When insulin was initially discovered by Banting and Best in 1922, it was hailed as a cure for type 1 diabetes. Given the ability of insulin to reverse ketoacidosis and severe hyperglycemia, who could doubt that the ravages of type 1 diabetes would be relegated to the archives of medical history? However, within a few short decades of insulin’s discovery, it became apparent that the short-term mortality associated with type 1 diabetes was being replaced by longer term morbidities related to renal failure, blindness, nerve damage and vascular disease. The “cure” had treated the short-term sequelae related to the metabolic derangements of insulin deficiency but unfortunately had not (in its initial use) affected the longer-term consequences of hyperglycemia.
It was only after careful follow-up from prospective epidemiologic studies that we realized that type 1 diabetes had been transformed but not cured. The acquisition of knowledge and insights into the natural history of diabetes did not, however, minimize the significance of the discovery of insulin (for which the investigators received the Nobel Prize) but highlighted the importance of judiciously evaluating how a new therapy impacts a disease. After 70 years, the role of insulin, not as a way to resolve type 1 diabetes, but, as a means to reduce the risk of serious complications through rigorous control of serum glucose levels, was established by the results of the multi-center DCCT.(1)
In this issue of the The American Journal of Medicine, Buchwald et al report on a meta-analysis of the impact of bariatric surgery in severely obese patients with type 2 diabetes of varying duration.(2) Using data compiled from 621 studies involving more than 4000 patients with diabetes, the authors conclude that bariatric surgery “resolved or improved” diabetes in the “greater majority” of patients with type 2 diabetes.
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— Stuart R. Chipkin, MD, Robert J. Goldberg, PhD
This article was originally published in the March 2009 issue of The American Journal of Medicine.
Related Article:
Weight and Type 2 Diabetes after Bariatric Surgery: Systematic Review and Meta-analysis
