Type 2 diabetes mellitus (T2DM) shows substantial clinical heterogeneity. A study published in Diabetes, Obesity and Metabolism evaluated whether recently described T2DM subphenotypes predict outcomes after metabolic and bariatric surgery (MBS).

The retrospective analysis included 233 individuals with T2DM from four clinical centers who underwent MBS. Participants were classified into subphenotypes using the Ahlqvist methodology. The primary outcome was T2DM remission at two years. Secondary outcomes included changes in beta-cell function assessed by the homeostasis model assessment of beta-cell function (HOMA2-%B), insulin resistance measured by the homeostasis model assessment of insulin resistance (HOMA2-IR), and percentage total body weight loss (%TWL). Intraoperative liver biopsies were evaluated for metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH).

Participants were categorized as mild obesity-related diabetes (MOD) in 62.2%, severe insulin-resistant diabetes (SIRD) in 19.7%, and severe insulin-deficient diabetes (SIDD) in 18.1%. At two years, remission occurred in 36.7% of SIDD compared with 79.3% in MOD and 97.2% in SIRD (p < 0.001).

Individuals with SIDD had lower body mass index (38.3 vs 45.2 vs 43.2 kg/m²; p < 0.001) and lower HOMA2-%B (92.4 vs 131.5 vs 164; p = 0.010). HOMA2-IR was highest in SIRD (6.0 ± 3.4 vs 4.4 ± 2.8 vs 3.6 ± 1.9; p < 0.001). Percentage total weight loss was similar across groups. Baseline metabolic dysfunction-associated steatohepatitis prevalence was highest in SIDD (60.5% vs 46.3% vs 46.3%). Remission after MBS differed across T2DM subphenotypes, with the lowest remission observed in SIDD at two years.