Bariatric Surgery Offers Varied Benefits for Individuals at High Risk of Developing Diabetes

Over 2.5 billion adults worldwide struggle with overweight and obesity, many of whom face increased risks of developing type 2 diabetes (T2D) and related health complications. Bariatric surgery has proven to be an effective intervention for substantial weight loss and reducing the chance of comorbidities. However, predicting the specific benefits for individuals without T2D has been challenging.

Recent research conducted by teams from Germany, France, and Italy has shed light on how different metabolic profiles, or subtypes, of at-risk individuals respond to bariatric surgery. The study analyzed two cohorts of patients undergoing surgical procedures and a control group engaged in lifestyle changes, with key assessments including glucose regulation, prediabetes remission, liver fat content, insulin resistance, and beta cell function.

Participants were first classified into various risk subtypes before surgery. Those with subtypes 3, 5, and 6 have been identified as having the highest risk of progressing to T2D or developing related complications. Conversely, subtype 4 includes individuals with obesity but a lower risk, while subtypes 1, 2, and 3 typically involve less excess weight and lower diabetes risk.

The findings revealed that individuals belonging to the high-risk subtypes 5 and 6 benefited significantly from bariatric surgery, showing notable improvements in beta cell function, insulin sensitivity, and glucose regulation. Many in these groups experienced normalization of blood sugar levels (prediabetes remission) and reduction in liver fat. Additionally, most transitioned from high to low-risk categories post-surgery. In contrast, those in low-risk subtype 4 saw less benefit in blood sugar regulation despite similar weight loss, indicating the importance of metabolic profiling.

Professor Reiner Jumpertz von Schwartzenberg emphasized that these results underscore the importance of preoperative classification for personalized treatment strategies. Identifying which subtypes will benefit most can refine patient selection for bariatric procedures, advancing a more precise approach to obesity management.

This research advances our understanding of how metabolic diversity influences surgical outcomes and supports the development of customized interventions for individuals at risk of T2D.