery on diabetes remission and complications in individuals with type 2 diabetes: a Danish population-based matched cohort study[J]. Diabetologia, 2019, 62(4): 611-620. DOI: 10.1007/s00125-019-4816-2.

[29] UMEMURA A, SASAKI A, NITTA H, et al. Prognostic factors and a new preliminary scoring system for remission of type 2 diabetes mellitus after laparoscopic sleeve gastrectomy[J]. Surg Today, 2020, 50(9): 1056-1064. DOI: 10.1007/s00595-020-01990-z.

[30] MOH M C, CHENG A, TAN C H, et al. Metabolic surgery diabetes remission (MDR) score: a new preoperative scoring system for predicting type 2 diabetes remission at 1 year after metabolic surgery in the Singapore multi-ethnic Asian setting[J]. Obes Surg, 2020, 30(9): 3387-3393. DOI: 10.1007/s11695-020-04576-3.

[31] CAO Y, NÄSLUND I, NÄSLUND E, et al. Using a convolutional neural network to predict remission of diabetes after gastric bypass surgery: machine learning study from the Scandinavian obesity surgery register[J]. JMIR Med Inform, 2021, 9(8): e25612. DOI: 10.2196/25612.

[32] PAN Y H, HAN X D, KAM H, et al. Nomogram for predicting 5-year diabetes remission after Roux-en-Y gastric bypass surgery in Chinese patients with obesity[J]. Obes Surg, 2022, 32(5): 1556-1562. DOI: 10.1007/s11695-022-05952-x.

[33] YUAN K S, WU B, ZENG R Q, et al. Construction and validation of a nomogram for predicting diabetes remission at 3 months after bariatric surgery in patients with obesity combined with type 2 diabetes mellitus[J]. Diabetes Obes Metab, 2024, 26(1): 169-179. DOI: 10.1111/dom.15303.

[34] NIU L J, MU L Q, WU R D, et al. Preoperative contributing factors and the remission of diabetes after metabolic surgery: the mediating role of preoperative triglyceride[J]. Eat Weight Disord, 2024, 29(1): 18. DOI: 10.1007/s40519-024-01647-7.

[35] ZHU H M, GUO P S, ZHAO Y, et al. Prediction model of diabetes remission at 1-year after sleeve gastrectomy and comparison with other models[J]. Obes Surg, 2025, 35(1): 249-256. DOI: 10.1007/s11695-024-07634-2.

[36] YI X H, ZHU L Y, ZHU S H. Predictors of T2DM remission after bariatric surgery in patients with a BMI 35 kg/m²: a meta-analysis[J]. Obes Surg, 2023, 33(8): 2342-2355. DOI: 10.1007/s11695-023-06671-7.

[37] VANEGAS S M, CURADO S, ZHOU B Y, et al. Variations in weight loss and glycemic outcomes after sleeve gastrectomy by race and ethnicity[J]. Obesity (Silver Spring), 2025, 33(8): 1567-1579. DOI: 10.1002/oby.24320.

[38] LEE P C, THAM K W, GANGULY S, et al. Ethnicity does not influence glycemic outcomes or diabetes remission after sleeve gastrectomy or gastric bypass in a multiethnic Asian cohort[J]. Obes Surg, 2018, 28(6): 1511-1518. DOI: 10.1007/s11695-017-3050-6.

[39] RUBINO F, CUMMINGS D E, ECKEL R H, et al. Definition and diagnostic criteria of clinical obesity[J]. Lancet Diabetes Endocrinol, 2025, 13(3): 221-262. DOI: 10.1016/S2213-8587(24)00316-4.

[40] YU C Y, WANG Z, WUYUN Q, et al. Comparison of various prediction models in the effect of Roux-en-Y gastric bypass on type 2 diabetes in the Chinese population 5 years after surgery[J]. Surg Obes Relat Dis, 2023, 19(11): 1288-1295. DOI: 10.1016/j.soard.2023.05.012.

[41] IKRAMUDDIN S, BILLINGTON C J, LEE W J, et al. Roux-en-Y gastric bypass for diabetes (the Diabetes Surgery Study): 2-year outcomes of a 5-year, randomised, controlled trial[J]. Lancet Diabetes Endocrinol, 2015, 3(6): 413-422. DOI: 10.1016/S2213-8587(15)00089-3.

[42] GHUSN W, SALAMEH Y, ABI MOSLEH K, et al. Using pre-operative insulin dose to predict diabetes remission after Roux-en-Y gastric bypass and sleeve gastrectomy[J]. Surg Innov, 2024, 31(5): 484-492. DOI: 10.1177/15533506241273368.

[43] DE CLEVA R, KAWAMOTO F, BORGES G, et al. C-peptide level as predictor of type 2 diabetes remission and body composition changes in non-diabetic and diabetic patients after Roux-en-Y gastric bypass[J]. Clinics (Sao Paulo), 2021, 76: e2906. DOI: 10.6061/clinics/2021/e2906.

[44] ZHAO L, LI W Z, SU Z H, et al. Preoperative fasting C-peptide predicts type 2 diabetes mellitus remission in low-BMI Chinese patients after Roux-en-Y gastric bypass[J]. J Gastrointest Surg, 2018, 22(10): 1672-1678. DOI: 10.1007/s11605-018-3818-6.

[45] AARTS E O, JANSSEN J, JANSSEN I M, et al. Preoperative fasting plasma C-peptide level may help to predict diabetes outcome after gastric bypass surgery[J]. Obes Surg, 2013, 23(7): 867-873. DOI: 10.1007/s11695-013-0872-8.

[46] YU H Y, DI J Z, BAO Y Q, et al. Visceral fat area as a new predictor of short-term diabetes remission after Roux-en-Y gastric bypass surgery in Chinese patients with a body mass index less than 35 kg/m² [J]. Surg Obes Relat Dis, 2015, 11(1): 6-11. DOI: 10.1016/j.soard.2014.06.019.

[47] ZHAO L J, NI Y, YU H Y, et al. Serum stearic acid/palmitic acid ratio as a potential predictor of diabetes remission after Roux-en-Y gastric bypass in obesity[J]. FASEB J, 2017, 31(4): 1449-1460. DOI: 10.1096/fj.201600927R.

[48] THAHER O, WOLLENHAUPT F, CRONER R S, et al. Evaluation of the effect of sleeve gastrectomy versus Roux-en-Y gastric bypass in patients with morbid obesity: multicenter comparative study[J]. Langenbecks Arch Surg, 2024, 409(1): 156. DOI: 10.1007/s00423-024-03341-9.

[49] MURPHY R, PLANK L D, CLARKE M G, et al. Effect of banded Roux-en-Y gastric bypass versus sleeve gastrectomy on diabetes remission at 5 years among patients with obesity and type 2 diabetes: a blinded randomized clinical trial[J]. Diabetes Care, 2022, 45(7): 1503-1511. DOI: 10.2337/dc21-2498.

[50] PANG W S, LOO G H, TAN G J, et al. Comparative evaluation of early diabetic outcomes in Southeast Asian patients with type 2 diabetes mellitus undergoing Roux-en-Y gastric bypass (RYGB) versus sleeve gastrectomy (LSG)[J]. Sci Rep, 2024, 14(1): 614. DOI: 10.1038/s41598-024-51384-1.

[51] YU C Y, WANG L, XU G Z, et al. Comparison of various prediction models in the effect of laparoscopic sleeve gastrectomy on type 2 diabetes mellitus in the Chinese population 5 years after surgery[J]. Chin Med J, 2024, 137(3): 320-328. DOI: 10.1097/CM9.0000000000002718.

[52] TURNER R M, SPIEGELHALTER D J, SMITH G C, et al. Bias modelling in evidence synthesis[J]. J R Stat Soc Ser A Stat Soc, 2009, 172(1): 21-47. DOI: 10.1111/j.1467-985X.2008.00547.x.

[53] BUSE J B, CAPRIO S, CEFALU W T, et al. How do we define cure of diabetes?[J]. Diabetes Care, 2009, 32(11): 2133-2135. DOI: 10.2337/dc09-9036.

[54] RIDDLE M C, CEFALU W T, EVANS P H, et al. Consensus report: definition and interpretation of remission in type 2 diabetes[J]. Diabetes Care, 2021, 44(10): 2438-2444. DOI: 10.2337/dci21-0034.

[55] 乔钰涵, 程吕佳, 吴丽娜, 等. 腹腔镜胃袖状切除联合双通道吻合术: 减重代谢外科术式新选择[J]. 腹腔镜外科杂志, 2024, 29(5): 384-389. DOI: 10.13499/j.cnki.fqjwkzz.2024.05.384.

[56] COLOSIMO S, MARTÍNEZ-SÁNCHEZ M A, BALAGUER-ROMÁN A, et al. A novel model for predicting diabetes remission after bariatric surgery based on the measurement of C-peptide and creatinine in serum: a pilot study[J]. Nutr Metab Cardiovasc Dis, 2024, 34(5): 1142-1145. DOI: 10.1016/j.numecd.2023.12.008.

[57] YI X H, LING J P, MENG H, et al. Lipid accumulation product predicts diabetes remission after bariatric surgery in Chinese patients with BMI 35 kg/m²: a multicenter cohort study[J]. Obes Surg, 2022, 32(6): 1935-1943. DOI: 10.1007/s11695-022-06003-1.

[58] ASSEM S, ABDELBAKI T N, MOHY-EL DINE S H, et al. SERPINE-1 gene methylation and protein as molecular predictors of laparoscopic sleeve gastrectomy outcome[J]. Obes Surg, 2020, 30(7): 2620-2630. DOI: 10.1007/s11695-020-04533-0.

[59] HERNÁNDEZ-MONTOLIU L, RODRÍGUEZ-PEÑA M M, PUIG R, et al. A specific gut microbiota signature is associated with an enhanced GLP-1 and GLP-2 secretion and improved metabolic control in patients with type 2 diabetes after metabolic Roux-en-Y gastric bypass[J]. Front Endocrinol, 2023, 14: 1181744. DOI: 10.3389/fendo.2023.1181744.

[60] LAJEUNESSE-TREMPE F, PICHÉ M E, MARCEAU S, et al. Preoperative predictors of type 2 diabetes remission after bilio-pancreatic diversion with duodenal switch[J]. Surg Obes Relat Dis, 2024, 20(6): 507-514. DOI: 10.1016/j.soard.2023.11.006.

[61] OHIRA M, ABE K, YAMAGUCHI T, et al. Preoperative plasma aldosterone predicts complete remission of type 2 diabetes after bariatric surgery[J]. Obes Facts, 2022, 15(3): 373-383. DOI: 10.1159/000521855.

[62] HAJDUCH E, LE STUNFF H. Serum ceramides could predict durable diabetes remission following gastric bypass surgery[J]. Med, 2022, 3(7): 440-441. DOI: 10.1016/j.medj.2022.06.005.

[63] ALMAZROUEI B, MOUSA M, BARREIROS A, et al. Multi-omics analysis of bariatric surgery's impact on type 2 diabetes and prediabetes[J]. Sci Rep, 2025, 15(1): 29215. DOI: 10.1038/s41598-025-14577-w.

基金资助

陕西省自然科学基础研究计划项目(2024JC-ZDXM-60)