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Updated: Feb 25, 2026

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Published on: November 14, 2020
Individualized Metabolic Surgery Score: Procedure Selection Based on Diabetes Severity.
Ali Aminian1, Stacy A Brethauer, Amin Andalib
1*Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH †Center for Bariatric Surgery, McGill University, Montreal, QC, Canada ‡Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH §Hospital Clínic Universitari, Barcelona, Spain ¶Department of Surgery, University Putra Malaysia, Selangor, Malaysia ||Department of Surgery, Khon Kaen University, Khon Kaen, Thailand **Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA ††Endocrine and Metabolic Institute, Cleveland Clinic, Cleveland, OH ‡‡CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain.
A new scoring system helps select bariatric surgery for type 2 diabetes (T2DM) based on severity. Roux-en-Y gastric bypass (RYGB) showed better long-term remission in intermediate T2DM than sleeve gastrectomy (SG).
Area of Science:
- Metabolic Surgery
- Diabetes Management
- Surgical Outcomes
Background:
- Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are common for type 2 diabetes (T2DM).
- No validated model currently guides procedure selection for optimal long-term glucose control in T2DM patients.
Purpose of the Study:
- To develop and validate a scoring system for evidence-based selection of bariatric and metabolic surgery.
- To categorize T2DM severity to guide surgical procedure choice.
Main Methods:
- Analysis of 659 T2DM patients undergoing RYGB or SG with ≥5-year follow-up to generate a predictive model.
- External validation using 241 T2DM patients from a Spanish academic center.
- Development of the Individualized Metabolic Surgery (IMS) score based on predictors of remission.
Main Results:
- Diabetes remission (HbA1c <6.5% off medications) observed in 49% after RYGB vs. 28% after SG (P < 0.001) at a median 7-year follow-up.
- Four predictors identified: T2DM duration, number of medications, insulin use, and glycemic control (HbA1c <7%).
- RYGB was significantly more effective than SG in an intermediate T2DM severity group.
Conclusions:
- The study presents the largest cohort (n=900) with long-term glycemic follow-up after bariatric surgery.
- A novel IMS score categorizes T2DM into 3 validated severity stages for evidence-based procedure selection.
- Procedure recommendations are provided for each T2DM severity stage.
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