Surgical options for glycaemic control in Type 1 diabetes

Abstract

In recent years, bariatric surgery, also referred to as metabolic surgery, has become the most successful treatment option in those with Type 2 diabetes and obesity. There are some similarities in the pathological pathways in Type 1 and Type 2 diabetes, but the use of surgery in Type 1 diabetes remains unestablished and controversial. The treatment and management of Type 1 diabetes can be very challenging but recent advances in surgical interventions and technology has the potential to expand and optimize treatment options. This review discusses the current status of some surgical options available to people with Type 1 diabetes. These include implantable continuous glucose monitoring systems, continuous intraperitoneal insulin infusion pumps, closed‐loop insulin delivery systems (also known as the artificial pancreas system) utilizing the latter two modalities of glucose monitoring and insulin delivery, and bariatric or metabolic surgery. Whole pancreas and islet transplantation are beyond the scope of this review but are briefly discussed.

The Impact of obesity and diabetes mellitus on pancreatic cancer: Molecular mechanisms and clinical perspectives

“…Lifestyle modifications (eg exercise and healthy diets) for the purpose of reducing obesity could also reduce PC rates. In cases when these measures alone were found to be ineffective, bariatric (metabolic) surgery was a useful alternative 86,94,95 . Bariatric surgery in extremely obese patients may produce many health benefits along with weight loss, consequently reducing the chances of PC, especially when additionally incorporating healthy lifestyle habits.…”

Outside in

“…This can be achieved using intraperitoneal insulin delivery systems or through islet transplantation. 4 In this issue, islet transplantation is reviewed, including its impact on microvascular complications and surrogates for macrovascular disease. 5 The international experience with pancreatic islets emphasises the huge impact of native human insulin delivered in an anatomically optimised location, reducing HbA 1c and severe hypoglycaemia along with retinopathy and neuropathy burden.…”