Metabolic Response to Bariatric Surgery of Novel High-Risk Prediabetes Subphenotypes

A novel pathophysiology-based method to subphenotype individuals at elevated risk for type 2 diabetes has recently identified 6 subgroups, 2 of which constitute obese, high-risk subpopulations with different glycemic, renal, cardiovascular and all-cause mortality risk profiles. The aim of our study was to evaluate differences in response to weight-loss surgery between these clusters, termed clusters 5 & 6 by Wagner et al. We performed this clustering on the Bialystok Bariatric Surgery Study Cohort consisting of nondiabetic patients with at least one year of follow-up data who underwent sleeve gastrectomy surgery. We used generalized linear models to test for differences between clusters in baseline parameters and changes after one year. At baseline, 48 (47%) patients were classified as cluster 5 and 54 (53%) as cluster 6. Before the surgery, cluster 5 subjects had significantly (q-value<0.05) higher levels of fasting and 2-hour glucose and insulin, HbA1c, triglycerides and visceral fat mass, and lower levels of HDL-cholesterol and Matsuda Index. There were no significant differences in age, weight, BMI or body composition. Further, we found that cluster 5 presented a greater reduction in fasting and 2-h glucose, but lesser in hip and waist circumferences, compared to cluster 6. However, after adjusting for baseline values of these parameters, only change in hip and waist circumferences remained significant. We did not find any differences in body composition or lipid parameter responses between clusters. Our study confirms that cluster 5 shows more severe glycemic and lipid deterioration compared to cluster 6 despite their shared obese phenotypes. However, bariatric surgery seems to be equally beneficial in both clusters, except for small differences in hip and waist circumference response. Disclosure L. Szczerbinski: None. J. Goscik: None. W. Kwedlo: None. G.E.P. Wojciechowska: None. A. Citko: None. P. Konopka: None. A. Paszko: None. M. Taylor: None. H.R. Hady: None. A.J. Kretowski: None.