Subphenotype-Dependent Benefits of Bariatric Surgery for Individuals at Risk for Type 2 Diabetes

作者：Leontine Sandforth, Violeta Raverdy, Arvid Sandforth, Pierre Bauvin, Estelle Chatelain, Hélène Verkindt, Geltrude Mingrone, Caterina Guidone, Ornella Verrastro, Karin Zhou, Rami Archid, André L. Mihaljević, Robert Caïazzo, Grégory Baud, Camille Marciniak, Mikaël Chetboun, Marlene Ganslmeier, Vitória Minelli Faiao, Martin Heni, Louise Fritsche, Anja Moller, Kοnstantinos Kantartzis, Andreas Peter, Rainer Lehmann, Róbert Wágner, Katsiaryna Prystupa, Andreas Fritsche, Norbert Stefan, Hubert Preißl, Andreas L. Birkenfeld, Reiner Jumpertz von Schwartzenberg, François Pattou · 发表于：Diabetes Care · 年份：2025 · DOI：10.2337/dc25-0160 · 被引用次数：15 · 研究领域：Bariatric Surgery and Outcomes、Food composition and properties、Diabetes, Cardiovascular Risks, and Lipoproteins

OBJECTIVE: Bariatric surgery is an effective treatment option for individuals with obesity and type 2 diabetes (T2D). However, whether outcomes in subtypes of individuals at risk for T2D and/or comorbidities (Tübingen Clusters) differ, is unknown. Of these, cluster 5 (C5) and cluster 6 (C6) are high-risk clusters for developing T2D and/or comorbidities, while cluster 4 (C4) is a low-risk cluster. We investigated bariatric surgery outcomes, hypothesizing that high-risk clusters benefit most due to great potential for metabolic improvement. RESEARCH DESIGN AND METHODS: We allocated participants without T2D but at risk for T2D, defined by elevated BMI, to the Tübingen Clusters. Participants had normal glucose regulation or prediabetes according to American Diabetes Association criteria. Two cohorts underwent bariatric surgery: a discovery (Lille, France) and a replication cohort (Rome, Italy). A control cohort (Tübingen, Germany) received behavioral modification counseling. Main outcomes included alteration of glucose regulation parameters and prediabetes remission. RESULTS: In the discovery cohort, 15.0% of participants (n = 121) were allocated to C4, 22.3% (n = 180) to C5, and 62.4% (n = 503) to C6. Relative body weight loss was similar among all clusters; however, reduction of insulin resistance and improvement of β-cell function were strongest in C5. Prediabetes remission rate was lowest in low-risk C4 and highest in high-risk C5. Individuals from high-risk clusters changed ...