Although it is now nine years since Opie first described the occurrence of definite lesions in the islands of Langerhans in diabetes, we are still uncertain as to just what relation these structures and their pathologic alterations may have to diabetes. While there are those who have gone as far as Dale and denied the very existence of the Langerhans islands as independent structures, and others have disputed their relation to carbohydrate metabolism, the balance of evidence and the weight of opinion are now altogether in favor of considering them as specific organs of internal secretion which are considered in carbohydrate metabolism. Just what part they play in this process, or how they do it, are admitted to be unsettled problems. Granting the fundamental importance of these structures in the utilization of sugar by the body, their connection with diabetes is to be assumed, and the finding of lesions in them in diabetes would settle the matter were these lesions more constant. However, the results obtained by different observers have been so much at variance that it has been extremely difficult to draw satisfactory conclusions, and therefore some pathologists are more than a little skeptical as to the importance of the lesions that have been described.
THE PANCREAS AND THE LIVER IN DIABETES. JAMA. 2009;301(15):1609. doi:10.1001/jama.2009.434