Bariatric surgeries at diabetic patients

Authors: Martin Haluzík 1,2
Authors‘ workplace: Endokrinologický ústav, Praha 1;  Ústav lékařské biochemie a laboratorní diagnostiky 1. LF UK a VFN v Praze 2
Published in: Vnitř Lék 2016; 62(Suppl 4): 30-35
Category: Reviews


A worldwide increase in the prevalence of obesity and type 2 diabetes mellitus along with accompanying chronic, in particular cardiovascular, complications represents one of the leading challenges of current medicine. Despite major advances in diabetes pharmacotherapy, bariatric surgery remains the most effective treatment of diabetes. It not only markedly decreases body weight and improves glucose control but also induces diabetes remission in a significant percentage of patients. According to current recommendations, bariatric surgery is indicated in patients with 3rd degree obesity (even without any complications) or with 2nd degree obesity with complications (e.g. diabetes, dyslipidemia etc.). There is a growing body of evidence that bariatric surgery is efficacious also in type 2 diabetics with 1st degree obesity or even with BMI bellow 30 kg/m2. This paper summarizes practical aspects of indications of diabetics to different types of bariatric operations and their long-term follow up. It also discusses the differences between various types of operations and their mechanisms of positive metabolic effects.

Key words:
bariatric surgery – cardiovascular complications – diabetes remission – mechanisms of action – type 2 diabetes mellitus


1. Musso G, Cassader M, De Michieli F et al. Nonalcoholic steatohepatitis versus steatosis: adipose tissue insulin resistance and dysfunctional response to fat ingestion predict liver injury and altered glucose and lipoprotein metabolism. Hepatology 2012; 56(3): 933–942. Dostupné z DOI: <>.

2. Bluher M. Adipose tissue dysfunction contributes to obesity related metabolic diseases. Best Pract Res Clin Endocrinol Metab 2013; 27(2): 163–177. Dostupné z DOI: <>.

3. Nantel J, Mathieu ME, Prince F. Physical activity and obesity: biomechanical and physiological key concepts. J Obes 2001; 2011: 650230. Dostupné z DOI: <>.

4. Dixon JB, le Roux CW, Rubino F et al. Bariatric surgery for type 2 diabetes. Lancet 2012; 379 (9833): 2300–2311. Dostupné z DOI: <–6736(12)60401–2>.

5. Sjostrom L, Larsson B, Backman L et al. Swedish obese subjects (SOS). Recruitment for an intervention study and a selected description of the obese state. International journal of obesity and related metabolic disorders. Int J Obes Relat Metab Disord 1992; 16(6): 465–479.

6. Torgerson JS, Sjostrom L. The Swedish Obese Subjects (SOS) study – rationale and results. Int J Obes Relat Metab Disord 2001; 25(Suppl 1) S2-S4.

7. Sjostrom L. Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes 2008; 32(Suppl 7): S93-S97. Dostupné z DOI: <>.

8. Eliasson B, Liakopoulos V, Franzen S et al. Cardiovascular disease and mortality in patients with type 2 diabetes after bariatric surgery in Sweden: a nationwide, matched, observational cohort study. Lancet Diabetes Endocrinol 2015; 3(11): 847–854. Dostupné z DOI: <–8587(15)00334–4>.

9. Haluzik M. Bariatric surgery and the mechanism of diabetes remission: are we getting there? J Clin Endocrinol Metab 2013; 98(11): 4336–4338. <–3698>.

10. Buchwald H, Estok R, Fahrbach K et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 2009; 122(3): 248–256. Dostupné z DOI: <>.

11. Rubino F. From bariatric to metabolic surgery: definition of a new discipline and implications for clinical practice. Curr Atheroscler Rep 2013; 15(12): 369. Dostupné z DOI: <–013–0369-x>.

12. Greve JW, Rubino F. Bariatric surgery for metabolic disorders. Br J Surg 2008; 95(11): 1313–1314. Dostupné z DOI: <>.

13. Ahn SM, Pomp A, Rubino F. Metabolic surgery for type 2 diabetes. Ann N Y Acad Sci 2010; 1212: E37-E45. Dostupné z DOI: <–6632.2011.05984.x>.

14. Chakravartty S, Tassinari D, Salerno A et al. What is the Mechanism Behind Weight Loss Maintenance with Gastric Bypass? Curr Obes Rep 2015; 4(2): 262–268. Dostupné z DOI: <–015–0158–7>.

15. Shi X, Karmali S, Sharma AM et al. A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg 2010; 20(8): 1171–1177. Dostupné z DOI: <–010–0145–8>.

16. Kasalicky M, Michalsky D, Housova J et al. Laparoscopic sleeve gastrectomy without an over-sewing of the staple line. Obes Surg 2008; 18(10): 1257–1262. Dostupné z DOI: <–008–9635–3>.

17. Anderson B, Gill RS, de Gara CJ et al. Biliopancreatic diversion: the effectiveness of duodenal switch and its limitations. Gastroenterol Res Pract 2013; 2013: 974762. Dostupné z DOI: <>.

18. Hainer V et al. Základy klinické obezitologie. 2. ed. Grada: Praha 2011. ISBN 978–80–247–3252–7.

19. Fried M et al. Bariatrická a metabolická chirurgie. Mladá fronta: Praha 2011. ISBN 978–80–204–2424–2

20. O’Brien PE. Bariatric surgery: mechanisms, indications and outcomes. J Gastroenterol Hepatol 2010; 25(8): 1358–1365. Dostupné z DOI: <–1746.2010.06391.x>.

21. Pournaras DJ, Osborne A, Hawkins SC et al. Remission of type 2 diabetes after gastric bypass and banding: mechanisms and 2 year outcomes. Ann Surg 2010; 252(6): 966–971. Dostupné z DOI: <>.

22. Mingrone G, Castagneto-Gissey L. Mechanisms of early improvement/resolution of type 2 diabetes after bariatric surgery. Diabetes Metab 2009; 35(6 Pt 2): 518–523. Dostupné z DOI: <–3636(09)73459–7>.

23. Yumuk V, Tsigos C, Fried M et al. European Guidelines for Obesity Management in Adults. Obes Facts 2015; 8(6): 402–424. Dostupné z DOI: <>.

24. Giordano S, Victorzon M. Bariatric surgery in elderly patients: a systematic review. Clin Interv Aging 2015; 10: 1627–1635. Dostupné z DOI: <>.

25. Kalarchian MA, Marcus MD. Psychosocial Interventions Pre and Post Bariatric Surgery. Eur Eat Disord Rev 2015; 23(6): 457–462. Dostupné z DOI: <>.

26. van Rutte PW, Smulders JF, de Zoete JP et al. Indications and short-term outcomes of revisional surgery after failed or complicated sleeve gastrectomy. Obes Surg 2012; 22(12): 1903–1908. Dostupné z DOI: <–012–0774–1>.

27. Genser L, Casella Mariolo JR, Castagneto-Gissey L et al. Obesity, Type 2 Diabetes, and the Metabolic Syndrome: Pathophysiologic Relationships and Guidelines for Surgical Intervention. Surg Clin North Am 2016; 96(4): 681–701. Dostupné z DOI: <>.

28. Rubino F, Shukla A, Pomp A et al. Bariatric, metabolic, and diabetes surgery: what’s in a name? Ann Surg 2014; 259(1): 117–122. Dostupné z DOI: <>.

29. Ji Y, Wang Y, Zhu J et al. A systematic review of gastric plication for the treatment of obesity. Surg Obes Relat Dis 2014; 10(6): 1226–1232. Dostupné z DOI: <>.

30. Mingrone G, Panunzi S, De Gaetano A et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 2015; 386(9997): 964–973. Dostupné z DOI: <–6736(15)00075–6>.

31. Welbourn R, Pournaras D. Bariatric surgery: a cost-effective intervention for morbid obesity; functional and nutritional outcomes. Proc Nutr Soc 2010; 69(4): 528–535.

32. Bal BS, Finelli FC, Koch TR. Origins of and recognition of micronutrient deficiencies after gastric bypass surgery. Curr Diab Rep 2011; 11(2): 136–141. Dostupné z DOI: <–010–0169–4>.

33. Rubino F, Nathan DM, Eckel RH et al. Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations. Diabetes Care 2016; 39(6): 861–877. Dostupné z DOI: <–0236>.

34. Patel SR, Mason J, Hakim N. The Duodenal-Jejunal Bypass Sleeve (EndoBarrier Gastrointestinal Liner) for Weight Loss and Treatment of Type II Diabetes. Indian J Surg 2012; 74(4): 275–277. Dostupné z DOI: <–012–0721–3>.

35. Koehestanie P, de Jonge C, Berends FJ et al. The effect of the endoscopic duodenal-jejunal bypass liner on obesity and type 2 diabetes mellitus, a multicenter randomized controlled trial. Ann Surg 2014; 260(6): 984–992. Dostupné z DOI: <>.

36. Sucharda P, Stránská Z. Metabolická chirurgie: definice, indikace, příprava a sledování pacientů internistou. In: Haluzík M et al. Praktická léčba diabetu. 2. ed. Mladá fronta: Praha 2013. ISBN 978–80–204–2880–6.

Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue Suppl 4

2016 Issue Suppl 4

Most read in this issue
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account