Diabetes, obesity & metabolism · 2026
Type 2 diabetes subphenotypes are associated with differential outcomes after metabolic and bariatric surgery: An international multicentre retrospective cohort study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Poljo Adisa, Reichl Jakob J, Kollmann Lars, Kalinowski Piotr, Frankowska Aleksandra, Grąt Michał, Felinska Eleni A, Heger Ulrike, Kopf Stefan, Noeva Donna, Tuffs Christopher, Hepprich Matthias, Seelig Eleonora, Peterli Ralph, Kraljević Marko, Klasen Jennifer M, Müller Beat P, Schneider Romano, Billeter Adrian T
Аннотация
AIMS: Type 2 diabetes (T2D) is characterized by its clinical heterogeneity. Newly described T2D subphenotypes, each with distinct metabolic and co-morbidity risk profiles, may enable a more personalized care. This study examined whether these subphenotypes can predict outcomes in patients undergoing metabolic and bariatric surgery (MBS).
MATERIALS AND METHODS: A total of 233 people with T2D from four clinical centres undergoing MBS were retrospectively assigned to T2D subphenotypes based on the Ahlqvist methodology. The primary outcome was T2D remission at 2 years; secondary outcomes included changes in HOMA2-%B, HOMA2-IR, and total body weight loss (%TWL). Intraoperative liver biopsies were evaluated for metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH).
RESULTS: All participants were classified as mild obesity-related diabetes (MOD) (62.2%), severe insulin-resistant diabetes (SIRD) (19.7%), or SIDD (18.1%). At 2 years, diabetes remission was lower in severe insulin-deficient diabetes (SIDD) (36.7%) than MOD (79.3%) and SIRD (97.2%; p < 0.001). SIDD had lower BMI (38.3 vs. 45.2 and 43.2 kg/m2; p < 0.001) and worse beta-cell function (HOMA2-%B, 92.4 vs. 131.5 vs. 164; p = 0.010), with highest HOMA2-IR in SIRD (6.0 ± 3.4 vs. 4.4 ± 2.8 vs. 3.6 ± 1.9; p < 0.001). %TWL was similar across subphenotypes. SIDD showed higher baseline MASH prevalence (60.5% vs. 46.3% vs. 46.3%).
CONCLUSION: T2D subphenotypes respond differently to T2D remission after MBS with SIDD showing a significantly lower remission rate than MOD and SIRD at 2 years. Considering metabolic status in treatment decisions may improve patient outcomes.
MATERIALS AND METHODS: A total of 233 people with T2D from four clinical centres undergoing MBS were retrospectively assigned to T2D subphenotypes based on the Ahlqvist methodology. The primary outcome was T2D remission at 2 years; secondary outcomes included changes in HOMA2-%B, HOMA2-IR, and total body weight loss (%TWL). Intraoperative liver biopsies were evaluated for metabolic dysfunction-associated steatotic liver disease (MASLD) and steatohepatitis (MASH).
RESULTS: All participants were classified as mild obesity-related diabetes (MOD) (62.2%), severe insulin-resistant diabetes (SIRD) (19.7%), or SIDD (18.1%). At 2 years, diabetes remission was lower in severe insulin-deficient diabetes (SIDD) (36.7%) than MOD (79.3%) and SIRD (97.2%; p < 0.001). SIDD had lower BMI (38.3 vs. 45.2 and 43.2 kg/m2; p < 0.001) and worse beta-cell function (HOMA2-%B, 92.4 vs. 131.5 vs. 164; p = 0.010), with highest HOMA2-IR in SIRD (6.0 ± 3.4 vs. 4.4 ± 2.8 vs. 3.6 ± 1.9; p < 0.001). %TWL was similar across subphenotypes. SIDD showed higher baseline MASH prevalence (60.5% vs. 46.3% vs. 46.3%).
CONCLUSION: T2D subphenotypes respond differently to T2D remission after MBS with SIDD showing a significantly lower remission rate than MOD and SIRD at 2 years. Considering metabolic status in treatment decisions may improve patient outcomes.