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43 Sj?str?m et al, comparing bariatric surgery and nonsurgical treatment, confirmed that bariatric surgery was associated with more frequent diabetes remission and fewer diabetes-related complications (microvascular and macrovascular) than usual care. On the other hand, in the surgically treated patient group, the reported type 2 diabetes remission of 72% at the 2-year follow-up decreased by 38% and 30% at 10 years and 15 years (although the rates were significantly more favorable learn more than those for the control nonsurgically treated group).43 Nevertheless, even the Swedish Obese Subjects study has certain limitations mainly due to the fact that the randomized design was not approved by the Ethics Review Boards because of high postoperative mortality rates following bariatric surgery in the 1980s and because the matching procedure created surgery and control groups that differed in some respects (age, BMI, blood pressure, and fasting serum insulin at baseline).43 Several studies have shown a more favorable diabetes remission in patients with short diabetes duration at baseline (E-64 preoperative diabetes also evaluated by fasting C-peptide (influenced by insulin resistance and residual ��-cell function).44�C46 The Swedish Obese Subjects43 study confirmed this finding and extended the information by demonstrating that short diabetes duration at baseline is associated with higher remission rates at 10 and 15 years after surgery.43 Given these findings, preoperative metabolic data could be of primary importance to asses which patients may effectively benefit from bariatric-metabolic surgery in diabetes control.45 Patients with extensive weight loss were more likely to achieve type 2 diabetes remission after bariatric surgery. Percent excess weight loss (%EWL) represents an important factor related to the outcome of bariatric surgery and to diabetes remission.47 The risk of diabetes recurrence appeared to be inversely correlated with long-term excess weight loss and directly correlated with the duration of diabetes and severity of diabetes preoperatively.44,48 About one-third of the patients experienced diabetes recurrence within 5 years of initial remission.44 These results can raise some concerns about the use of bariatric-metabolic surgery in diabetic, nonmorbid obese patients2,23 but do not contraindicate R428 supplier bariatric-metabolic procedures in morbidly, obese diabetic patients at higher risk of failure (diabetes duration more than 10 years, preoperative uncontrolled disease) in relation to diabetes remission and recurrence.44 Some studies have demonstrated that a transient period of aggressive glycemic control can induce a beneficial ��metabolic memory�� effect and reduce incident microvascular events in diabetic patients.44 On the other hand, in these patients, bariatric-metabolic approach can improve other important cardiovascular risk factors.