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β-Cell mass versus function in type 1 diabetes mellitus: truth or dare?

Nature Reviews Endocrinology volume 13, page 1 (2017)Cite this article

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In a recent article by Mikael Knip (Loss of β-cell mass — an acute event before T1DM presentation? Nat. Rev. Endocrinol. 13, 253–254 (2017))1, a series of issues were raised with respect to our article2 that we would like to address.

Knip suggests that “...no direct evidence indicates that β-cell mass remains intact before clinical disease onset...” (Ref. 1). However, it is accepted that this is the case, at least at the stage of autoantibody positivity (single and double), in samples obtained from the Network for Pancreatic Organ Donors with Diabetes (nPOD) — a finding that has also been reported by other groups3,4. On the basis of these data, we suggest that, if β-cell mass is preserved at the multiple autoantibody stage, secondary prevention before clinical onset will probably be more effective than tertiary prevention in patients with recent-onset disease (in whom the autoimmune process has already taken over and a critical loss of β-cell mass is often present). The key questions are whether or not β-cell mass correlates with function and whether an early (before symptomatic onset) decline in first phase insulin response (FPIR) could be a direct reflection of a decrease in β-cell mass.

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References

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Authors and Affiliations

  1. Type 1 Diabetes Center, La Jolla Institute for Allergy and Immunology, 9420 Athena Circle, La Jolla, California 92037, USA; and at Helmholtz Zentrum München, Helmholtz Diabetes Center, Institute of Diabetes Research, Heidemannstr. 1, 80939 Munich, Germany.,

    Teresa Rodriguez-Calvo

  2. and at Helmholtz Zentrum München, Helmholtz Diabetes Center, Institute of Diabetes Research, Heidemannstr. 1, 80939 Munich, Germany.,

    Teresa Rodriguez-Calvo

  3. Department of Pathology, University of Florida, Gainesville, 32611, Florida, USA

    Mark Atkinson

  4. Type 1 Diabetes Center, La Jolla Institute for Allergy and Immunology, 9420 Athena Circle, La Jolla, California 92037, USA,

    Matthias von Herrath

  5. and at the Novo Nordisk Diabetes Research & Development Center, 530 Fairview Ave N # 5000, Seattle, Washington 98109, USA.,

    Matthias von Herrath

Authors
  1. Teresa Rodriguez-Calvo
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  2. Mark Atkinson
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  3. Matthias von Herrath
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Correspondence to Matthias von Herrath.

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Rodriguez-Calvo, T., Atkinson, M. & von Herrath, M. β-Cell mass versus function in type 1 diabetes mellitus: truth or dare?. Nat Rev Endocrinol 13, 1 (2017). https://doi.org/10.1038/nrendo.2017.83

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