title: Remission of type 2 diabetes mellitus should not be the foremost goal after bariatric surgery.
abstract: BACKGROUND
  Remission of type 2 diabetes (T2D) is a desired outcome after bariatric surgery (BS). Even if this goal is not achieved, individuals who do not strictly fulfill remission criteria experience an overall improvement. The aim of this study was to evaluate the metabolic control status in patients considered as diabetes "non-remitters."
  
  
  METHODS
  A retrospective study of 125 patients (59.2 % women) with preoperative diagnosis of T2D who underwent BS in a single center (2006-2011) was conducted. We collected anthropometric and metabolic parameters before surgery and at 1-year follow-up. T2D remission was defined according to the 2009 consensus statement: glycosylated hemoglobin (HbA1c) <6 %, fasting glucose (FG) <100 mg/dLs, and absence of pharmacologic treatment. We evaluated metabolic status of non-remitters, according to the American Diabetes Association's (ADA) target recommendations: HbA1c <7 %, LDL-c <100 mg/dL, triglycerides <150 mg/dL, and HDL-c >40 (male) or >50 mg/dL (female).
  
  
  METHODS
  analysis of variance.
  
  
  RESULTS
  Baseline characteristics (mean ± SD): age 53.5 ± 9.7 years, BMI 43.5 ± 5.6 kg/m(2), time since diagnosis of T2D 7.7 ± 7.9 years, FG 162.0 ± 56.3 mg/dL, HbA1c 7.7 ± 1.6 %. ADA's target recommendations were present in 12 patients (9.6 %) preoperatively, and in 45 (36.0 %) at 1-year follow-up (p <0.001). Sixty-two (49.6 %) patients did not achieve diabetes remission; 26 (41.9 %) had now diet treatment, 30 (48.4 %) oral medications, and 6 (9.7 %) required insulin. Of the non-remitters, 57 (91.9 %) had HbA1c <7 % and 18 (40.0 %) achieved ADA's target recommendations. There were no differences between remitters and non-remitters in the number of individuals reaching ADA's combined metabolic control.
  
  
  CONCLUSIONS
  Although almost 50 % of the patients may not be classified as diabetes remitters, their significant improvement in metabolic control should be regarded as a success, according to most scientific societies' target recommendations.
authors.affiliation: Department of Endocrinology and Nutrition, Facultad de Medicina, Complutense University, C/Prof. Martin Lagos s/n. 28040, Madrid, Spain, ana_ramoslevi@hotmail.com.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Ramos-Levi
authors.forename: Andres
authors.initials: A
authors.lastname: Sanchez-Pernaute
authors.forename: Lucio
authors.initials: L
authors.lastname: Cabrerizo
authors.forename: Pilar
authors.initials: P
authors.lastname: Matia
authors.forename: Ana
authors.initials: A
authors.lastname: Barabash
authors.forename: Carmen
authors.initials: C
authors.lastname: Hernandez
authors.forename: Alfonso L
authors.initials: AL
authors.lastname: Calle-Pascual
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Torres
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Rubio
mesh_terms: D015904:Biliopancreatic Diversion; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism* / Q000601:surgery; D005260:Female; D015390:Gastric Bypass; D015391:Gastroplasty; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000378:metabolism / Q000601:surgery*; D018579:Patient Selection; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
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