Role of Surgical Intervention in The Management of Diabetes Mellitus

Abstract

Diabetes can be managed by careful monitoring of blood glucose and timely delivery of exogenous insulin. However, even with fastidious compliance, people with diabetes can suffer from numerous complications including atherosclerosis, retinopathy, neuropathy, and kidney disease. This is because delivery of exogenous insulin coupled with glucose monitoring cannot provide the fine level of glucose control normally provided by endogenous b-cells in the context of intact islets. Vascularized pancreas transplantation remains as the most effective treatment for type 1 diabetes. There are surgical complications and immunosuppression is mandatory. However, there is improved quality of life and greater survival in uremic diabetic patients after pancreas transplant. Isolated pancreatic transplant is the appropriate treatment for patients with labile diabetes and should be indicated. Pancreatic islet transplantation is a minimally invasive, alternative to pancreas transplantation that can achieve insulin independence and improved glycemic control without the risks associated with vascularized whole organ transplantation. Though still considered experimental, islet transplantation is likely to become a clinically approved, reimbursable procedure in the near future. Major achievements in the isolation, culture and targeted differentiation of stem cells prompt hopes that it will one day be possible to replenish beta-cell mass in patients with diabetes using stem cell-derived engineered insulin-producing cells. However, in light of ethical concerns and technical obstacles still to be overcome. Metabolic surgery is emerging as a major paradigm shift in the 21st Century management of T2DM, and has revolutionised the care of diabesity. Massive weight loss with remission of T2DM in a significant proportion of cases along with improvement of most other obesityrelated ailments makes the treatment a very attractive option for clinicians and patients. A recent data analysis clearly showed its cost effectiveness. Appropriate patient selection and long-term follow up of cases are necessary to optimise the outcomes and reduce the complications.