Antibodies and disorders of glucose metabolism: A courting couple

A brief review is presented on the growing evidence that immunologic processes play an important part in the pathogenesis of diabetes mellitus (DM), especially for insulin-dependent DM. Using a rodent model which spontaneously develops DM at a time when the typical insulitus or lymphatic-infiltration reaction occurs within the islets of Langerhans, it was found the DM could be prevented or reversed by treatment with antiserum to rat lymphocytes. Other work supports this finding of DM prevention or alleviation. Other studies have shown that immunology also is important in carbohydrate disorders as characterized by hypoglycemia. Patients with auto-immune hypoglycemia also exhibited glucose intolerance, and some had evidence of other immunologic disorders (e.g., Graves' disease). The growing complexity involving antibodies, insulin, and hypoglycemia is discussed. While knowledge of the association between disorders of glucose homeostasis and immunologic disease is still growing, further identification of the genetic and humoral factors should confirm the closeness of this association. (wz)