In type 2 diabetes mellitus (T2DM) and obese patients the adipose tissue could over-express cytokines, sirtuin-1 (SIRT1), and microRNAs (miRs) implied in the regulation of left ventricle (LV) diastolic function (LV-DF). Ghrelin could modulate these pathways. Thus, in the current study authors will investigate ghrelin expression in T2DM obese patients after abdominal fat excision, and particularly in those with normalization of LV-DF at 1 year of follow-up.

Inclusion Criteria:

• Clinical diagnosis of T2DM obese patients;
• T2DM obese patients under anti-diabetic full medical therapy and glycemic control.

Exclusion Criteria:

• clinical diagnosis of type 1 diabetes;
• T2DM patients in poor glycemic control (HbA1c values of >7%);
• chronic neurological disorders;
• heart failure and coronary heart disease or depression of left ventricular ejection fraction (LVEF <55%);
• severe anemia;
• thyroid dysfunction;
• kidney failure;
• uncontrolled blood pressure (blood pressure > 140/90 mmHg on two occasions 2 weeks apart);
• inflammatory chronic disease;
• neoplastic disease.

The authors will enroll T2DM obese patients, according to the evidence or not of LV diastolic dysfunction, and then divided in three groups. The LV diastolic dysfunction was characterized as indicated by international recommendations, by the values of E/E' ratio (18). Thus, the patients without LV diastolic dysfunction (E/E'<9) were characterized as group 1. Those with LV diastolic dysfunction (E/E'>9), were divided in two groups, in accordance with the E/E' values: group 2 (the patients with 9<E/E'<13), and group 3 (the patients with E/E'>13).

Obesity will be diagnosed as body mass index (BMI) > 30 (15). All enrolled patients will have T2DM according to international guidelines diagnostic criteria: evidence of fasting plasma glucose of ≥7.0 mmol/L (126 mg/dL; impaired fasting glucose [IFG]), a 2-hour glucose of ≥11.1 mmol/L during a 75 g oral glucose tolerance test (GTT) (>200 mg/dL; impaired glucose tolerance [IGT]), or a plasma hemoglobin (Hb) A1c of ≥48 mmol/mol (≥6.5%), (16).