The pathogenesis of IDDM is one of slow, progressive immunological destruction of the beta cell mass by antigen specific cytotoxic T-lymphocytes augmented by cytokine release from macrophages and NK-Cells.
The loss of beta cells is slow and one can detect progressive glucose intolerance over time. Symptomatic diabetes mellitus and insulin dependence occurs only when the beta cell mass is reduced to 10% of normal and often presents acutely as a result of an increase in insulin resistance associated with puberty or concurrent infection.
Although the humoral immune response is not thought to play an important role in the destruction of beta cells a number of autoantibodies have been identified and are of some predictive significance:
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