Five Stages of Evolving Beta-Cell Dysfunction During Progression to Diabetes

摘要: This article proposes five stages in the progression of diabetes, each which is characterized by different changes β-cell mass, phenotype, and function. Stage 1 compensation: insulin secretion increases to maintain normoglycemia face resistance and/or decreasing mass. stage maintenance differentiated function with intact acute glucose-stimulated (GSIS). 2 occurs when glucose levels start rise, reaching ∼5.0–6.5 mmol/l; this a stable state adaptation loss mass disruption as evidenced diminished GSIS dedifferentiation. 3 transient unstable period early decompensation rise relatively rapidly frank diabetes 4, more severe Finally, 5 representing profound reduction ketosis. Movement across 1–4 can be either direction. For example, individuals treated type move from 4 or 2. remission develops, typically found. Delineation these provides insight into pathophysiology both diabetes.