Benefits of Bariatric Surgery on Risk Cluster Assignment in Individuals at High Risk for Type 2 Diabetes

A recent data-driven classification of subjects at risk for type 2 diabetes (T2D) has identified three subtypes at high risk to develop T2D and/or complications. Among these, clusters 5 and 6 were specifically insulin resistant and both had a very high risk for nephropathy, despite the fact that cluster 6 had a delayed development of T2D. We hypothesized that particularly clusters 5 and 6 benefit from bariatric surgery (BS) in terms of risk reduction. We investigated 72 obese individuals at risk for T2D who underwent BS and were followed up for up to 24 months (15.3±4.5 months). At baseline, 97% of subjects were assigned to high risk clusters 5 or 6. Cluster 5 had a mean BMI of 42.8±4.9 kg/m2 vs. 42.5±4.0 kg/m2 in cluster 6, p=0.3. At baseline, HOMA-IR was 8.3±4.9 in cluster 5 and 4.7±2.6 in cluster 6 (p<0.001). After BS, subjects from both clusters normalized HOMA-IR (1.7±1.0 vs. 1.5±1.0) with cluster 5 benefitting significantly more from BS (p group over time <0.001). Unadjusted HOMA-β did not differ between clusters before and after BS. Importantly, 93% of individuals switched to low risk clusters 2 and 4 after BS with comparable distribution of baseline cluster assignment (p=0.5, figure). These data show that BS leads to a switch from high to low risk clusters in persons at risk for T2D and suggest that BS decreases the risk for future complications also in high risk individuals, especially in high risk cluster 5. Disclosure L.Sandforth: None. E.Lembo: None. O.Verrastro: None. A.Sandforth: None. A.Fritsche: Advisory Panel; Novo Nordisk, Lilly, Sanofi, Boehringer-Ingelheim, Speaker's Bureau; AstraZeneca, SYNLAB Holding Deutschland GmbH. R.Jumpertz von schwartzenberg: Other Relationship; Sanofi, Amgen Inc., Lilly, Novo Nordisk. G.Mingrone: Advisory Panel; Fractyl Health, Inc., Board Member; Novo Nordisk, Consultant; Novo Nordisk, Fractyl Health, Inc., ReCor Medical, Inc. A.L.Birkenfeld: None.