Exploring the Benefits of Bariatric Surgery for Diabetes Risk Groups

Over 2.5 billion adults globally are classified as overweight or obese, with a significant number developing type 2 diabetes (T2D) and related health issues. Bariatric surgery has emerged as a viable option for substantial weight loss and the mitigation of these associated risks. However, predicting the outcomes of bariatric surgery for individuals who do not yet have T2D remains challenging.

Recent research conducted by teams from Germany, France, and Italy sought to identify variations in metabolic improvements among individuals categorized into different diabetes risk subtypes before undergoing bariatric surgery. The findings were published in Diabetes Care.

The study began by classifying overweight individuals without T2D but at risk of developing diabetes into distinct subtypes based on factors such as Body Mass Index (BMI). According to researchers, individuals categorized as subtypes 3, 5, and 6 face the highest likelihood of developing T2D and associated comorbidities. Conversely, subtype 4 consists of overweight or obese individuals with a lower risk of diabetes, while subtypes 1 and 2 typically represent those with minimal excess weight and a reduced diabetes risk.

Participants from two cohorts, one in Lille, France, and the other in Rome, Italy, underwent bariatric surgery. In contrast, a control group based in Tübingen, Germany, received lifestyle interventions aimed at promoting behavioral changes. Metrics such as glucose regulation, prediabetes remission (defined as the normalization of glucose levels), liver fat content, insulin resistance, and beta cell function were carefully monitored to assess the effectiveness of the interventions.

The results indicated that individuals classified under high-risk subtypes 5 and 6 experienced significant benefits from bariatric surgery. Key improvements included enhanced beta cell function, increased insulin sensitivity, normalized blood sugar levels, and reduced liver fat. Notably, a majority of these high-risk individuals transitioned to lower-risk categories following surgical intervention.

In contrast, the control group that underwent lifestyle changes, despite achieving similar relative weight loss, showed less favorable outcomes. Specifically, participants from the low-risk subtype 4 exhibited a lower rate of prediabetes remission and thus gained less in terms of blood sugar regulation improvement.

These findings highlight the importance of prediabetes classification for those with severe obesity. The differential responses of the various subtypes to bariatric surgery underscore the potential for tailoring treatment approaches in this field, paving the way for advancements in precision medicine as it relates to bariatric procedures.

For further details, refer to the study: Subphenotype-Dependent Benefits of Bariatric Surgery for Individuals at Risk for Type 2 Diabetes, published in Diabetes Care.