The importance of residual endogenous beta-cell preservation in type 1 diabetes

Achieving tight glycaemic control in type 1 diabetes remains very challenging for patients. However, some individuals retain a degree of endogenous beta-cell function for 5 or more years after diagnosis, and prospective studies confirm that this is associated not only with lower glycated haemoglobin A1c levels, and less hypoglycaemia, but also a reduced incidence of long-term complications. An independent effect of insulin C-peptide may contribute to this beneficial effect. Retention of even small amounts of endogenous beta-cell function for as long as possible should therefore be a key therapeutic goal in type 1 diabetes. Tight glycaemic control from diagnosis has already been shown to help in this regard, and we argue that the introduction of novel immunotherapies which achieve this important goal should be strongly encouraged, even if they fall short of an insulin-free 'cure'.