Objectives: The purpose of this study was to look into the benefit of a bariatric surgery in four artificial intelligence-assisted metabolic (AIM) subtypes of obesity with respect to the improvement of glucometabolism, as well as the remission of diabetes and hyperinsulinemia.

Methods: This multicenter retrospective study prospectively collected data from 5 hospitals in China from 2010 to 2021. A total of 1008 patients who underwent a bariatric surgery were enrolled (median age 31 years; median BMI 38.1kg/m2; 57.40% women) and grouped into four AIM subtypes of obesity. Data at baseline, 3- and 12-months post-surgery were collected for the longitudinal effect analysis.

Results: At baseline, the hypermetabolic obesity-hyperinsulinemia (HMO-I) group was characterized by severe insulin resistance and high incidence of hyperinsulinemia (87.8%) . After surgery, HMO-I with hyperinsulinemia had achieved remission, yet the prevalence of hypoglycemia was still high (42.9%) . Hypometabolic obesity (LMO) group showed decompensated insulin secretion and high incidence of diabetes (99.2%) at baseline. After surgery, 62.1% of LMO patients with diabetes achieved remission, lower than the other three groups. Still, the bariatric surgery significantly reduced their blood glucose (median HbA1c decreased by 27.2%) . For both metabolic healthy obesity (MHO) and hypermetabolic obesity-hyperuricemia (HMO-U) groups, who showed a relatively healthy glucometabolism at baseline, prevalence of glucometabolic comorbidities improved moderately after surgery.

Conclusion: This multicenter study found that the four AIM subtypes of obesity benefited differently from a bariatric surgery in terms of glucometabolism. Bariatric surgery significantly relieves hyperinsulinemia and hyperglycemia for HMO-I and LMO, respectively. As a result, patients of the two subtypes should be motivated for a bariatric surgery for the improvement of glucometabolism.


Y. Liu: None. C. Sheng: None. Z. Lin: None. S. Qu: n/a.


Clinical Research Plan of SHDC (No.SHDC2020CR1017B) , National Natural Science Foundation of China (82170861,81970677) , Shanghai Medicine and Health Development Foundation (DMRFP_I_07) , Shanghai Commission of Science and Technology (19DZ1910200)

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