A multi-center study on glucometabolic response to bariatric surgery for different subtypes of obesity

Yao Liu; Chunjun Sheng; Wenhuan Feng; Fang Sun; Jingjing Zhang; Ying Chen; Lili Su; Jia Liu; Lei Du; Xuyang Jia; Hui You; Xiu Huang; Shandong Wu; Ziwei Lin; Shen Qu

doi:10.3389/fendo.2022.989202

A multi-center study on glucometabolic response to bariatric surgery for different subtypes of obesity

Front Endocrinol (Lausanne). 2022 Nov 3:13:989202. doi: 10.3389/fendo.2022.989202. eCollection 2022.

Authors

Yao Liu¹, Chunjun Sheng¹, Wenhuan Feng², Fang Sun³, Jingjing Zhang^{4

5}, Ying Chen⁶, Lili Su¹, Jia Liu¹, Lei Du¹, Xuyang Jia¹, Hui You¹, Xiu Huang¹, Shandong Wu^{7

8

9}, Ziwei Lin¹, Shen Qu¹

Affiliations

¹ Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
² Department of Endocrinology, Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China.
³ Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, Chongqing, China.
⁴ National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
⁵ Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
⁶ Ministry of Education, Key Laboratory of Metabolism and Molecular Medicine, Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China.
⁷ Department of Radiology, Department of Biomedical Informatics, Department of Bioengineering, Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, United States.
⁸ Department of Biomedical Informatics, Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, United States.
⁹ Department of Bioengineering, Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, United States.

Abstract

Objectives: To assess the benefit of a bariatric surgery in four artificial intelligence-identified metabolic (AIM) subtypes of obesity with respect to the improvement of glucometabolism and the remission of diabetes and hyperinsulinemia.

Methods: This multicenter retrospective study prospectively collected data from five hospitals in China from 2010 to 2021. At baseline 1008 patients who underwent a bariatric surgery were enrolled (median age 31 years; median BMI 38.1kg/m²; 57.40% women) and grouped into the four AIM subtypes. Baseline and follow-up data (506 and 359 patients at 3- and 12-month post-surgery) were collected for longitudinal effect analysis.

Results: Out of the four AIM subgroups, hypometabolic obesity (LMO) group was characterized by decompensated insulin secretion and high incidence of diabetes (99.2%) pre-surgery. After surgery, 62.1% of LMO patients with diabetes achieved remission, lower than the other three subgroups. Still, the bariatric surgery significantly reduced their blood glucose (median HbA1c decreased by 27.2%). The hypermetabolic obesity-hyperinsulinemia (HMO-I) group was characterized by severe insulin resistance and high incidence of hyperinsulinemia (87.8%) pre-surgery, which had been greatly alleviated post-surgery. For both metabolic healthy obesity (MHO) and hypermetabolic obesity-hyperuricemia (HMO-U) groups who showed a relatively healthy glucometabolism pre-surgery, rate of glucometabolic comorbidities improved moderately post-surgery.

Conclusion: In terms of glucometabolism, the four AIM subtypes of patients benefited differently from a bariatric surgery, which significantly relieved hyperglycemia and hyperinsulinemia for the LMO and HMO-I patients, respectively. The AIM-based subtypes may help better inform clinical decisions on bariatric surgery and patient counseling pertaining to post-surgery outcomes.

Keywords: bariatric surgery; diabetes; hyperinsulinemia; hypoglycemia; obesity subtypes.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Artificial Intelligence
Bariatric Surgery* / methods
Female
Humans
Hyperinsulinism* / etiology
Male
Obesity / surgery
Obesity, Morbid* / surgery
Retrospective Studies