Pancreatic islet reserve in type 1 diabetes,Annals of the New York Academy of Sciences

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Pancreatic islet reserve in type 1 diabetes
Annals of the New York Academy of Sciences ( IF 4.1 ) Pub Date : 2021-02-06 , DOI: 10.1111/nyas.14572
Anneliese J S Flatt _{1,

2} , Carla J Greenbaum ₃ , James A M Shaw _{1,

2} , Michael R Rickels _{4,

5}

Affiliation

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.

中文翻译：

1型糖尿病的胰岛储备

1型糖尿病（T1D）是一种慢性自身免疫性疾病，其特征是胰岛β细胞丢失和功能障碍，导致胰岛素缺乏和高血糖。在已建立的 β 细胞自身免疫的症状前阶段，β 细胞丢失可能首先通过评估 β 细胞分泌能力（一种功能性 β 细胞质量的量度）来明显。胰岛 β 细胞储备的减少最终表现为胰岛素对葡萄糖的第一时相反应受损和糖耐量异常，直至 β 细胞分泌的功能能力不能再满足对胰岛素控制血糖的需求。可能需要约 25% 的正常功能性 β 细胞量来避免有症状的 T1D，但已经与胰高血糖素分泌失调有关。对于有症状的 T1D，刺激的 C 肽水平 >0.60 ng/mL (0. 200 pmol/mL）表明存在有临床意义的残留 β 细胞功能，有助于血糖控制，尽管更高的残留 C 肽似乎对于证明可能有助于维持（接近）正常的葡萄糖依赖性胰岛 β 和 α 细胞功能是必要的血糖。通过胰岛移植进行的 β 细胞替代可以恢复胰岛素分泌的生理储备能力，从而确定独立于胰岛素治疗所需的功能性 β 细胞量的阈值。

更新日期：2021-02-06

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