• Pre-operative counselling for bariatric surgery candidates with T2DM
• Procedure selection — estimating T2DM remission probability across RYGB, LSG, and LAGB
• Setting realistic expectations before surgery in insulin-requiring patients
• Clinical documentation of anticipated surgical benefit for payers and multidisciplinary teams
• Identifying candidates unlikely to achieve remission despite surgery

Each variable reflects a distinct physiological predictor: younger age indicates preserved beta-cell plasticity; higher BMI signals greater incretin upregulation post-surgery; elevated C-peptide confirms residual beta-cell mass; shorter T2DM duration reflects less glucotoxic beta-cell destruction.

• Uses only routine pre-operative parameters — no specialist investigations required
• Validated across multiple independent bariatric surgery cohorts globally
• Discriminates between RYGB/LSG high-responders and LAGB-appropriate patients
• C-peptide directly quantifies residual beta-cell function, the key surgical response predictor
• Scores ≥8 consistently predict >80% complete remission across validation studies

• Not validated for revisional bariatric surgery — use original surgery data only
• C-peptide assay required — unavailable in some resource-limited settings
• Less predictive in patients with secondary diabetes (e.g. post-pancreatectomy)
• Does not account for specific surgical technique variations within procedure types
• Validated primarily in Asian cohorts; performance may vary in different ethnicities

• Counsel patient: >80% probability of complete T2DM remission post-RYGB or LSG
• Proceed with standard bariatric surgery work-up
• Set medication review plan for 3–6 months post-surgery (anticipate dose reductions)
• Arrange endocrinology co-management to guide insulin weaning protocol

• Counsel patient on partial or delayed remission — improvement likely, full remission not guaranteed
• Discuss adjuvant pharmacotherapy (GLP-1 RAs) as post-operative adjunct
• Proceed with surgery if other metabolic/bariatric indications are met
• Prioritise RYGB over LSG or LAGB for higher remission probability in this range

• Counsel that surgery may improve glycaemic control but complete remission is unlikely
• Review whether other surgical benefits (weight loss, CVD risk reduction) justify surgery
• Consider DiaRem Score for complementary risk perspective
• Ensure patient has realistic expectations — focus goals on HbA1c improvement, not remission

Taiwanese bariatric surgeon at Min-Sheng General Hospital, Taoyuan, Taiwan. Dr. Lee is one of Asia's most prolific bariatric surgery researchers, with particular focus on metabolic outcomes and diabetes remission after laparoscopic surgery.

The ABCD Score was developed from the observation that T2DM remission after bariatric surgery is not uniform — some patients achieve complete remission while others see minimal glycaemic benefit. Lee's team identified that pre-operative beta-cell reserve (C-peptide), disease duration, age, and BMI were the key determinants, leading to the four-variable model derivation in 2012.