Rethinking the β-cell in type 1 diabetes

A changing view of disease progression

Type 1 diabetes mellitus (T1DM) has traditionally been viewed as an autoimmune disease in which immune cells progressively destroy pancreatic β-cells until insulin production becomes insufficient. New studies of human pancreatic tissue are now revealing a more complex process.

In this Perspective, published in October 2026, Decio L. Eizirik and colleagues review recent evidence obtained using high-resolution imaging, single-cell and spatial molecular techniques, and artificial intelligence-assisted tissue analysis. These approaches suggest that β-cells are not simply passive targets of autoimmunity. They actively respond to immune stress. Importantly, substantial numbers of β-cells can remain present when clinical diabetes develops, although their ability to produce and release insulin can already be severely impaired.