Predictive Performance of Advanced-Diarem for Diabetes Remission After Roux-En-Y Gastric Bypass Surgery Publisher Pubmed



Abdollahi A ; Afshar M ; Karimi Y ; Pazouki A ; Kabir A
Source: Obesity Surgery Published:2026

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. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2026.