title: Decreased beta-cell mass in diabetes: significance, mechanisms and therapeutic implications.
abstract: 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.
authors.affiliation: Division of Endocrinology and Diabetes, Department of Medicine, University Hospital, 8091, Zurich, Switzerland. marc.donath@usz.ch.
authors.forename: M Y
authors.initials: MY
authors.lastname: Donath
authors.affiliation: Department of Genetic Medicine and Development, University Medical Centre, Geneva, Switzerland.
authors.forename: P A
authors.initials: PA
authors.lastname: Halban
mesh_terms: D016923:Cell Death; D003920:Diabetes Mellitus / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D007328:Insulin / Q000378:metabolism; D000078790:Insulin Secretion; D007515:Islets of Langerhans / Q000033:anatomy & histology* / Q000473:pathology
chemical_list: D007328:Insulin