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QJM Advance Access originally published online on June 13, 2005
QJM 2005 98(8):547-556; doi:10.1093/qjmed/hci088
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© The Author 2005. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

Review

Immunology of type 1 diabetes

P. Narendran1, E. Estella2 and S. Fourlanos3

From 1Clinical Science at North Bristol, University of Bristol, Southmead Hospital, Bristol, UK, 2St Vincent's Institute, Fitzroy, Victoria, Australia, and 3Autoimmunity and Transplant Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia

Address correspondence to: Dr P. Narendran, Clinical Science at North Bristol, University of Bristol, Southmead Hospital, Bristol BS10 5NB. email: parth.narendran@bristol.ac.uk

The first 150 words of the full text of this article appear below.


   Introduction
 
The incidence of type 1 diabetes in the UK is 20 per 100 000 and increasing, particularly in the under-5-years age group.1 It comes with the burden of daily insulin injection and blood testing, as well as both short- and long-term complications, and this can include premature death. The standardized mortality ratio for type 1 diabetes has been estimated as 4-fold for females and 2.7-fold for males in the UK.2 Even with tight glucose control, there is a significant risk of neuropathy, retinopathy and nephropathy, as well as a 3-fold increase in the risk of severe hypoglycaemia.3

Understanding the pathology of type 1 diabetes may help improve management. Type 1 diabetes is characterized by an absolute loss of insulin secretion, and results from an autoimmune process that destroys insulin-producing ß cells within the pancreatic islet. This review will focus on the immunology of type 1 diabetes, and how this understanding . . . [Full Text of this Article]


   The immune nature of type 1 diabetes
 

   The natural history of type 1 diabetes
 

   Association of type 1 diabetes with other autoimmune diseases
 

   Islet immunity in patients presenting with symptoms of type 2 diabetes
 

   Absence of islet autoimmunity in patients presenting with type 1 diabetes
 

   New strategies for prevention and treatment of type 1 diabetes
 
(1) Interventions to prevent the development of islet immunity
Cows milk
Viruses
Gluten
(2) Intervention after the onset of islet autoimmunity
OKT3
Nicotinamide
Insulin
Cyclosporin and azathioprine
Heat shock protein
GAD
(3) Intervention in established type 1 diabetes

   Conclusion
 

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