Diabetes mellitus type 1 surgery

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Case #1

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]Vishal Devarkonda, M.B.B.S [4]

Overview

Surgery is not the first-line treatment option for patients with type 1 DM. β-Cell Replacement Therapy is usually reserved for patients with either who have an indication for kidney transplantation and are poorly controlled with large glycemic excursions or in patients who already received a kidney transplant.

The role of bariatric surgery in patients with type 1 DM who also suffer with obesity and obesity-associated comorbidities remains unclear. Patients do experience significant weight loss, comorbidity resolution, decline in total insulin requirement after surgery. Data is insufficient to recommend any particular procedure.^[1]

"1.Consider solid organ pancreas transplantation simultaneously with kidney transplantation in patients with type 1 diabetes who have an indication for kidney transplantation and are poorly controlled with large glycemic excursions.. (Level of Evidence: B)"
"2.Consider solid organ pancreas transplantation after kidney transplantation in adult patients with type 1 diabetes who have already received a kidney transplant. (Level of Evidence: C)"
"3.Judiciously consider solid organ pancreas transplantation alone in adults with type 1 diabetes, unstable glucose control, hypoglycemia unawareness, and an increased risk of diabetes-related mortality, who have attempted all of the more traditional approaches to glycemic control and have remained unsuccessful, yet are judged responsible enough to manage the antirejection medication regimen, risks, and follow-up required with an organ transplant. (Level of Evidence: C)"
"4. Consider referral to research centers for protocolized islet cell transplantation in patients with type 1 diabetes and debilitating complications of diabetes who are interested in research possibilities and fit the criteria for the research protocol.(Level of Evidence: E)"