Can We Change the Course of Beta-Cell Destruction in Type 1 Diabetes?

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Abstract
Imagine a nephrologist with no biopsy needle, no imaging techniques, no serum creatinine measurement — a nephrologist whose patients need dialysis when they first present for care. This is the predicament of the diabetologist, whose patients with type 1 diabetes routinely present with end-stage pancreatic beta-cell failure and must be informed that they have an incurable condition requiring lifelong rear-guard action against vascular complications. The future may not be so bleak, however. The natural history of the process leading to type 1 diabetes has been charted by prospective studies; robust predictive strategies are in place; and trials of a variety . . .