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Review
. 2006 Feb;49(2):261-70.
doi: 10.1007/s00125-005-0100-8. Epub 2006 Jan 11.

The Rise and Fall of Insulin Secretion in Type 1 Diabetes Mellitus

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Review

The Rise and Fall of Insulin Secretion in Type 1 Diabetes Mellitus

E B Tsai et al. Diabetologia. .

Abstract

An understanding of the natural history of beta cell responses is an essential prerequisite for interventional studies designed to prevent or treat type 1 diabetes. Here we review published data on changes in insulin responses in humans with type 1 diabetes. We also describe a new analysis of C-peptide responses in subjects who are at risk of type 1 diabetes and enrolled in the Diabetes Prevention Trial-1 (DPT-1). C-peptide responses to a mixed meal increase during childhood and through adolescence, but show no significant change during adult life; responses are lower in adults who progress to diabetes than in those who do not. The age-related increase in C-peptide responses may account for the higher levels of C-peptide observed in adults with newly diagnosed type 1 diabetes compared with those in children and adolescents. Based on these findings, we propose a revised model of the natural history of the disease, in which an age-related increase in functional beta cell responses before the onset of autoimmune beta cell damage is an important determinant of the clinical features of the disease.

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