Surgical options for glycaemic control in Type 1 diabetes

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. What's new? Implantable devices such as continuous glucose monitoring systems, continuous intraperitoneal insulin infusion pumps and closed‐loop insulin delivery systems show great promise in achieving glycaemic control for those with Type 1 diabetes. Awareness that these therapeutic options exist, and their availability, needs to be raised. Bariatric or metabolic surgery has been shown to make tremendous improvements to the glycaemic status in people with Type 2 diabetes and obesity. These effects may potentially be translatable to those with Type 1 diabetes and obesity.