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Beta cells in type 1 diabetes: mass and function; sleeping or dead? – published online 14/02/2019

Fig 1 from Oram paper

Richard A. Oram, Emily K. Sims, Carmella Evans-Molina

Recent in vivo and human pancreatic analyses have challenged the notion that all beta cells are destroyed in longstanding type 1 diabetes. These findings have raised a number of questions regarding how remaining beta cells have escaped immune destruction, whether pools of ‘sleeping’ or dysfunctional beta cells could be rejuvenated and whether there is potential for new growth of beta cells. In this issue, Oram et al (https://doi.org/10.1007/s00125-019-4822-4) address these open questions by reviewing existing clinical and histological data on long-duration type 1 diabetes. They summarise evidence for new growth of beta cells and beta cell turnover in type 1 diabetes and highlight recent data supporting the idea that beta cell abnormalities and heterogeneity contribute to type 1 diabetes pathogenesis. The authors also discuss the possibility that some beta cells in longstanding type 1 diabetes may be ‘sleeping’, dysfunctional or dedifferentiated. Finally, they highlight specific settings where functional recovery seems to occur and suggest ideas for future research. The figure from this review is available as a downloadable slide.

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