Beta cells in type 1 diabetes: mass and function; sleeping or dead?

Richard A. Oram, Emily K. Sims, Carmella Evans-Molina

Research output: Contribution to journalReview article

18 Scopus citations


Histological analysis of donor pancreases coupled with measurement of serum C-peptide in clinical cohorts has challenged the idea that all beta cells are eventually destroyed in type 1 diabetes. These findings have raised a number of questions regarding how the remaining beta cells have escaped immune destruction, whether pools of ‘sleeping’ or dysfunctional beta cells could be rejuvenated and whether there is potential for new growth of beta cells. In this Review, we describe histological and in vivo evidence of persistent beta cells in type 1 diabetes and discuss the limitations of current methods to distinguish underlying beta cell mass in comparison with beta cell function. We highlight that evidence for new beta cell growth in humans many years from diagnosis is limited, and that this growth may be very minimal if at all present. We review recent contributions to the debate around beta cell abnormalities contributing to the pathogenesis of type 1 diabetes. We also discuss evidence for restoration of beta cell function, as opposed to mass, in recent-onset type 1 diabetes, but highlight the absence of data supporting functional recovery in the setting of long-duration diabetes. Finally, future areas of research are suggested to help resolve the source and phenotype of residual beta cells that persist in some, but not all, people with type 1 diabetes.

Original languageEnglish (US)
Pages (from-to)567-577
Number of pages11
Issue number4
StatePublished - Apr 1 2019


  • Beta cell function
  • Beta cell mass
  • C-peptide
  • Network for Pancreatic Organ Donors with Diabetes
  • Proinsulin
  • Review
  • Type 1 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Fingerprint Dive into the research topics of 'Beta cells in type 1 diabetes: mass and function; sleeping or dead?'. Together they form a unique fingerprint.

  • Cite this