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. 2026 Jan 3.
doi: 10.1007/s11695-025-08477-1. Online ahead of print.

Predictive Performance of Advanced-DiaRem for Diabetes Remission after Roux-en-Y Gastric Bypass Surgery

Arash Abdollahi  1 , Maziar Afshar  2 , Yeganeh Karimi  3 , Abdolreza Pazouki  1   4 , Ali Kabir  5   6
Affiliations

Predictive Performance of Advanced-DiaRem for Diabetes Remission after Roux-en-Y Gastric Bypass Surgery

Arash Abdollahi et al. Obes Surg. .

Abstract

Background: The global epidemics of obesity and type II diabetes highlight the need for reliable tools to predict surgical outcomes, particularly diabetes remission. The applicability of the Advanced DiaRem (Ad-DiaRem) score to Iranian patients undergoing Roux-en-Y gastric bypass (RYGB) remains uncertain due to cultural, genetic, and environmental differences. This study aimed to validate the predictive value of the Ad-DiaRem score in an Iranian cohort.

Methods: This mixed cohort study included 280 diabetic adults who underwent RYGB from 2016 to 2023. Ad-DiaRem scores were calculated based on preoperative clinical variables. Diabetes remission was defined as HbA1c < 6.5% (or fasting blood glucose < 126 mg/dL) at least three months post-surgery without diabetes medications. Various cut-offs were tested, and the Ad-DiaRem's predictive performance was assessed using sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) analysis.

Results: Remission episodes were recorded in 57.9% of patients. Those achieving remission had significantly lower median Ad-DiaRem scores (6 vs. 9). At the cut-off score of 7, Ad-DiaRem showed 51.9% sensitivity, 78.0% specificity, 76.4% positive predictive value, 54.1% negative predictive value, and 62.9% accuracy for predicting remission. The area under the ROC curve (AUC) was 66.7%.

Conclusions: In Iranian patients, the Ad-DiaRem score demonstrated limited predictive performance for diabetes remission after RYGB, with lower accuracy than previously reported in other populations. Recalibration of Ad-DiaRem components is necessary, and development of population-specific scoring systems validated in larger cohorts with longer follow-up is recommended.

Keywords: Advanced-DiaRem; Diagnostic performance; Metabolic bariatric surgery; Roux-en-Y gastric bypass.

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Conflict of interest statement

Declarations. Ethical/Board Approval: This study was approved by the Institutional Review Board of Redacted for peer review and conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Informed Consent: Written informed consent was obtained from all participants during their initial visit, detailing the study’s purpose, procedures, potential risks, benefits, and their right to withdraw at any time. Participant confidentiality was maintained through anonymized data collection and secure storage of electronic medical records. Competing Interests: The authors declare no competing interests.

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