Discussion
INFLAMMATION, DISEASE, TYPE 1 DIABETES, DYSFUNCTION, RETINA, INSULIN RESISTANCE, PATHOGENESIS, COMPLICATIONS
This study describes a Overall, our result suggests that early diagnosis and prompt treatment initiation may improve outcomes in type 1 diabetes treated with LDX, particularly in patients with β-cell dysfunction, which is indicated by higher HbA1c and DIR and lower HOMA-B and C-peptide levels. In our trial, β-cell dysfunction may suggest that the immune system is still actively attacking the insulin-producing cells in the pancreas, making prevention therapies potentially more effective in stopping further damage. This hypothesis is also supported by previous research that found a greater response to teplizumab among individuals with lower C-peptide responses to a glucose tolerance test (The other differences in endo-metabolic and immunologic features between HIGH-DIR and LOW-DIR to LDX in type 1 diabetes further suggest the presence of different degrees of β-cell dysfunction and immune dysregulation.The glucagon-to-C-peptide ratio is a significant marker of alpha cell dysfunction in the pancreas. In individuals with type 1 diabetes, this ratio is often increased due to the damage and loss of beta cells. This leads to reduced insulin secretion and elevated glucagon levels, resulting in an imbalance in hormone secretion and an elevated glucagon-to-C-peptide ratio. Normally, alpha cells secrete glucagon, which raises blood glucose levels by stimulating glycogenolysis and gluconeogenesis. In healthy individuals, the release of insulin from beta cells helps inhibit glucagon secretion and maintain glucose homeostasis. However, in type 1 diabetes, the loss of beta cell function leads to inadequate insulin production and reduced inhibitory signals on alpha cells. As a result, glucagon secretion remains unchecked, causing an elevated glucagon-to-C-peptide ratio. Additionally, insulin resistance, which primarily affects peripheral tissues, can also impact alpha cell function and glucagon secretion. In individuals with insulin resistance, alpha cells may become less responsive to the inhibitory effects of insulin (Adiponectin is a hormone secreted by adipose tissue that plays a role in regulating glucose and lipid metabolism. In autoimmune type 1 diabetes, adiponectin levels have been shown to be elevated at the time of diagnosis (CCL2/MCP-1 is a chemokine produced by various cell types and acts as a chemoattractant for monocytes, T cells, and natural killer cells, involved in recruiting immune cells to sites of inflammation. Its levels are elevated in patients with type 1 diabetes, particularly during the early stages of the disease (VEGF is a potent angiogenic factor that plays a key role in the development and maintenance of blood vessels in the body. In type 1 diabetes, increased VEGF expression has been observed in various tissues, including the retina and kidney, and is thought to be involved in the pathogenesis of microvascular complications. The presence of VEGF in individuals with type 1 diabetes at onset was positively associated with indicators of glycemic control and inflammatory parameters (Th1, Th1/Th2 ratio), while being negatively associated with the percentage of Treg cells (Our study has some limitations. The first limitation is the small number of participants. The second limitation is that, even if started by a predefined subgroup analysis, the study remains In summary, this 