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INTRODUCTION: Type 2 diabetes mellitus (T2DM) is associated with dysbiosis in the gut microbiota (MB). Individually, each medication appears to partially correct this. However, there are no studies on the response of the MB to changes in A1c. Therefore, we investigated the MB's response to intensive glycemic control. RESEARCH DESIGN AND METHODS: We studied two groups of patients with uncontrolled T2DM, one group with an A1c <9% (18 patients-G1) and another group with an A1c >9% (13 patients-G2), aiming for at least a 1% reduction in A1c. We collected A1c and fecal samples at baseline, 6, and 12 months. G1 achieved an average A1c reduction of 1.1%, while G2 a reduction of 3.13%. RESULTS: G1's microbiota saw a decrease in Erysipelotrichaceae_UCG_003 and in Mollicutes order (both linked to metabolic syndrome and associated comorbidities). G2, despite having a more significant reduction in A1c, experienced an increase in the proinflammatory bacteria Megasphaera and Acidaminococcus, and only one beneficial genus, Phascolarctobacterium, increased, producer of butyrate. CONCLUSION: Despite a notable A1c outcome, G2 could not restore its MB. This seeming resistance to change, leading to a persistent inflammation component found in G2, might be part of the "metabolic memory" in T2DM.

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BACKGROUND: There is a debate over results obtained from type 2 diabetes mellitus (DM2) obese patients and non-DM2 patients, in reference to metabolic control and ponderal loss, after bariatric surgery. AIM: To evaluate weight loss and metabolic profile of obese patients with DM2 versus non-DM2 subjects, one and three years after bariatric surgery. METHODS: Data from 38 non-DM2 patients and 44 DM2 patients submitted to Roux-en-Y gastric-bypass were analysed retrospectively. For the pre-operatory, first and third year of post-operatory, were compared: weight, body mass index (BMI), fasting glucose (FG), high density lipoprotein (HDL) and triglycerides (TG). RESULTS: Preoperatively, both groups were statistically equivalent in regards to weight, BMI (P = 0.90) and HDL (P = 0.73). This was not the case when TG (P = 0.043) and FG (P<0.01) were analyzed. In PO1, both DM2 and non-DM2 groups showed a reduction in weight, BMI and TG, just as FG in the DM2 group (P < 0.05). HDL increased (P < 0.05) in PO1 in both groups. In the following period, between PO1 and PO3, only TG continued to decrease in the non-DM2 group (P = 0.039), while the other variables did not change. In the DM2 group mean A1c in PO3 was 6.2

RACIONAL: Tem havido debate sobre os resultados obtidos da cirurgia bariátrica nos obesos diabéticos versus não diabéticos, no quesito controle metabólico e perda ponderal. OBJETIVO: Avaliar a perda ponderal e perfil metabólico dos obesos diabéticos e não diabéticos após um e três anos da cirurgia bariátrica. MÉTODO: Análise retrospectiva dos prontuários de 44 diabéticos tipo 2 (DM2) e 38 não-DM2 submetidos à gastroplastia com derivação em Y-de-Roux. Dados como peso, índice de massa corpórea (IMC), glicemia de jejum (GJ), lipoproteína de alta densidade (HDL) e triglicérides (TG) foram vistos no pré-operatório, primeiro (PO1) e terceiro ano (PO3) após a operação. RESULTADOS: No pré-operatório, ambos os grupos foram estatisticamente equivalentes em peso, IMC (P=0,90) e HDL (P=0.73). Não se verificou o mesmo quando TG (P=0.043) e GJ (P < 0.01) foram analisados. No PO1, ambos DM2 e não-DM2 mostraram redução no peso, IMC e TG, assim como GJ no grupo DM2 (P < 0.05). HDL aumentou (P < 0.05) no PO1 em ambos os grupos. No período seguinte, entre PO1 e PO3, somente TG continuou a cair nos não-DM2 diabéticos (P=0,039), enquanto as outras variáveis não mudaram. No grupo DM2, a média da A1c no PO3 foi 6,2

+- 0,75 (P=0,027). Compararam-se os dados do pós-operatório de ambos os grupos. A variação de HDL e TG entre os grupos não foi diferente no PO1 e entre PO1 e PO3. Peso no PO1 e PO3, assim como IMC no PO1 e PO3, não foram estatisticamente diferentes. CONCLUSÃO: No PO1, perda de peso e melhora metabólica foi vista em ambos os grupos. Este dado foi sustentado no PO3, sem reganho de peso ou alteração lipídica significativa. A A1c encontrada no pós-operatório mostrou bom controle do diabetes pela operação. Houve tendência à menor perda ponderal no grupo DM2 (P=0,053).

+- 0.75 (P = 0.027). It was compared both group's post-operative data. HDL's and TG's variation between groups did not differ in PO1 or between PO1 and PO3. Weight in PO1 and PO3, just as BMI in PO1 and PO3, were not significantly different either. CONCLUSION: In PO1, weight loss and metabolic improvement was seen in both groups. This was sustained in PO3, with no significant weight regain or lipid/FG change. A1c found suggests a reasonable control of DM2 surgery. A trend towards a less intense weight loss could be noticed in the DM2 group (P = 0.053).

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