Nomogram for predicting type 2 diabetes remission after bariatric metabolic surgery in women: a multicenter cohort study

Background The prevalence of obesity with type 2 diabetes mellitus (T2DM) among Asian women has been increasing. However, systematic studies on diabetes prevalence and postoperative remission after metabolic and bariatric surgery (MBS) in this population remain limited. This study aimed to identify risk factors for T2DM in women with obesity undergoing MBS and to develop and validate a predictive model for diabetes remission (DR) at 1-year post-MBS as the primary outcome. Methods This study utilized a 10-year cohort dataset (2014–2024) from 128 bariatric centers in China, involving 7,322 women with obesity who underwent MBS. Univariate and multivariate logistic regression analyses were performed to identify the risk factors of diabetes and predictors of DR, and a nomogram model was constructed and internally validated. Results A total of 1,440 individuals had T2DM, accounting for 19.7% of the total study population. Factors associated with the prevalence of T2DM in women with obesity included age, follicle-stimulating hormone level, family history of diabetes, hemoglobin A1c (HbA1c), and fasting plasma glucose. Within the diabetic population, the median age was 35 years, and the median BMI was 36.1 kg/m 2 . Independent factors influencing postoperative DR included family history of diabetes, postpartum obesity, childhood-onset obesity, diabetes duration, HbA1c level, and insulin requirement. The nomogram model demonstrated excellent discrimination and calibration in both the training and validation sets, with decision curve analysis confirming its clinical utility. Conclusions This study identified risk factors for T2DM in Chinese women with obesity and, established and validated a DR-predictive nomogram for T2DM in Chinese women with obesity after MBS. The model incorporates female-specific factors (e.g., postpartum obesity) and may serve as a reliable tool for personalized surgical decision-making and postoperative management.