Abstract
In insulin-dependent diabetes mellitus (IDDM), or type 1 diabetes, there is selective loss of the beta cells of the pancreas. This leads to insulinopenia, ketosis, and the need for exogenous insulin to sustain life. Although IDDM can occur at any age, it usually arises in the young and as a result is among the most common, major chronic pediatric diseases in the Western world. In Canada, the annual incidence is approximately 9 new cases/100,000 in those under 19 years of age (Ehrlich et al., 1982). Despite provision of parenteral insulin, chronic IDDM is associated with undue morbidity, including micro- and macrovasculopathy and neuropathy (Kolb and Nerup, 1985) and premature mortality (Borch-Johnsen et al., 1986). This has led to a search into the fundamental causes of the disease with the hope of developing curative treatment—in distinction to the existing, problematic one of substitution.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Assan, R., Feutren, G., Debray-Sachs, M., Quiniou-Debrie, M. C., Laborie, C., Thomas, G., Chatenoud, L., and Bach, J. E., 1985, Metabolic and immunological effects of cyclosporin in recently diagnosed Type 1 diabetes mellitus, Lancet 1:69–71.
Assan, R., Feutren, G., and Sirmai, J., 1988, Cyclosporine trials in diabetes: Updated results of the French experience, Transplant. Proc. 20(3S4):178–183.
Bell, G. I., Horita, S., and Karam, J. H., 1984, A polymorphic locus near the human insulin gene is associated with IDDM, Diabetes 33:176–83.
Borch-Johnsen, K., Kreiner, S., and Deckert, T., 1986, Mortality of Type 1 diabetes in Denmark: A study of relative mortality in 2930 Danish Type 1 diabetic patients diagnosed from 1933-1972, Diabetologia 29:767–72.
Bottazo, G. E., Dean, B. M., McNally, J. M., MacKay, E. H., Swift, P. G., and Gamble, D. R., 1985, In situ characterization of autoimmune phenomena and expression of HLA molecules in the pancreas in diabetic insulitis, N. Engl. J. Med. 313:353–60.
Bougneres, P. E., Carel, J. C., Castano, L., Boitard, C., Gardin, J. P., Landais, P., Hors, J., Mihatsch, M. J., Paillard, M., Chaussain, J. L., and Bach, J. E., 1988, Factors determining early remission of type 1 diabetes in children treated with cyclosporin A, N. Engl. J. Med. 318:633–670.
The Canadian-European Randomized Control Trial Group (CERT), 1988, Cyclosporin-induced remission of IDDM after early intervention, Diabetes 37:1574–1582.
Cook, J. J., Hudson, I., Harrison, L. C., Dean, B., Colmon, P. G., Werther, G. A., Warne, G. L., and Court, J. M., 1989, A double-blind controlled trial of azathioprine in children with newly diagnosed type 1 diabetes, Diabetes 38:779–783.
Diabetes Epidemiology Research International, 1987, Preventing IDDM: The environmental challenge, Br. Med. J. 295:479–481.
The Diabetic Control and Complications Trial Group, 1986, The diabetic control and complications trial (DCCT), Diabetes 35:530–545.
Drash, A. L., 1986, Diabetes mellitus in the child and adolescent, Curr. Problems Pediatr. 16:413–466.
Dupre, J., Stiller, C. R., Jenner, M. R., Mahon, J. L., Keown, P., Rodger, N. W., and Wolfe, B., 1987, Responses to nutrients in non-insulin requiring remission of Type 1 diabetes during administration of cyclosporin, Diabetes 36(S1):74A.
Dupre, J., Stiller, C. R., Gent, M., Donner, A., von Graffenreid, B., Murphy, G., Heinrichs, D., Jenner, M. R., Keown, P. A., Laupacis, A., Mahon, J., Martell, R., Rodger, N. W., and Wolfe, B. W., 1988, Effects of immunosuppression with Cy in IDDM of recent onset: The Canadian Open Study at 44 months, Transplant. Proc. 20(3S4):184–192.
Ehrlich, R. M., Walsh, L. J., Falk, J. A., Middleton, P. J., and Simpson, N. E., 1982, The incidence of IDD in Toronto, Diabetologia 22:289–291.
Eisenbarth, G. S., 1987, Genes, generator of diversity, glycoconjugates, and autoimmune beta-cell insufficiency in type 1 diabetes, Diabetes 36:355–364.
Eisenbarth, G. S., Srikanta, S., Rabinowe, S. L., Jackson, R. A., Ganda, O. P., and Soeldner, J. S., 1986, Restoration of first-phase insulin secretion by daily prednisone in two islet cell antibody positive nondiabetic individuals, Transplant. Proc. 18:805–808.
Elliott, R. B., Pilcher, C. C., and Edgar, B. W., 1986, Long-term outcome of children with IDDM treated ab initio with prednisone, Pediatr. Adoelsc. Endocrinol 15:345–349.
Feutren, G., 1988, Functional consequences and risk factors of chronic cyclosporine nephrotoxicity in Type 1 diabetes trials, Transplant. Proc. 20(3S4):356–366.
Feutren, G., Papoz, L., Assan, R., Vialettes, B., Karsenty, G., Vexiau, P., Du Rostu, H., Rodier, M, Sirmai, J., Lallemand, A., and Bach, J. F., 1986, Cyclosporin increases the rate and length of remissions in IDDM of recent onset, Lancet 2:119–123.
Gepts, W., 1965, Pathological anatomy of the pancreas in juvenile diabetes mellitus Diabetes 14:619–633.
Gorsuch, A. N., Spencer, K. M., Lister, J., McNally, J. M., Dean, B. M., Bottazo, G. E., and Cudworth, A. G., 1981, The natural history of IDDM: The evidence for a long prediabetic period, Lancet 2:1363–1365.
Harrison, L. C., Colmon, P. G., Dean, B., Baxter, R., and Martin, F. I., 1985, Increase in remission rate in newly diagnosed Type 1 diabetic subjects treated with azathioprine, Diabetes 34:1306–1308.
Heaton, D. A., Millward, B. A., Gray, P., Tun, Y., Hules, C. N., Pyke, D A., and Leslie, R. D, 1987, Evidence of beta-cell dysfunction which does not lead on to diabetes: A study of identical twins of insulin dependent diabetics, Br. Med. J. 294: 145–146.
Hodge, S., Anderson, C., Neiswanger, K., Field, L., Spence, M., Sparkes, R., Crist, M., Terasaki, P., Rimoin, D., and Rotter, J., 1981, Close genetic linkage between diabetes mellitus and Kidd blood group, Lancet 2:893–895.
Hramiak, I., Finegood, D., and Dupre, J., 1988, Insulin sensitivity in Cy-treated type 1 diabetics in remission, Diabetes 37(S1):16A.
Karjalainen, J., Salmela, P., Ilonen, J., Surcel, H., and Knip, M., 1989, A comparison of childhood and adult type 1 diabetes mellitus, N. Engl. J. Med. 320:881–886.
Koivisto, V. A., Aro, A., Cantell, K., et al., 1984, Remissions in newly diagnosed type 1 (insulin-dependent) diabetes mellitus: Influence of interferon as an adjunct to insulin therapy, Diabetobgia 27:193–197.
Kolb, H., and Nerup, J., 1985, TIDM: Rationale for immune intervention, in: Cycbsporin in Autoimmune Diseases (R. Schindler, ed.), Springer-Verlag, Berlin, pp. 117–119.
Lernmark, A., 1985, Molecular biology of IDDM, Diabetobgia 28:195–203.
Levy-Marchal, C., Czernichow, P., Quiniou, M. C., Shahs, M., and Bach, J. F., 1983, Cyclosporin administration reversed abnormalities in a prediabetic child, Diabetes 32(S1):51A.
Ludvigsson, J., Samuelsson, U., Benforts, C., Deschamps, I., Drash, A., Francois, R., Herz, G., New, M., and Schober, E., 1986, HLA-DR3 is associated with a more slowly progressive form of insulin dependent diabetes, Diabetobgia 29:207–210.
Maclaren, N. K., Home, G., Spillar, R. P., Barbour, H., Harrison, O., and Duncan, J., 1985, Islet cell autoantibodies in U.S. school children, Diabetes 34(S1):335A.
Madsbad, S., 1983, Prevalence of residual B cell function and its metabolic consequences in Type 1 diabetes, Diabetobgia 24: 141–147.
Mandrup-Poulsen, T., 1988, On the pathogenesis of IDDM, Dan. Med. Bull. 35:438–460.
Mandrup-Poulsen, T., Nerup, J., Stiller, C. R., Marner, B., Bille, G., Heinrichs, D., Martell, R., Dupre, J., Keown, P. A., Jenner, M. R., Rodger, N. W., Wolfe, B., Graffenreid, B. V, and Binder, C., 1985, Disappearance and reappearance of islet cell cytoplasmic antibodies in cyclosporin-treated insulin dependent diabetics, Lancet 1:599–602.
Mandrup-Poulsen, T., Molvig, J., Andersen, H. U., Helqvist, S., and Munck, M., for the Canadian/European Diabetes Study Group, 1990, Lack of predictive value of islet cell antibodies, insulin autoantibodies, and HLA-DR phenotype for remission in Type 1 diabetic patients treated with cyclosporine, Diabetes 39:204–210.
Mistura, L., Beccaria, L., Meschi, E., DArcais, A., Pellini, C., Puzzovio, M., and Chiumello, G., 1981, Prednisone treatment in newly diagnosed Type 1 diabetic children: 1 year follow-up, Diabetes Care 10:39–43.
Nerup, J., 1989, Rationale of immune intervention in type one diabetes, in: Immunotherapy of Type One Diabetes (H. Kolb, D. Andreani, and P. Pozzilli, eds.), John Wiley and Sons, Chichester, pp. 5–11.
Nerup, J., Anderson, O. O., Bendixen, G., Egeborg, J., and Poulsen, J. E., 1971, Antipancreatic cellular hypersensitivity in diabetes mellitus, Diabetes 20:424–427.
Nerup, J., Mandrup-Poulsen, T., and Molvig, J., 1987, The HLA-IDDM association: Implications for etiology and pathogenesis of IDDM, Diabetes Metab. Rev. 3:770–802.
Nerup, J., Mandrup-Poulsen, T., Molvig, J., Helqvist, S., Wogensen, L., and Egeborg, J., 1988, Mechanisms of pancreatic beta-cell destruction in type 1 diabetes, Diabetes Care 11(Suppl.1):16–23.
Prosser, P. R., and Karam, J. H., 1978, Diabetes mellitus following rodenticide ingestion in man, J. Am. Med. Assoc. 239:1148–1150.
Shah, S. C., Malone, J. I., and Simpson, N. E., 1989, A randomized trial of intensive insulin in newly diagnosed IDDM, N. Engl J. Med. 320:550–554.
Sibley, R. K., Sutherland, D. E., Goetz, E., and Michael, A. E., 1985, Recurrent diabetes mellitus in the pancreas iso-and allograft, Lab. Invest. 53:132–144.
Silverstein, J., Riley, W., Spillar, R., Buithieu, M., Barbour, H., Harrison, D, and Alamo, A., 1986, A trial of immunosuppression with Imuran, Diabetes 35(Suppl.1):5A.
Silverstein, J., Spillar, R., Maclaren, N., and Decker, P., 1987, Immunotherapy with steroids and azathioprine in IDDM: The importance of steroid induction, Diabetes 36(Suppl.1):74A.
Silverstein, J., Maclaren, N., Riley, W., Spillar, R., Radjenovic, D, and Johnson, S., 1988, Immunosuppression with azathioprine and prednisone in recent-onset IDDM, N. Engl. J. Med. 319:599–604.
Skyler, J., 1988, Immune intervention studies in IDDM, Diabetes Metab. Rev. 3:1017–1035.
Spinas, G. A., Palmer, J. P., Mandrup-Poulsen, T., Andersen, H., Nielsen, J., and Nerup, J., 1988, The bimodal effect of interleukin 1 on rat pancreatic beta-cells—stimulation followed by inhibition—depends upon dose, duration of exposure, and ambient glucose concentration, Acta Endocrinol. 119:307–311.
Srikanta, S., Ricker, T., McCulloch, D. K., Soeldner, J. S., Eisenbarth, G. S., and Palmer, J. P., 1986, Autoimmunity to insulin, beta-cell dysfunction, and development of IDDM, Diabetes 35:139–142.
Stiller, C. R., Dupre, J., Gent, M., Jenner, M. R., Keown, P. A., Laupacis, A., Martell, R., Rodger, N. W., Graffenried, B. V, and Wolfe, B. M., 1984, Effects of cyclosporine immunosuppression in IDDM of recent onset, Science 223:1362–1367.
Tattersall, R. B., and Pyke, D. A., 1972, Diabetes in identical twins, Lancet 2:1120–1125.
Usadel, K. H., Teuber, J., Schmeidl, R., Schwedes, U., Bicker, U., and Herz, M., 1986, Management of type 1 diabetes with ciamexone, Lancet 2:567.
Vague, P. N., Violettes, B., Lassmann-Vague, V, and Velio, J. J., 1987, Nicotinamide may extend remission phase in ID diabetes, Lancet 1:619.
Wilkin, T., and Armitage, M., 1986, Markers for IDDM: Towards early detection, Br. Med. J. 293:1323–1326.
Woda, B. A., and Biron, C. A., 1986, Natural killer cell number and function in the spontaneously diabetic BB\ rat, J. Immunol. 137:1860–1866.
Yoon, J. W., Austin, M., Ondera, T., and Notkins, A. L., 1979, Virus-induced diabetes mellitus: Isolation of a virus from a pancreas of a child with diabetic ketoacidosis, N. Engl. J. Med. 300:1173–1179.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1992 Springer Science+Business Media New York
About this chapter
Cite this chapter
Mahon, J.L., Dupre, J., Stiller, C.R. (1992). Insulin-Dependent Diabetes Mellitus. In: Rugstad, H.E., Endresen, L., Førre, Ø. (eds) Immunopharmacology in Autoimmune Diseases and Transplantation. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-1167-4_23
Download citation
DOI: https://doi.org/10.1007/978-1-4899-1167-4_23
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4899-1169-8
Online ISBN: 978-1-4899-1167-4
eBook Packages: Springer Book Archive