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Juvenile diabetes (type 1) may not involve absent insulin secretion at onset. Preserving beta-cell function through early detection and intensive treatment is crucial for metabolic control in children with diabetes.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Disorders
Background:
- Juvenile-onset diabetes (type 1 diabetes) is often presumed to have minimal or absent insulin secretion at diagnosis.
- Understanding residual beta-cell function is key to managing diabetes in children.
Purpose of the Study:
- To investigate the presence and significance of C-peptide levels at the onset of juvenile diabetes.
- To assess the long-term beta-cell function in juvenile diabetics and its impact on metabolic control.
Main Methods:
- Measured C-peptide and proinsulin levels in juvenile diabetic patients at diagnosis and during follow-up.
- Assessed beta-cell response to breakfast stimulation in patients during remission periods.
Main Results:
- Appreciable C-peptide levels were detected at onset in 12 juvenile diabetic patients, even with ketonuria.
- Most patients maintained near-normal C-peptide levels during remission, showing responsive beta-cell capacity.
- Many juvenile diabetics demonstrated persisting beta-cell function, correlating with stable metabolic control.
Conclusions:
- Insulin secretion may be present at the onset of juvenile diabetes, contrary to common belief.
- Early detection and intensive treatment before severe metabolic disturbances may preserve beta-cell function.
- Sustained beta-cell function is important for achieving stable metabolic control in juvenile diabetes.
Abstract:
Although it is generally believed that insulin secretion is minimal or absent in juvenile-onset diabetes, we have found appreciable levels of C-peptide at the time of onset in 12 patients, 4 to 16 years old (9.3 +/- 4.2). Ten of them had ketonuria but none severe ketoacidosis. All entered a remission period. Most of the patients had near normal C-peptide levels during the remission, and their beta cells had the capacity to respond to a breakfast stimulation with increased insulin secretion. C-peptide and proinsulin were also determined in 98 juvenile diabetics with age at onset of 1 to 16 years (6.8 +/- 3.9) and a duration of diabetes between two and 17 years (6.7 +/- 3.4). Many were found to have persisting beta-cell function, which seems to be of importance for ensuring stability in metabolic control. Although little is known about factors that may slow or reverse the process leading to beta-cell failure, our results suggest that early detection and intensive treatment of diabetes before severe metabolic disturbances have occurred may help preserve beta-cell function.