{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T08:53:04Z","timestamp":1790067184943,"version":"4.0.1"},"reference-count":40,"publisher":"American Diabetes Association","issue":"6","license":[{"start":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T00:00:00Z","timestamp":1744329600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"name":"Type 1 Diabetes Exchange"},{"name":"The European Federation of Pharmaceutical Industries and Associations"},{"name":"Agence National de la Recherche","award":["ANR-10-LABX-46"],"award-info":[{"award-number":["ANR-10-LABX-46"]}]},{"name":"Agence National de la Recherche","award":["Precinash-16-RHUS-0006"],"award-info":[{"award-number":["Precinash-16-RHUS-0006"]}]},{"name":"Juvenile Diabetes Research Foundation"},{"DOI":"10.13039\/501100000780","name":"European Commission","doi-asserted-by":"crossref","award":["FEDER 12003944"],"award-info":[{"award-number":["FEDER 12003944"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Obesity Action Coalition"},{"DOI":"10.13039\/100011102","name":"Seventh Framework Programme","doi-asserted-by":"publisher","award":["FP7\/2007-2013"],"award-info":[{"award-number":["FP7\/2007-2013"]}],"id":[{"id":"10.13039\/100011102","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Helmholtz Society"},{"DOI":"10.13039\/100019009","name":"Fondation Francophone pour la Recherche sur le Diab\u00e8te","doi-asserted-by":"publisher","award":["FFRD-2015"],"award-info":[{"award-number":["FFRD-2015"]}],"id":[{"id":"10.13039\/100019009","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100013322","name":"EFPIA","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100013322","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Cluster of Excellence Controlling Microbes to Fight Infections","award":["03.007"],"award-info":[{"award-number":["03.007"]}]},{"name":"Innovative Medicines Initiative Joint Undertaking","award":["115317"],"award-info":[{"award-number":["115317"]}]},{"name":"Innovative Medicines Initiative Joint Undertaking","award":["115881"],"award-info":[{"award-number":["115881"]}]},{"DOI":"10.13039\/100031584","name":"German Center for Diabetes Research","doi-asserted-by":"crossref","award":["01GI0925"],"award-info":[{"award-number":["01GI0925"]}],"id":[{"id":"10.13039\/100031584","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001659","name":"German Research Association","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Helmholtz Young Investigator Group","award":["VH-NG-1619"],"award-info":[{"award-number":["VH-NG-1619"]}]},{"name":"Fondation Coeur et Arteres","award":["FCA R15112EE"],"award-info":[{"award-number":["FCA R15112EE"]}]},{"name":"Innovative Medicines Initiative 2 Joint Undertaking","award":["875534"],"award-info":[{"award-number":["875534"]}]},{"DOI":"10.13039\/501100002347","name":"Federal Ministry of Education and Research","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Helmholtz Munich"},{"name":"EU Horizon 2020 research and innovation program"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Bariatric surgery is an effective treatment option for individuals with obesity and type 2 diabetes (T2D). However, whether outcomes in subtypes of individuals at risk for T2D and\/or comorbidities (T\u00fcbingen Clusters) differ, is unknown. Of these, cluster 5 (C5) and cluster 6 (C6) are high-risk clusters for developing T2D and\/or comorbidities, while cluster 4 (C4) is a low-risk cluster. We investigated bariatric surgery outcomes, hypothesizing that high-risk clusters benefit most due to great potential for metabolic improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>We allocated participants without T2D but at risk for T2D, defined by elevated BMI, to the T\u00fcbingen Clusters. Participants had normal glucose regulation or prediabetes according to American Diabetes Association criteria. Two cohorts underwent bariatric surgery: a discovery (Lille, France) and a replication cohort (Rome, Italy). A control cohort (T\u00fcbingen, Germany) received behavioral modification counseling. Main outcomes included alteration of glucose regulation parameters and prediabetes remission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>In the discovery cohort, 15.0% of participants (n = 121) were allocated to C4, 22.3% (n = 180) to C5, and 62.4% (n = 503) to C6. Relative body weight loss was similar among all clusters; however, reduction of insulin resistance and improvement of \u03b2-cell function were strongest in C5. Prediabetes remission rate was lowest in low-risk C4 and highest in high-risk C5. Individuals from high-risk clusters changed to low-risk clusters in both bariatric surgery cohorts but not in the control cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Participants in C5 had the highest benefit from bariatric surgery in terms of improvement in insulin resistance, \u03b2-cell function, and prediabetes remission. This novel classification might help identify individuals who will benefit specifically from bariatric surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc25-0160","type":"journal-article","created":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T10:54:36Z","timestamp":1744368876000},"page":"996-1006","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":17,"title":["Subphenotype-Dependent Benefits of Bariatric Surgery for Individuals at Risk for Type 2 Diabetes"],"prefix":"10.2337","volume":"48","author":[{"given":"Leontine","family":"Sandforth","sequence":"first","affiliation":[{"name":"1Internal Medicine IV, Endocrinology, Diabetology and Nephrology, University Hospital of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"2Institute for Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"3German Center for Diabetes Research (DZD), Neuherberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5754-2028","authenticated-orcid":false,"given":"Violeta","family":"Raverdy","sequence":"additional","affiliation":[{"name":"4INSERM, CHU Lille, Institut Pasteur de Lille, UMR 1190 Translational Research for Diabetes, European Genomic Institute for Diabetes, University Lille, Lille, France"},{"name":"5Integrated Center for Obesity, General and Endocrine Surgery, CHU Lille, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arvid","family":"Sandforth","sequence":"additional","affiliation":[{"name":"1Internal Medicine IV, Endocrinology, Diabetology and Nephrology, University Hospital of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"2Institute for Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"3German Center for Diabetes Research (DZD), Neuherberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Bauvin","sequence":"additional","affiliation":[{"name":"6INSERM, CHU Lille, Institut Pasteur de Lille, U1190-EGID, University Lille, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estelle","family":"Chatelain","sequence":"additional","affiliation":[{"name":"7CNRS, INSERM, CHU Lille, Institut Pasteur de Lille, US 41-UAR 2014-PLBS, University Lille, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helene","family":"Verkindt","sequence":"additional","affiliation":[{"name":"4INSERM, CHU Lille, Institut Pasteur de Lille, UMR 1190 Translational Research for Diabetes, European Genomic Institute for Diabetes, University Lille, Lille, France"},{"name":"5Integrated Center for Obesity, General and Endocrine Surgery, CHU Lille, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2021-528X","authenticated-orcid":false,"given":"Geltrude","family":"Mingrone","sequence":"additional","affiliation":[{"name":"8Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy"},{"name":"9Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"},{"name":"10Division of Diabetes and Nutritional Sciences, School of Cardiovascular and Metabolic Medicine & Sciences, King\u2019s College London, London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Guidone","sequence":"additional","affiliation":[{"name":"9Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ornella","family":"Verrastro","sequence":"additional","affiliation":[{"name":"8Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Zhou","sequence":"additional","affiliation":[{"name":"1Internal Medicine IV, Endocrinology, Diabetology and Nephrology, University Hospital of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"2Institute for Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"3German Center for Diabetes Research (DZD), Neuherberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rami","family":"Archid","sequence":"additional","affiliation":[{"name":"11Department of General, Visceral, and Transplant Surgery, University Hospital of T\u00fcbingen, T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Mihaljevic","sequence":"additional","affiliation":[{"name":"11Department of General, Visceral, and Transplant Surgery, University Hospital of T\u00fcbingen, T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Caiazzo","sequence":"additional","affiliation":[{"name":"4INSERM, CHU Lille, Institut Pasteur de Lille, UMR 1190 Translational Research for Diabetes, European Genomic Institute for Diabetes, University Lille, Lille, France"},{"name":"5Integrated Center for Obesity, General and Endocrine Surgery, CHU Lille, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Baud","sequence":"additional","affiliation":[{"name":"4INSERM, CHU Lille, Institut Pasteur de Lille, UMR 1190 Translational Research for Diabetes, European Genomic Institute for Diabetes, University Lille, Lille, 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Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Moller","sequence":"additional","affiliation":[{"name":"1Internal Medicine IV, Endocrinology, Diabetology and Nephrology, University Hospital of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"2Institute for Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"3German Center for Diabetes Research (DZD), Neuherberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Kantartzis","sequence":"additional","affiliation":[{"name":"1Internal Medicine IV, Endocrinology, Diabetology and Nephrology, University Hospital of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"2Institute for Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"3German Center for Diabetes Research (DZD), Neuherberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Peter","sequence":"additional","affiliation":[{"name":"2Institute for Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"3German Center for Diabetes Research (DZD), Neuherberg, Germany"},{"name":"12Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital of T\u00fcbingen, T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Lehmann","sequence":"additional","affiliation":[{"name":"2Institute for Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"3German Center for Diabetes Research (DZD), Neuherberg, Germany"},{"name":"12Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital of T\u00fcbingen, T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Wagner","sequence":"additional","affiliation":[{"name":"3German Center for Diabetes Research (DZD), Neuherberg, Germany"},{"name":"14Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University D\u00fcsseldorf (DDZ), D\u00fcsseldorf, Germany"},{"name":"15Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Hospital, D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsiaryna","family":"Prystupa","sequence":"additional","affiliation":[{"name":"3German Center for Diabetes Research (DZD), Neuherberg, Germany"},{"name":"14Institute for Clinical Diabetology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University D\u00fcsseldorf (DDZ), D\u00fcsseldorf, Germany"},{"name":"15Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University Hospital, D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4987-1961","authenticated-orcid":false,"given":"Andreas","family":"Fritsche","sequence":"additional","affiliation":[{"name":"1Internal Medicine IV, Endocrinology, Diabetology and Nephrology, University Hospital of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"2Institute for Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"3German Center for Diabetes Research (DZD), Neuherberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2186-9595","authenticated-orcid":false,"given":"Norbert","family":"Stefan","sequence":"additional","affiliation":[{"name":"1Internal Medicine IV, Endocrinology, Diabetology and Nephrology, University Hospital of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"2Institute for Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"3German Center for Diabetes Research (DZD), Neuherberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8859-4661","authenticated-orcid":false,"given":"Hubert","family":"Preissl","sequence":"additional","affiliation":[{"name":"1Internal Medicine IV, Endocrinology, Diabetology and Nephrology, University Hospital of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"2Institute for Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"3German Center for Diabetes Research (DZD), Neuherberg, Germany"},{"name":"16Department of Pharmacy and Biochemistry, Institute of Pharmaceutical Sciences, and Interfaculty Centre for Pharmacogenomics and Pharma Research, Eberhard Karls University T\u00fcbingen, T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas L.","family":"Birkenfeld","sequence":"additional","affiliation":[{"name":"1Internal Medicine IV, Endocrinology, Diabetology and Nephrology, University Hospital of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"2Institute for Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, University of T\u00fcbingen, T\u00fcbingen, Germany"},{"name":"3German Center for Diabetes Research (DZD), Neuherberg, Germany"},{"name":"17School of Cardiovascular and Metabolic Medicine and Sciences, King\u2019s College London, London, U.K."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5544-099X","authenticated-orcid":false,"given":"Reiner","family":"Jumpertz von Schwartzenberg","sequence":"additional","affiliation":[{"name":"1Internal Medicine IV, Endocrinology, 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