The Pathology Of The Endocrine Pancreas In Diabetes

Diabetes mellitus represents one of the most frequent and serious clinical syn dromes in contemporary medicine. Since the end of the nineteenth century, the endocrine pancreas has been implicated in the pathogenesis of this disease. Several pathologists of the twentieth century detected various lesions and mor phologic alterations in the pancreatic islets of diabetic patients, but the patho physiologic basis of their findings remained long obscure. The systematic mi croscopic work of WILLY GEPTS clarified the views and related the variety in histopathology to differences in origin, duration and clinical expression of the disease. Over the past two decades, the concept of a multifactorial origin of diabetes has become widely accepted. Various agents and mechanisms have been identified which can lead to a quantitative or qualitative deficit in pancre atic B-cells. The purpose of this book is to bring an update on the many path ways which may induce an absolute or relative insufficiency in insulin release and hence a diabetic state. Rather than bringing a complete account on all re search relevant to the understanding of the pathology of the diabetic pancreas, the authors of the various chapters of this volume have focussed on selected processes which can impair B-cell function, survival or regeneration.

Diabetes mellitus represents one of the most frequent and serious clinical syn dromes in contemporary medicine. Since the end of the nineteenth century, the endocrine pancreas has been implicated in the pathogenesis of this disease. Several pathologists of the twentieth century detected various lesions and mor phologic alterations in the pancreatic islets of diabetic patients, but the patho physiologic basis of their findings remained long obscure. The systematic mi croscopic work of WILLY GEPTS clarified the views and related the variety in histopathology to differences in origin, duration and clinical expression of the disease. Over the past two decades, the concept of a multifactorial origin of diabetes has become widely accepted. Various agents and mechanisms have been identified which can lead to a quantitative or qualitative deficit in pancre atic B-cells. The purpose of this book is to bring an update on the many path ways which may induce an absolute or relative insufficiency in insulin release and hence a diabetic state. Rather than bringing a complete account on all re search relevant to the understanding of the pathology of the diabetic pancreas, the authors of the various chapters of this volume have focussed on selected processes which can impair B-cell function, survival or regeneration.

Dr. Robert L. Jackson, Professor of Child Health at the Uni versity of Missouri-Columbia, decided to retire from clinical practice in 1977 and the Department of Child Health planned a con ference in his honor. The Thirteenth Annual MidweSt Conference on Endocrinology and Metabolism also was in the planning stages and scheduled for two days in the fall. It seemed appropriate to com bine the two into an expanded three-day conference. In view of Dr. Jackson's international reputation in the study and care of children with diabetes mellitus, the conference topic was not dif ficult to find. Experts in this field were delighted to be asked to speak at a conference in Dr. Jackson's honor. We selected a number of excellent speakers to survey the physiology and pathophy siology of pancreatic hormones and their effects in diabetes mel litus, to discuss current knowledge of the microvascular complica tions of the disease, and to put it all into the proper historical perspective of where we have been and where we are going. We think the conference achieved its objective to pay meaningful trib ute to a distinguished member of the scientific community. As with any conference, the conversion of the presentations and discussions to the printed page is a long and arduous process. Many manuscripts were completed well after the conference and references often are more recent than the date of the conference.

This book attempts to explore the contribution that biochemistry has made, thus far, to our understanding of the endocrine pancreas and its relationship to diabetes mellitus. It was written with the aim of using an important clinical problem to illustrate, to medical students, that there are many aspects of the biochemistry taught in the early years which have direct relevance to clinical medicine. Furthermore, it is hoped that such information might provide biochemistry students with a frame work on which to base further studies. To this end a selection of recent references has been placed at the end of each chapter. In spite of considerable advances in our understanding of diabetes mellitus, it is still a disease which many physicians do not seem to com prehend. This is in part related to their lack of understanding of the molecular biology of the disease. Advances in this area have been dramatic in recent years and we are now able to offer a molecular basis for a rational approach to therapy. It may be therefore that this book will provide some physicians with the information they require to help them gain a deeper understanding of the disease. I hope that everyone who reads this book is able to capture some of the fascination that the islets of Langerhans hold for myself and the many other workers actively engaged in trying to unravel their mys teries.

I consider it an honor to have been asked to write the Foreword for The Diabetic Pancreas. Although I have been involved in the study of the pancreas since 1921, my interest goes back even further to the time, in 1918, that my father's sister, a nurse who had trained at the Massachusetts General Hospit.al, devel oped diabetes, lost weight, and died in diabetic coma. This sad event made a deep impression on me and was certainly pardy responsible for my choosing to join the Department of Physiology of the University of Toronto to begin a career in research into diabetes. This is not the place to describe in detail the wide-ranging research and study of the diabetic pancreas in which I have engaged in the past 56 years. Suffice it to say that I am familiar enough with the subject area to be able to predict a great future for this book. The editors have undertaken a very ambitious and worthwhile project, and their efforts have been supported and strengthened by contributors who are respected authorities in their fields, thus ensuring a successful presentation of this major work.

The 1997 classification of diabetes mellitus, now accepted worldwide, includes a large section of ‘Other specific types of diabetes’, a good part of which is made up of diabetes secondary to other endocrine or pancreatic disorders. However, a comprehensive overview on how these disorders may lead to diabetes, and how to diagnose and treat them, was not available so far. Filling this gap, this book includes detailed descriptions of glucose metabolism derangements in other endocrine and pancreatic disorders. Leading experts in their fields present an exhaustive overview of the most-updated evidence on the etiopathological mechanisms underlying the development of diabetes in patients with endocrine and pancreatic disorders, and the relevant diagnostic and therapeutic approaches. Because of its multidisciplinary approach, this book is of great interest to endocrinologists, diabetologists, general practitioners, internal medicine specialists and surgeons, and will remain a reference source for years to come.

This book attempts to explore the contribution that biochemistry has made, thus far, to our understanding of the endocrine pancreas and its relationship to diabetes mellitus. It was written with the aim of using an important clinical problem to illustrate, to medical students, that there are many aspects of the biochemistry taught in the early years which have direct relevance to clinical medicine. Furthermore, it is hoped that such information might provide biochemistry students with a frame work on which to base further studies. To this end a selection of recent references has been placed at the end of each chapter. In spite of considerable advances in our understanding of diabetes mellitus, it is still a disease which many physicians do not seem to com prehend. This is in part related to their lack of understanding of the molecular biology of the disease. Advances in this area have been dramatic in recent years and we are now able to offer a molecular basis for a rational approach to therapy. It may be therefore that this book will provide some physicians with the information they require to help them gain a deeper understanding of the disease. I hope that everyone who reads this book is able to capture some of the fascination that the islets of Langerhans hold for myself and the many other workers actively engaged in trying to unravel their mys teries.