High-Diabetes-Risk 'Cluster 5' Sees the Most Prediabetes Remission After Bariatric Surgery

A study published in Diabetes Care reports that when people with obesity who are at risk of diabetes are divided into subtypes by metabolic characteristics, the blood glucose benefit of bariatric surgery differs by subtype. Researchers at the University Hospital of Tübingen in Germany analyzed the data together with French and Italian cohorts.

Tübingen clusters applied to three cohorts

The researchers assigned people who did not have diabetes but were in a risk group because of a high body mass index to the previously proposed 'Tübingen Clusters.' Of these, clusters 5 (C5) and 6 (C6) are groups at high risk of diabetes and comorbid conditions, and cluster 4 (C4) is a low-risk group. Participants had normal blood glucose or prediabetes. The researchers compared a French discovery cohort in Lille and an Italian replication cohort in Rome, both of whom had surgery, with a German control cohort in Tübingen who received only behavioral modification counseling.

In the discovery cohort, there were 121 people in C4, 180 in C5 and 503 in C6. Weight loss was similar across the clusters, but the reduction in insulin resistance and the improvement in beta-cell (β-cell) function were greatest in C5. The prediabetes remission rate was also highest in C5 and lowest in C4. In both surgical cohorts, some people moved from a high-risk cluster to a low-risk cluster, but no such shift occurred in the control cohort.

A clue for tailored treatment, but not a randomized comparison

The findings show that even with the same amount of weight loss, the metabolic benefit may differ by subtype, which could serve as a criterion in selecting candidates for surgery. However, this is a comparison of observational cohorts rather than a randomized assignment, and the remission rate figures by cluster and whether long-term diabetes developed are not confirmed in the abstract, so further validation is needed.