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Pancreatic islet reserve in type 1 diabetes

Lookup NU author(s): Dr Anneliese Flatt, Professor James Shaw


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© 2021 New York Academy of Sciences.Type 1 diabetes (T1D) is a chronic autoimmune disease characterized by pancreatic islet β cell loss and dysfunction resulting in insulin deficiency and hyperglycemia. During a presymptomatic phase of established β cell autoimmunity, β cell loss may first be evident through assessment of β cell secretory capacity, a measure of functional β cell mass. Reduction in pancreatic islet β cell reserve eventually manifests as impaired first-phase insulin response to glucose and abnormal glucose tolerance, which progresses until the functional capacity for β cell secretion can no longer meet the demand for insulin to control glycemia. A functional β cell mass of ∼25% 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 β cell function for contributing to glycemic control, although even higher residual C-peptide appears necessary for evidencing glucose-dependent islet β and α cell function that may contribute to maintaining (near)normal glycemia. β cell replacement by islet transplantation can restore a physiologic reserve capacity for insulin secretion, confirming thresholds for functional β cell mass required for independence from insulin therapy.

Publication metadata

Author(s): Flatt AJS, Greenbaum CJ, Shaw JAM, Rickels MR

Publication type: Review

Publication status: Published

Journal: Annals of the New York Academy of Sciences

Year: 2021

Volume: 1495

Issue: 1

Pages: 40-54

Print publication date: 01/07/2021

Online publication date: 06/02/2021

Acceptance date: 21/01/2021

ISSN (print): 0077-8923

ISSN (electronic): 1749-6632

Publisher: John Wiley and Sons Inc


DOI: 10.1111/nyas.14572

PubMed id: 33550589