BMS offers different benefits for people with an increased risk of diabetes

The novel classification of diabetes risk subtypes can help to identify people who benefit particularly greatly from bariatric surgery, according to researchers from the Institute of Diabetes Research and Metabolic Diseases of Helmholtz Munich at the Eberhard Karls University of Tübingen, the University Hospital of Tübingen, the German Center for Diabetes Research (DZD), as well as the Universities of Lille and Rome.

High-risk subtypes benefit bariatric significantly from surgery (Credit: DZD)

They investigated the extent to which the different subtypes benefit from bariatric surgery and the results indicate that this could be an important step towards precision medicine.

Researchers from Germany, France and Italy assessed whether differences in metabolic improvements could be identified in people from different diabetes risk subtypes. They analysed two cohorts of people who underwent bariatric surgery and a control group.

First, overweight people without T2D but at risk of diabetes (defined by an increased BMI, among other things) were assigned to the various diabetes risk subtypes.

"People with obesity who belong to subtypes 3, 5 and 6 have the highest risk of developing T2D and/or comorbidities," explained DZD researcher, Leontine Sandforth from the University Hospital of Tübingen. Together with Violeta Raverdy from the University of Lille, she is the first author of the publication.

Subtype 4 includes people who are overweight/obese with a low risk of diabetes. Subtypes 1, 2 and 3 usually have little or no excess weight and a lower risk of diabetes.

People in a cohort from Lille (France) and a cohort from Rome (Italy) underwent bariatric surgery. A control cohort in Tübingen (Germany) received a lifestyle intervention with behavioural change. To determine the success of the intervention, glucose regulation, prediabetes remission (normalisation of glucose regulation), liver fat, insulin resistance and beta cell function were examined.

Outcomes

People with high-risk subtypes 5 and 6 benefited the most from bariatric surgery. Beta cell function and insulin sensitivity improved. In addition, blood sugar levels normalised (prediabetes remission) and liver fat was reduced. Moreover, the majority of high-risk groups transitioned to low-risk groups after bariatric surgery.

This was not the case in the control cohort with lifestyle change counselling. Although relative weight loss was similar across all subtypes, surprisingly, participants from low-risk subtype 4 had a lower remission rate of prediabetes and thus benefited less in terms of improvement in blood sugar regulation.

"Our results show the relevance of the prediabetes classification for people with severe obesity. We were able to identify different reactions of the subtypes to bariatric surgery," added Prof Dr Reiner Jumpertz von Schwartzenberg. "These findings could help to advance precision medicine approaches in bariatric surgery."

The findings were reported in the paper, ‘Subphenotype-Dependent Benefits of Bariatric Surgery for Individuals at Risk for Type 2 Diabetes’, published in Diabetes Care. To access this paper, please click here