Following bariatric surgery, the MOD subtype showed significant improvements in transaminases, triglycerides (-22%), and LDL-cholesterol (-20%) compared to the SIRD subtype (all p<0.05).
Cohort (n=48)
Does bariatric surgery improve cardiovascular risk factors and liver function differently in moderate obesity-related diabetes (MOD) compared to severe insulin-resistant diabetes (SIRD)?
Bariatric surgery yields similar weight loss and glycemic improvements across diabetes subtypes, but moderate obesity-related diabetes (MOD) derives greater benefits in liver function and lipid profiles compared to severe insulin-resistant diabetes (SIRD).
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 p0.01) 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 p0.05). 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 p0.01). 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).
Zaharia et al. (Fri,) conducted a cohort in Diabetes (MOD and SIRD subtypes) undergoing bariatric surgery (n=48). Moderate obesity-related diabetes (MOD) subtype vs. Severe insulin-resistant diabetes (SIRD) subtype was evaluated on Changes in BMI, HbA1c, fatty liver index, insulin resistance, transaminases, and plasma lipids. Following bariatric surgery, the MOD subtype showed significant improvements in transaminases, triglycerides (-22%), and LDL-cholesterol (-20%) compared to the SIRD subtype (all p<0.05).