diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM12814diaendo-12814Research ArticleОбзорыReviewПрогнозирование ремиссии сахарного диабета 2 типа после выполнения бариатрической операцииPrediction of remission of type 2 diabetes mellitus after bariatric surgeryhttps://orcid.org/0000-0003-3454-4690КорнюшинО. В.KornyushinO. V.

Корнюшин Олег Викторович, к.м.н.

SPIN: 4525-2712

Санкт-Петербург

 

Oleg V. Kornyushin, MD, PhD

SPIN: 4525-2712

St. Petersburg

o.kornyushin@gmail.comhttps://orcid.org/0000-0003-1335-8645СакеянИ. С.SakeianI. S.

Сакеян Инга Суреновна

Researcher ID: AAX-9221-2021

Санкт-Петербург

Inga S. Sakeian

Researcher ID: AAX-9221-2021

St. Petersburg

smart.imna@mail.ruhttps://orcid.org/0000-0003-3124-1512КравчукЕ. Н.KravchukE. N.

Кравчук Екатерина Никодимовна, к.м.н.

Researcher ID: AAB-5672-2020

SPIN: 3245-0237

Санкт-Петербург

Ekaterina N. Kravchuk, MD, PhD

Researcher ID: AAB-5672-2020

SPIN: 3245-0237

St. Petersburg

kravchuke@gmail.comВасилевскийД. И.VasilevskyD. I.

Василевский Дмитрий Игоревич, д.м.н., доцент

SPIN: 7598-6339

Санкт-Петербург

Dmitri I. Vasilevsky, MD, PhD, associate professor

SPIN: 7598-6339

St. Petersburg

vasilevsky1969@gmail.comhttps://orcid.org/0000-0001-9540-7812ДаниловИ. Н.DanilovI. N.

Данилов Иван Николаевич, к.м.н.

SPIN: 3267-5056

Санкт-Петербург

Ivan N. Danilov, MD, PhD

SPIN: 3267-5056

St. Petersburg

ivandanilov75@mail.ruhttps://orcid.org/0000-0003-4925-0126НеймаркА. Е.NeimarkA. E.

Неймарк Александр Евгеньевич, к.м.н., доцент

SPIN: 6554-3217

Scopus Author ID: 8454779100

197341, Санкт-Петербург, ул. Аккуратова, д. 2

Aleksandr E. Neimark, MD, PhD

SPIN: 6554-3217

Scopus Author ID: 8454779100

2 Akkuratov street, 197341 St. Petersburg

 

sas_spb@mail.ruНациональный медицинский исследовательский центр им. В.А. АлмазоваV.A. Almazov National Medical Research CenterПервый Санкт-Петербургский государственный медицинский университет им. академика И.П. ПавловаV.A. Almazov National Medical Research Center202123122021246565570Copyright © Корнюшин О.В., Сакеян И.С., Кравчук Е.Н., Василевский Д.И., Данилов И.Н., Неймарк А.Е., 20222022Корнюшин О.В., Сакеян И.С., Кравчук Е.Н., Василевский Д.И., Данилов И.Н., Неймарк А.Е.Kornyushin O.V., Sakeian I.S., Kravchuk E.N., Vasilevsky D.I., Danilov I.N., Neimark A.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/12814

Распространенность сахарного диабета 2 типа (СД2) резко увеличивается во всем мире. Консервативные методики лечения приносят нестойкий и зачастую недостаточный эффект, не говоря уже об отсутствии перспективы излечения заболевания. Однако накопленные данные указывают на то, что полная ремиссия СД2 возможна на фоне хирургического лечения. Эффективность бариатрической хирургии, в частности в достижении гликемического контроля, выдвинула оперативное лечение на первый план в качестве возможности достижения излечения СД2. По сравнению с интенсивной медикаментозной терапией и коррекцией образа жизни метаболическая хирургия показала превосходство благодаря уменьшению количества принимаемых лекарственных препаратов и улучшению метаболических показателей, что приводит к долгосрочным преимуществам в отношении прогрессирования СД2 и развития осложнений. Понимание же факторов, прогнозирующих ремиссию диабета после выполнения операции, поможет в отборе пациентов для выполнения бариатрической операции и в выборе наиболее эффективного типа вмешательства. В данном обзоре литературы проведен анализ исследований наиболее значимых клинических и биохимических предикторов ремиссии СД2 после бариатрических вмешательств, а также освещены известные математические модели прогнозирования.

Type 2 diabetes prevalence is increasing dramatically worldwide. Conservative therapy doesn’t bring stable effect and is often insufficient, not to mention the lack of prospects to cure the disease. Fortunately, accumulating evidence points towards the notion that a complete remission of type 2 diabetes is feasible following a choice of surgical interventions. The efficacy of bariatric surgery in particular for achieving glycemic control has highlighted surgery as a candidate curative intervention for type 2 diabetes. When compared to intensive medical therapy and lifestyle intervention, metabolic surgery has shown superiority in achieving reducing number of medications and metabolic factors improvement, which translates in long-term benefits on diabetes progression and complications. Understanding factors that predict diabetes remission can help to select patients who will benefit most from bariatric surgery and to choose the most effective type of operation. This literature review analyzes studies of the most significant clinical and biochemical predictors of remission of type 2 diabetes mellitus after bariatric interventions, as well as highlights well-known mathematical prediction models.

бариатрическая хирургияремиссия диабетаметаболическая хирургиядиабет 2 типаbariatric surgerydiabetes remissionmetabolic surgerytype 2 diabetesРабота выполнена за счет средств государственного задания № 121031000362-3.ReferencesШестакова М.В., Скляник И.А., Дедов И.И. Возможна ли длительная ремиссия или излечение сахарного диабета 2-го типа в XXI веке? // Терапевтический архив. — 2017. — Т. 89. — №10. — С. 4-11. doi: https://doi.org/10.17116/terarkh201789104-11Shestakova MV, Sklyanik IA, Dedov II. Is it possible to achieve sustained remission or cure of type 2 diabetes mellitus in the 21st century? Ter Arkh. 2017;89(10):4-11. (In Russ.). doi: https://doi.org/10.17116/terarkh201789104-11Скляник И.А., Шестакова Е.А., Юрасов А.В., и др. Возможность достижения нормогликемии у пациентов с сахарным диабетом 2-го типа и ожирением: сравнение медикаментозного и хирургического методов лечения // Терапевтический архив. — 2019. — Т. 91. — №10. — С. 34-38. doi: https://doi.org/10.26442/00403660.2019.10.000375Sklyanik IA, Shestakova EA, Yurasov AV, at al. Glycemia normalization in patients with obesity and type 2 diabetes mellitus: bariatric surgery vs pharmacological therapy. Ter Arkh. 2019;91(10):34-38. (In Russ.). doi: https://doi.org/10.26442/00403660.2019.10.000375Aminian A, Zajichek A, Arterburn DE, et al. Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity. JAMA. 2019;322(13):1271-1282. doi: https://doi.org/10.1001/jama.2019.14231Aminian A, Zajichek A, Arterburn DE, et al. Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity. JAMA. 2019;322(13):1271-1282. doi: https://doi.org/10.1001/jama.2019.14231Rubino F, Nathan DM, Eckel RH, et al. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. Diabetes Care. 2016;39(6):861-877. doi: https://doi.org/10.2337/dc16-0236Rubino F, Nathan DM, Eckel RH, et al. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. Diabetes Care. 2016;39(6):861-877. doi: https://doi.org/10.2337/dc16-0236Pories WJ, Card JF, Flickinger EG, et al. The Control of Diabetes Mellitus (NIDDM) in the Morbidly Obese with the Greenville Gastric Bypass. Ann Surg. 1987;206(3):316-323. doi: https://doi.org/10.1097/00000658-198709000-00009Pories WJ, Card JF, Flickinger EG, et al. The Control of Diabetes Mellitus (NIDDM) in the Morbidly Obese with the Greenville Gastric Bypass. Ann Surg. 1987;206(3):316-323. doi: https://doi.org/10.1097/00000658-198709000-00009Яшков Ю.И. Возможности коррекции нарушений углеводного обмена при сахарном диабете 2 типа с применением бариатрических операций // Сахарный диабет. — 2000. —Т. 3. — №2. — С. 26-29. doi: https://doi.org/10.14341/2072-0351-5883Yashkov YI. Vozmozhnosti korrektsii narusheniy uglevodnogo obmena pri sakharnom diabete 2 tipa s primeneniem bariatricheskikh operatsiy. Diabetes mellitus. 2000;3(2):26-29. (In Russ.). doi: https://doi.org/10.14341/2072-0351-5883Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724-1737. doi: https://doi.org/10.1001/jama.292.14.1724Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724-1737. doi: https://doi.org/10.1001/jama.292.14.1724Sjöholm K, Pajunen P, Jacobson P, et al. Incidence and remission of type 2 diabetes in relation to degree of obesity at baseline and 2 year weight change: the Swedish Obese Subjects (SOS) study. Diabetologia. 2015;58(7):1448-1453. doi: https://doi.org/10.1007/s00125-015-3591-ySjöholm K, Pajunen P, Jacobson P, et al. Incidence and remission of type 2 diabetes in relation to degree of obesity at baseline and 2 year weight change: the Swedish Obese Subjects (SOS) study. Diabetologia. 2015;58(7):1448-1453. doi: https://doi.org/10.1007/s00125-015-3591-ySchauer PR, Bhatt DL, Kirwan JP, et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 3-Year Outcomes. N Engl J Med. 2014;370(21):2002-2013. doi: https://doi.org/10.1056/NEJMoa1401329Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 3-Year Outcomes. N Engl J Med. 2014;370(21):2002-2013. doi: https://doi.org/10.1056/NEJMoa1401329Ikramuddin S, Korner J, Lee W-J, et al. Roux-en-Y Gastric Bypass vs Intensive Medical Management for the Control of Type 2 Diabetes, Hypertension, and Hyperlipidemia. JAMA. 2013;309(21):2240-2249. doi: https://doi.org/10.1001/jama.2013.5835Ikramuddin S, Korner J, Lee W-J, et al. Roux-en-Y Gastric Bypass vs Intensive Medical Management for the Control of Type 2 Diabetes, Hypertension, and Hyperlipidemia. JAMA. 2013;309(21):2240-2249. doi: https://doi.org/10.1001/jama.2013.5835Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial — a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219-234. doi: https://doi.org/10.1111/joim.12012Sjöström L. Review of the key results from the Swedish Obese Subjects (SOS) trial — a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219-234. doi: https://doi.org/10.1111/joim.12012Kim S, Richards WO. Long-Term Follow-up of the Metabolic Profiles in Obese Patients With Type 2 Diabetes Mellitus After Roux-en-Y Gastric Bypass. Ann Surg. 2010;251(6):1049-1055. doi: https://doi.org/10.1097/SLA.0b013e3181d9769bKim S, Richards WO. Long-Term Follow-up of the Metabolic Profiles in Obese Patients With Type 2 Diabetes Mellitus After Roux-en-Y Gastric Bypass. Ann Surg. 2010;251(6):1049-1055. doi: https://doi.org/10.1097/SLA.0b013e3181d9769bSchauer PR, Burguera B, Ikramuddin S, et al. Effect of Laparoscopic Roux-En Y Gastric Bypass on Type 2 Diabetes Mellitus. Ann Surg. 2003;238(4):467-485. doi: https://doi.org/10.1097/01.sla.0000089851.41115.1bSchauer PR, Burguera B, Ikramuddin S, et al. Effect of Laparoscopic Roux-En Y Gastric Bypass on Type 2 Diabetes Mellitus. Ann Surg. 2003;238(4):467-485. doi: https://doi.org/10.1097/01.sla.0000089851.41115.1bde Hollanda A, Lecube A, Rubio MA, et al. New Metrics to Assess Type 2 Diabetes after Bariatric Surgery: The “Time-Within-Remission Range.” J Clin Med. 2020;9(4):1070. doi: https://doi.org/10.3390/jcm9041070de Hollanda A, Lecube A, Rubio MA, et al. New Metrics to Assess Type 2 Diabetes after Bariatric Surgery: The “Time-Within-Remission Range.” J Clin Med. 2020;9(4):1070. doi: https://doi.org/10.3390/jcm9041070Dang JT, Sheppard C, Kim D, et al. Predictive factors for diabetes remission after bariatric surgery. Can J Surg. 2019;6(5):315-319. doi: https://doi.org/10.1503/cjs.014516Dang JT, Sheppard C, Kim D, et al. Predictive factors for diabetes remission after bariatric surgery. Can J Surg. 2019;6(5):315-319. doi: https://doi.org/10.1503/cjs.014516Ершова Е.В., Яшков Ю.И. Состояние углеводного и липидного обмена у пациентов с ожирением и сахарным диабетом 2 типа после билиопанкреатического шунтирования // Ожирение и метаболизм. — 2013. — Т. 10. — №3. — С. 28-36. doi: https://doi.org/10.14341/2071-8713-3862Ershova EV, Yashkov YI. Status of carbohydrate and lipid metabolism in obese patients with type 2 diabetes mellitus after biliopancreatic diversion surgery. Obe Metab. 2013;10(3):28-36. (In Russ.). doi: https://doi.org/10.14341/2071-8713-3862Camerini GB, Papadia FS, Carlini F, et al. The long-term impact of biliopancreatic diversion on glycemic control in the severely obese with type 2 diabetes mellitus in relation to preoperative duration of diabetes. Surg Obes Relat Dis. 2016;12(2):345-349. doi: https://doi.org/10.1016/j.soard.2015.05.012Camerini GB, Papadia FS, Carlini F, et al. The long-term impact of biliopancreatic diversion on glycemic control in the severely obese with type 2 diabetes mellitus in relation to preoperative duration of diabetes. Surg Obes Relat Dis. 2016;12(2):345-349. doi: https://doi.org/10.1016/j.soard.2015.05.012Chikunguwo SM, Wolfe LG, Dodson P, et al. Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010;6(3):254-259. doi: https://doi.org/10.1016/j.soard.2009.11.003Chikunguwo SM, Wolfe LG, Dodson P, et al. Analysis of factors associated with durable remission of diabetes after Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2010;6(3):254-259. doi: https://doi.org/10.1016/j.soard.2009.11.003Purnell JQ, Dewey EN, Laferrère B, et al. Diabetes Remission Status During Seven-year Follow-up of the Longitudinal Assessment of Bariatric Surgery Study. J Clin Endocrinol Metab. 2021;106(3):774-788. doi: https://doi.org/10.1210/clinem/dgaa849Purnell JQ, Dewey EN, Laferrère B, et al. Diabetes Remission Status During Seven-year Follow-up of the Longitudinal Assessment of Bariatric Surgery Study. J Clin Endocrinol Metab. 2021;106(3):774-788. doi: https://doi.org/10.1210/clinem/dgaa849DiGiorgi M, Rosen DJ, Choi JJ, et al. Re-emergence of diabetes after gastric bypass in patients with mid- to longterm follow-up. Surg Obes Relat Dis. 2010;6(3):249-253. doi: https://doi.org/10.1016/j.soard.2009.09.019DiGiorgi M, Rosen DJ, Choi JJ, et al. Re-emergence of diabetes after gastric bypass in patients with mid- to longterm follow-up. Surg Obes Relat Dis. 2010;6(3):249-253. doi: https://doi.org/10.1016/j.soard.2009.09.019Ikramuddin S, Billington CJ, 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. Lancet Diabetes Endocrinol. 2015;3(6):413- 422. doi: https://doi.org/10.1016/S2213-8587(15)00089-3Ikramuddin S, Billington CJ, 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. Lancet Diabetes Endocrinol. 2015;3(6):413- 422. doi: https://doi.org/10.1016/S2213-8587(15)00089-3Yan W, Bai R, Yan M, Song M. Preoperative Fasting Plasma C-Peptide Levels as Predictors of Remission of Type 2 Diabetes Mellitus after Bariatric Surgery: A Systematic Review and Meta-Analysis. J Investig Surg. 2017;30(6):383-393. doi: https://doi.org/10.1080/08941939.2016.1259375Yan W, Bai R, Yan M, Song M. Preoperative Fasting Plasma C-Peptide Levels as Predictors of Remission of Type 2 Diabetes Mellitus after Bariatric Surgery: A Systematic Review and Meta-Analysis. J Investig Surg. 2017;30(6):383-393. doi: https://doi.org/10.1080/08941939.2016.1259375Скляник И.А. Ремиссия сахарного диабета 2 типа при использовании медикаментозного (лираглутид) и бариатрических методов лечения: сроки наступления, прогностические факторы, механизмы: Дис. … канд. мед. наук. — Москва; 2020. Доступно по: https://www.endocrincentr.ru/sites/default/files/specialists/science/dissertation/sklyanik_ia_dissertacia.pdf. Ссылка активна на 10.12.2021.Sklyanik IA. Remissija saharnogo diabeta 2 tipa pri ispol’zovanii medikamentoznogo (liraglutid) i bariatricheskih metodov lechenija: sroki nastuplenija, prognosticheskie faktory, mehanizmy. [dissertation] Moscow; 2020. (In Russ.) Доступно по: https://www.endocrincentr.ru/sites/default/files/specialists/science/dissertation/sklyanik_ia_dissertacia.pdf. Ссылка активна на 10.12.2021.Kaur R, Kim D, Cutfield R, et al. Good Glycemic Outcomes Following Bariatric Surgery Among Patients With Type 2 Diabetes, Obesity, and Low-Titer GAD Antibodies. Diabetes Care. 2021;44(2):607-609. doi: https://doi.org/10.2337/dc20-0804Kaur R, Kim D, Cutfield R, et al. Good Glycemic Outcomes Following Bariatric Surgery Among Patients With Type 2 Diabetes, Obesity, and Low-Titer GAD Antibodies. Diabetes Care. 2021;44(2):607-609. doi: https://doi.org/10.2337/dc20-0804Ceperuelo-Mallafré V, Llauradó G, Keiran N, et al. Preoperative Circulating Succinate Levels as a Biomarker for Diabetes Remission After Bariatric Surgery. Diabetes Care. 2019;42(10):1956-1965. doi: https://doi.org/10.2337/dc19-0114Ceperuelo-Mallafré V, Llauradó G, Keiran N, et al. Preoperative Circulating Succinate Levels as a Biomarker for Diabetes Remission After Bariatric Surgery. Diabetes Care. 2019;42(10):1956-1965. doi: https://doi.org/10.2337/dc19-0114Izaguirre M, Gómez-Ambrosi J, Rodríguez A, et al. GLP-1 Limits Adipocyte Inflammation and Its Low Circulating Pre-Operative Concentrations Predict Worse Type 2 Diabetes Remission after Bariatric Surgery in Obese Patients. J Clin Med. 2019;8(4):479. doi: https://doi.org/10.3390/jcm8040479Izaguirre M, Gómez-Ambrosi J, Rodríguez A, et al. GLP-1 Limits Adipocyte Inflammation and Its Low Circulating Pre-Operative Concentrations Predict Worse Type 2 Diabetes Remission after Bariatric Surgery in Obese Patients. J Clin Med. 2019;8(4):479. doi: https://doi.org/10.3390/jcm8040479Guo X, Zhang S, Zhang Q, et al. Neutrophil:lymphocyte ratio is positively related to type 2 diabetes in a large-scale adult population: a Tianjin Chronic Low-Grade Systemic Inflammation and Health cohort study. Eur J Endocrinol. 2015;173(2):217-225. doi: https://doi.org/10.1530/EJE-15-0176Guo X, Zhang S, Zhang Q, et al. Neutrophil:lymphocyte ratio is positively related to type 2 diabetes in a large-scale adult population: a Tianjin Chronic Low-Grade Systemic Inflammation and Health cohort study. Eur J Endocrinol. 2015;173(2):217-225. doi: https://doi.org/10.1530/EJE-15-0176Bonaventura A, Liberale L, Carbone F, et al. Baseline neutrophilto-lymphocyte ratio is associated with long-term T2D remission after metabolic surgery. Acta Diabetol. 2019;56(7):741-748. doi: https://doi.org/10.1007/s00592-019-01345-2Bonaventura A, Liberale L, Carbone F, et al. Baseline neutrophilto-lymphocyte ratio is associated with long-term T2D remission after metabolic surgery. Acta Diabetol. 2019;56(7):741-748. doi: https://doi.org/10.1007/s00592-019-01345-2Hayes MT, Hunt LA, 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. Obes Surg. 2011;21(7):910-916. doi: https://doi.org/10.1007/s11695-011-0370-9Hayes MT, Hunt LA, 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. Obes Surg. 2011;21(7):910-916. doi: https://doi.org/10.1007/s11695-011-0370-9Ramos-Levi AM, Matia P, Cabrerizo L, et al. Statistical models to predict type 2 diabetes remission after bariatric surgery. J Diabetes. 2014;6(5):472-477. doi: https://doi.org/10.1111/1753-0407.12127Ramos-Levi AM, Matia P, Cabrerizo L, et al. Statistical models to predict type 2 diabetes remission after bariatric surgery. J Diabetes. 2014;6(5):472-477. doi: https://doi.org/10.1111/1753-0407.12127Lee WJ, Hur KY, Lakadawala M, et al. Predicting success of metabolic surgery: Age, body mass index, C-peptide, and duration score. Surg Obes Relat Dis. 2013;9:379-384. doi: https://doi.org/10.1016/j.soard.2012.07.015Lee WJ, Hur KY, Lakadawala M, et al. Predicting success of metabolic surgery: Age, body mass index, C-peptide, and duration score. Surg Obes Relat Dis. 2013;9:379-384. doi: https://doi.org/10.1016/j.soard.2012.07.015Still CD, Wood GC, Benotti P, et al. Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a retrospective cohort study. Lancet Diabetes Endocrinol. 2014;2(1):38-45. doi: https://doi.org/10.1016/S2213-8587(13)70070-6Still CD, Wood GC, Benotti P, et al. Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: a retrospective cohort study. Lancet Diabetes Endocrinol. 2014;2(1):38-45. doi: https://doi.org/10.1016/S2213-8587(13)70070-6Still CD, Benotti P, Mirshahi T, et al. DiaRem2: Incorporating duration of diabetes to improve prediction of diabetes remission after metabolic surgery. Surg Obes Relat Dis. 2019;15(5):717-724. doi: https://doi.org/10.1016/j.soard.2018.12.020Still CD, Benotti P, Mirshahi T, et al. DiaRem2: Incorporating duration of diabetes to improve prediction of diabetes remission after metabolic surgery. Surg Obes Relat Dis. 2019;15(5):717-724. doi: https://doi.org/10.1016/j.soard.2018.12.020Aminian A, Brethauer SA, Andalib A, et al. Individualized Metabolic Surgery Score. Ann Surg. 2017;266(4):650-657. doi: https://doi.org/10.1097/SLA.0000000000002407Aminian A, Brethauer SA, Andalib A, et al. Individualized Metabolic Surgery Score. Ann Surg. 2017;266(4):650-657. doi: https://doi.org/10.1097/SLA.0000000000002407

The authors declare that there are no conflicts of interest present.