Pancreatic islet reserve in type 1 diabetes.
Ann N Y Acad Sci
; 1495(1): 40-54, 2021 07.
Article
em En
| MEDLINE
| ID: mdl-33550589
ABSTRACT
Type 1 diabetes (T1D) is a chronic autoimmune disease characterized by pancreatic islet ß cell loss and dysfunction resulting in insulin deficiency and hyperglycemia. During a presymptomatic phase of established ß cell autoimmunity, ß cell loss may first be evident through assessment of ß cell secretory capacity, a measure of functional ß cell mass. Reduction in pancreatic islet ß cell reserve eventually manifests as impaired first-phase insulin response to glucose and abnormal glucose tolerance, which progresses until the functional capacity for ß cell secretion can no longer meet the demand for insulin to control glycemia. A functional ß cell mass of â¼25% of normal may be required to avoid symptomatic T1D but is already associated with dysregulated glucagon secretion. With symptomatic T1D, stimulated C-peptide levels >0.60 ng/mL (0.200 pmol/mL) indicate the presence of clinically meaningful residual ß cell function for contributing to glycemic control, although even higher residual C-peptide appears necessary for evidencing glucose-dependent islet ß and α cell function that may contribute to maintaining (near)normal glycemia. ß cell replacement by islet transplantation can restore a physiologic reserve capacity for insulin secretion, confirming thresholds for functional ß cell mass required for independence from insulin therapy.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Diabetes Mellitus Tipo 1
/
Células Secretoras de Insulina
/
Secreção de Insulina
/
Insulina
Limite:
Humans
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article