Invincible β‐cells in type 1 diabetes

Duration of type 1 diabetes, however, differed across groups of C‐peptide production, with the longest duration observed in the negative C‐peptide group. [...]potential questions might arise in interpreting the data as to whether the difference of β‐cell secretory responses represented by C‐peptide and proinsulin secretion to hyperglycemia, acute C‐peptide and proinsulin responses to arginine, and suppression of C‐peptide levels and increment of glucagon in the euglycemic clamp followed by hypoglycemic clamp could exclusively be attributed to the level of stimulated C‐peptide or to the disease duration itself. Rickels et al. 3 reported that integrating data generated from continuous glucose monitoring (CGM) showed that time in range was higher with an increasing MMTT peak C‐peptide level. [...]preserving underlying β‐cell secretory capacity with residual C‐peptide by peak MMTT response as a surrogate parameter might be a reasonable therapeutic target in improving glycemic control. Adopting CGM technology with appropriate patient education has been shown to be related to improved glycemic control, as direct visualization of glycemic excursions not only motivates the patients as a part of the medical intervention, but also modifies behavior with proper understanding of the data. [...]although treatment goals should aim for preserving or restoring β‐cell function, type 1 diabetes patients with low levels of C‐peptide could also conversely benefit with the use of CGM metrics. α‐Cells are not subject to immune assault, as evidenced by the increased α‐to‐β‐cell ratio in type 1 diabetes patients, but they lose responsivity to hypoglycemia, showing “glucose blindness” early in the course of the disease.