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Diabetologia. 2004 Mar;47(3):581-589. doi: 10.1007/s00125-004-1336-4. Epub 2004 Feb 7.

Decreased beta-cell mass in diabetes: significance, mechanisms and therapeutic implications.

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Division of Endocrinology and Diabetes, Department of Medicine, University Hospital, 8091, Zurich, Switzerland.
Department of Genetic Medicine and Development, University Medical Centre, Geneva, Switzerland.


Increasing evidence indicates that decreased functional beta-cell mass is the hallmark of both Type 1 and Type 2 diabetes. This underlies the absolute or relative insulin insufficiency in both conditions. In this For Debate, we consider the possible mechanisms responsible for beta-cell death and impaired function and their relative contribution to insulin insufficiency in diabetes. Beta-cell apoptosis and impaired proliferation consequent to hyperglycaemia is one pathway that could be operating in all forms of diabetes. Autoimmunity and other routes to beta-cell death are also considered. Recognition of decreased functional beta-cell mass and its overlapping multifactorial aetiology in diabetic states, leads us to propose a unifying classification of diabetes.

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