Predominance of β-cell neogenesis rather than replication in humans with an impaired glucose tolerance and newly diagnosed diabetes

J Clin Endocrinol Metab. 2013 May;98(5):2053-61. doi: 10.1210/jc.2012-3832. Epub 2013 Mar 28.


Context: A decrease in pancreatic β-cell mass is involved in the development of type 2 diabetes.

Objective: The purpose of this study was to evaluate the β-cell mass and the incidence of β-cell neogenesis, replication, and apoptosis at both the prediabetic and diabetic stages.

Methods: We conducted a cross-sectional study of pancreatic tissues obtained from 42 patients undergoing a pancreatectomy who were classified into 4 groups: normal glucose tolerance (n = 11), impaired glucose tolerance (n = 11), newly diagnosed diabetes (n = 10), and long-standing type 2 diabetes (n = 10).

Results: The relative β-cell area decreased and the β-cell apoptosis increased during the development of diabetes. The number of single and clustered β-cells, some of which coexpressed nestin, increased in the patients with impaired glucose tolerance and newly diagnosed diabetes. The prevalence of cells positive for both insulin and glucagon or somatostatin also increased in these patients compared with those with normal glucose tolerance. These double-positive cells were mainly localized in single and clustered β-cells, rather than large islets, and were also positive for Pdx1 or Ngn3. The percentage of insulin-positive cells embedded within ducts increased in the impaired glucose tolerance group. There were no significant differences in the incidence of cells positive for both insulin and Ki67 among the groups.

Conclusions: These results suggest that β-cell neogenesis, rather than replication, predominates during impaired glucose tolerance and newly diagnosed diabetes in humans and may serve as a compensatory mechanism for the decreased β-cell mass.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Apoptosis*
  • Basic Helix-Loop-Helix Transcription Factors / metabolism
  • Biomarkers / metabolism
  • Cell Proliferation*
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / metabolism
  • Diabetes Mellitus, Type 2 / pathology*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Disease Progression
  • Female
  • Glucose Intolerance / metabolism
  • Glucose Intolerance / pathology*
  • Glucose Intolerance / physiopathology
  • Homeodomain Proteins / metabolism
  • Humans
  • Insulin-Secreting Cells / metabolism
  • Insulin-Secreting Cells / pathology
  • Insulin-Secreting Cells / physiology*
  • Intermediate Filament Proteins / metabolism
  • Ki-67 Antigen / metabolism
  • Male
  • Middle Aged
  • Nerve Tissue Proteins / metabolism
  • Nestin
  • Pancreas / metabolism
  • Pancreas / pathology
  • Pancreas / physiopathology
  • Prediabetic State / metabolism
  • Prediabetic State / pathology*
  • Prediabetic State / physiopathology
  • Regeneration*
  • Trans-Activators / metabolism


  • Basic Helix-Loop-Helix Transcription Factors
  • Biomarkers
  • Homeodomain Proteins
  • Intermediate Filament Proteins
  • Ki-67 Antigen
  • NES protein, human
  • NEUROG3 protein, human
  • Nerve Tissue Proteins
  • Nestin
  • Trans-Activators
  • pancreatic and duodenal homeobox 1 protein