In a Malaysian cohort of 204 adults with type 2 diabetes undergoing bariatric surgery (85% sleeve gastrectomy, 15% Roux-en-Y gastric bypass), overall remission reached 69.1%. The Ad-DiaRem score — which weights insulin use, HbA1c, diabetes duration, and treatment burden — achieved the strongest discrimination (AUC 0.852), outperforming DiaRem2 (AUC 0.781, p=0.009) and trending above the original DiaRem (AUC 0.807, p=0.115 primary cohort; p=0.036 in the expanded 256-patient sensitivity analysis). Adding diabetes duration alone (DiaRem2) failed to improve on the original DiaRem.
Predicting which patients will achieve diabetes remission after bariatric surgery is clinically vital: it informs shared decision-making and shapes realistic expectations, particularly as sleeve gastrectomy — historically considered metabolically inferior to gastric bypass — now dominates surgical practice globally. This study is among the first to validate these scores in a predominantly Asian, sleeve-heavy population, where body composition and diabetes phenotype differ meaningfully from Western cohorts in which the scores were derived. That Ad-DiaRem performed consistently across obesity classes and procedure types strengthens its practical utility. Key limitations include retrospective design, the need to reconstruct medication data from records (introducing misclassification risk), modest sample size limiting head-to-head statistical power, and single-center geography. Clinicians should treat these scores as decision-support aids rather than definitive predictors. Prospective Asian multicenter validation — especially comparing sleeve gastrectomy against bypass — remains the necessary next step.