2640-P: Role of Diabetes Subtypes for Reducing Modifiable Cardiovascular Risk Factors after Bariatric Surgery

Introduction and Objective: Phenotype-based clustering uncovered diabetes heterogeneity, but its relevance for tailored treatment remains unclear. The severe insulin-resistant diabetes subtype (SIRD) associates with steatotic liver disease, and higher cardiovascular risk, while moderate obesity-related diabetes (MOD) features mild metabolic alterations despite similar BMI. We examined whether SIRD and MOD exhibit different outcomes after bariatric surgery. Methods: Participants of the BARIA-DDZ study were assigned to MOD (n=37) or SIRD (n=11) using a validated algorithm (www.diabetescalculator.ddz.de). Anthropometric and laboratory data were measured before and 12 months after bariatric surgery. Non-parametric statistical testing was used to compare between clusters while paired testing was used to assess differences pre- and post-surgery within clusters. Results: Mean age was 48±6 years in MOD and 45±7 years in SIRD. Before surgery, MOD and SIRD had comparable BMI (all means, 48.5 kg/m2 vs. 46.8 kg/m2), HbA1c (6.6% vs. 7.0%) and liver lipid content (27.3% for MOD vs. 32.4%). After surgery, MOD and SIRD showed similar reductions in BMI (-28% vs. -33% for SIRD), HbA1c (-19% vs. -23% for SIRD), fatty liver index (both -25%) and insulin resistance (3fold rise in M-value; all p<0.01) without differences between subtypes. However, only MOD featured also improvements in transaminases (-15% AST, -25% ALT, -52% GGT), plasma triglycerides (-22%) and LDL-cholesterol (-20%, all p<0.05). In SIRD, changes in transaminases and plasma lipids were not statistically significant, while fasting C-peptide decreased by 66% as did HOMA-IR from 9.5 to 1.5 a.u. (both p<0.01). Conclusion: Despite similar surgically-induced weight loss and HbA1c decrease, the MOD subtype shows additional improvements in liver function and cardiovascular risk factors compared to SIRD, suggesting a specific benefit for MOD which should be considered for referral to bariatric surgery. Disclosure O. Zaharia: None. C. Binsch: None. S. Trenkamp: None. J. Pützer: None. G. Xourafa: None. M. Huttasch: None. P. Schrauwen: Consultant; Current; AstraZeneca. Research Support; Ended; Pfizer Inc., MedImmune. M. Schlensak: None. F.A. Granderath: None. M. Roden: Advisory Panel; Current; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly, Madrigal Pharmaceuticals, Inc., Novo Nordisk, Sanofi, Echosens. S. Kahl: None. Funding MKW NRW; BMG; BMBF; DZD; EFRE-0400191, EUREKA Eurostars-2 (E! 113230 DIA-PEP); DFG, SFB 1116/2, GRK 2576; DDG).