Khushboo Gala, MBBS, Wissam Ghusn, MD, Karim Al Annan, MD, Lea N. Sayegh, MD, Eric J. Vargas, MD, MS, Andrew Storm, MD, Andres Acosta, MD, PhD, Barham Abu Dayyeh, MD, MPH Mayo Clinic, Rochester, MN
Introduction: Endoscopic sleeve gastroplasty (ESG) is a safe and effective therapeutic modality for obesity, with patients generally achieving >15% total body weight loss. Although remission of metabolic comorbidities is usually expected with that degree of weight loss, not all patients achieve the desired outcome of remission of type 2 diabetes mellitus (T2D). The individualized metabolic score (IMS) is a validated score that uses preoperative variables predicting T2D remission (DR) in bariatric surgery. These include the duration of T2D in years, the number of T2D medications, insulin use, and glycemic control (glycated hemoglobin level, (HbA1c) < 7%). We evaluate the applicability of using the IMS score to predict DR in patients after ESG.
Methods: We performed a retrospective review of patients with obesity and T2D who underwent ESG at our institution between 2013 and 2022. Patient demographic and medical information were abstracted from the electronic medical records. IMS score and severity were calculated, and patients were divided based on IMS category: mild (IMS score ≤25), moderate (IMS score >25 to ≤95), and severe (IMS score >95). DR at 12 months was defined as HbA1c < 6.5 without any antidiabetic therapy, per 2021 American Diabetes Association consensus statement. Continuous variables were reported as mean ± standard deviation (SD), while categorical variables were reported as frequencies (%). Categorical data were analyzed using a chi-square test, and continuous data using ANOVA. A logistic regression model was used to analyze the relationship between IMS score and DR.
Results: We included 21 patients with 24% (5) with mild, 57% (11) with moderate, and 19% (4) with severe IMS scores. Baseline characteristics are described in Table 1a, with no significant differences between groups. Most baseline variables of T2DM severity were significantly different between groups, as expected (Table 1b). DR was achieved in 60%, 45.5%, and 0% of patients with mild, moderate, and severe IMS scores (p = 0.08) (Table 1c). IMS score was significantly associated with DR (p = 0.03), with patients with higher scores more likely to have a lower DR (Figure 1a). The AUC of ROC for predicting DR was calculated to be 0.85 (Figure 1b).
Discussion: We present pilot data that demonstrate a significant association of DR with baseline IMS score, and a trend towards association with IMS category in patients after ESG. IMS score appears to be useful in predicting DR after ESG.
Figure: Figure 1a: Logistic regression curve of DR and IMS score; Figure 1b: Receiver Operating Characteristic Abbreviations: IMS: Individualized metabolic score; T2DM: Type 2 diabetes mellitus; DR: Diabetes Remission
Disclosures:
Khushboo Gala indicated no relevant financial relationships.
Wissam Ghusn indicated no relevant financial relationships.
Karim Al Annan indicated no relevant financial relationships.
Lea Sayegh indicated no relevant financial relationships.
Andres Acosta: Amgen Pharmaceuticals – Consultant. General Mills – Consultant. Gila Therapeutics – Stock-privately held company. Phenomix Sciences – Stock-privately held company. Rhythm Pharmaceuticals – Consultant.
Barham Abu Dayyeh: Apollo Endosurgery – Consultant, Grant/Research Support. Aspire Bariatrics – Grant/Research Support. Boston Scientific – Consultant, Grant/Research Support. Cairn Diagnostics – Grant/Research Support. DyaMx – Consultant. Endogastric Solutions – Speakers Bureau. Endo-TAGSS – Consultant. GI Dynamics – Grant/Research Support. Johnson and Johnson – Speakers Bureau. Medtronic – Grant/Research Support. Olympus – Speakers Bureau. Spatz Medical – Grant/Research Support. USGI Medical – Consultant, Grant/Research Support.
Khushboo Gala, MBBS, Wissam Ghusn, MD, Karim Al Annan, MD, Lea N. Sayegh, MD, Eric J. Vargas, MD, MS, Andrew Storm, MD, Andres Acosta, MD, PhD, Barham Abu Dayyeh, MD, MPH. P2622 - Applicability of the Individualized Metabolic Score to Predict Diabetes Remission After Endoscopic Sleeve Gastroplasty, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
