[Auto-immunity and insulin-dependent diabetes]

Many observations suggest that auto-immune process are activated during the beta-cell destruction in insulin-dependent diabetes (IDD): they include association with organ specific auto-immune disease, frequency of circulating anti-organ antibodies, circulating anti-islet cell antibodies, insulitis-like lesions in the pancreas and in vitro lymphocytic reaction against pancreatic antigens. However, it is still uncertain if these reactions are actually involved in the beta cell destruction. Cytotoxicity experiments on beta cells in culture and animal models support this hypothesis. Nosologic classification which categorizes an autoimmune type of IDD, a viral type of IDD and a large proportion termed idiopathic IDD may be a useful device to further our understanding of the pathogenic pathways but may be open to criticism of undue simplification as in this presumably multifactorial disease, the differences between affected individuals may be quantitative and not qualitative.