The prevalence of diabetes mellitus (DM) continues to be a global concern among health care practitioners. Without collaboration and interventions, this chronic disease, which poses a significant financial burden for health care institutions, will continue to be problematic. Promoting the use of glycemic control measures among diabetic patients is an intervention, which has the potential to reduce diabetic complications and improve outcomes. The purpose of this doctoral project was to explore available evidence through a systematic review of the best practices for glucose management. The chronic care model served as the theoretical framework. The evidence based practice question was, What is the current evidence supporting the utilization of a computer-based glucose management system (CBGMS) for inpatient diabetic adults in acute and critical care settings? A systematic review was conducted, yielding 532 studies in which 3 of the studies related to CBGMSs published from 2008 to 2017 were critically appraised. The John Hopkins Nursing Evidence Appraisal Tool with specific inclusion and exclusion criteria was utilized. Participants were adult patients (aged 18 and over) with DM in inpatient care settings who were English speaking. Interventions included the traditional paper-based sliding scale regimen versus the utilization of a CBGMS. Outcome measures included decreased length of stay, reduced cost, and glucose optimization. A conclusion was the implementation of a CBGMS has the potential to improve patient outcomes with additional research that exhibits overall benefits and implement into practice. Thus, implementation of a CBGMS can lead to positive social change by aiding in a change in practice that will ultimately ameliorate patient health outcomes.

Diabetes, a chronic disease with devastating but preventable consequences, is common in the United States, especially within African American communities. Earlier research has indicated that 21.7% of African American parents have children diagnosed with Type 1 diabetes in the Mississippi Delta Region. Researchers have examined coping, stress, and behaviors of African American parents of children diagnosed with Type 1 diabetes; however, there is a gap in literature regarding how African American parents can cope with stress and how changes in health behavior due to Type 1 diabetes impact African American families. The purpose of this qualitative phenomenological study was to explore the lived experiences of African American parents, examining how they can cope with stress and how their families are impacted by the changes in health behavior due to Type 1 diabetes. The transtheoretical model, used to evaluate a person's preparedness to pursue a new healthier behavior, was applied. Through semi-structured interviews, data collected from 13 families were recorded, transcribed, and coded into themes. Phenomenological data analysis was performed based on the descriptive technique, using a computer-based NVivo model and preset codes. In this study, African Americans are likely to accept and acknowledge the impact of denial as a coping mechanism, while accepting the behavioral changes, and this will likely alert professionals in this field of study. Also, this will lead to a positive social change in the study of Type 1 Diabetes.

Várias evidências, incluindo as originadas de estudos anteriores do LBR&MEC, sugerem que condições adversas durante o desenvolvimento intrauterino promovam alterações moleculares e estruturais em órgãos e sistemas vitais podendo comprometer o seu funcionamento no indivíduo adulto. A hiperglicemia é um fator que influencia negativamente o desenvolvimento fetal, modificando processos biológicos importantes, como o padrão de síntese e deposição dos componentes da matriz extracelular (MEC). A MEC participa diretamente do processo de ramificação e morfogênese do pâncreas, e pouco é conhecido a respeito dos efeitos da hiperglicemia materna sobre a MEC desse órgão durante seu desenvolvimento. Investigamos por meio de imuno-histoquímica como a hiperglicemia materna severa modifica a distribuição de panlaminina, das cadeias &#945 1 ey1 das lamininas e da integrina &#945 3, moléculas da MEC que desempenham um papel chave na diferenciação do pâncreas endócrino. Avaliamos o perfil proliferativo das células presentes nas ilhotas e ainda, a distribuição das células &#945 e &#946 por meio da marcação de glucagon e insulina no pâncreas de fetos de 19 dias. Analisamos por RT-qPCRa expressão dos fatores de transcrição Pdx1 e Pax4 que controlam o desenvolvimento e diferenciação das células &#946 pancreáticas. O modelo utilizado foi o de gestação complicada por diabetes mellitus do tipo 1 (DM1), desenvolvido por nosso grupo, quimicamente induzido por aloxana sem tratamento de reposição insulínica, em camundongos. Observamos que a marcação de panlaminina e das cadeias &#945 1 e y1 das lamininas é mais fraca no pâncreas endócrino dos fetos de mães hiperglicêmicas, quando comparado ao grupo controle. Por outro lado, vimos um aumento na deposição da integrina &#945 3 na membrana basal das ilhotas pancreáticas dos fetos gerados sob condições de hiperglicemia materna. O índice proliferativo das células endócrinas, observado por imuno-histoquímica para PCNA, também é menor nesse grupo. Observamos um aumento da área de ilhotas fetais imunomarcadas para a insulina, indicando aumento na massa de células &#946 nessas ilhotas, enquanto que a área imunomarcada para glucagon estava com marcação menos intensa no grupo experimental comparado ao controle. Identificamos que a expressão relativa de Pdx1 é menor no pâncreas do grupo experimental comparado a expressão nos animais do grupo controle, enquanto a expressão de Pax4 está aumentada. Concluímos por meio de nossas abordagens histoquímicas que a hiperglicemia materna altera a morfogênese do pâncreas endócrino fetal modificando o padrão de deposição de moléculas da membrana basal peri-ilhotas, promovendo uma diminuição da atividade proliferativa das células endócrinas, associada a alterações na expressão de fatores de crescimento importantes para o estado diferenciado e proliferativo das células &#946. Essas células apresentam aumento da massa funcional identificada pelo aumento da deposição de insulina no tecido pancreático. / Previous studies from our lab and others have shown that adverse conditions during intrauterine development promotes molecular and structural changes in vital organs and systems which may alter on their function in the adult individuals. Hyperglycemia impacts on fetal development by modifying important biological processes, such as the pattern of synthesis and deposition of extracellular matrix (ECM) components. ECM cooperates in pancreatic branching and morphogenesis and little is known about the effect of maternal hyperglycemia on the pancreas ECM during development. We investigate through immunohistochemistry, how severe maternal hyperglycemia modifies the distribution of panlaminin, laminins &#945 1 and &#9781 chains and integrin &#945 3, ECM molecules that play a key role in the differentiation of the endocrine pancreas. We evaluate the proliferative index of islet cells and, &#945 and &#946 cells distribution, by insulin and glucagon fetal (E19.0) pancreas staining. We analyzed by RT-qPCR the expression of the Pdx1 and Pax4 transcription factors that control the development and differentiation of pancreatic &#946 cells. The model used was created by our group, a pregnancy model complicated by type 1 diabetes mellitus (T1D) chemically induced by alloxan without treatment of insulin replacement, in mice. We observed that the labeling of panlaminin and laminins &#945 1 and y1 chains is weaker in the endocrine pancreas of the fetuses from hyperglycemic mothers. On the other hand, integrin &#945 3 deposition increased in the basement membrane of the pancreatic islets of the fetuses generated under maternal hyperglycemia. Immunohistochemistry for PCNA showed lower proliferative index of endocrine cells. There was an increase in the area of immunolabeled fetal islets indicating an increase in &#946-cell mass in these islets; whereas the glucagon-immunolabeled area was smaller in the experimental group compared to the control group. The relative expression of Pdx1 was lower in the pancreas from the experimental group, and the Pax4 expression was increased. We conclude from our histochemical approaches that maternal hyperglycemia alters fetal endocrine pancreas morphogenesis by modifying the pattern of peri-islet basement membrane molecules, promoting a decrease in endocrine cell proliferative activity associated with changes in the expression of important growth factors for the differentiated and proliferative state of the &#946-cells. These cells have increased functional mass identified by increased insulin deposition in pancreatic tissue.

O Diabetes Mellitus do tipo 1 (DM1) é uma doença metabólica multifatorial caracterizada por hiperglicemia e hipoinsulinemia crônicas, decorrentes da destruição progressiva das células &#946 pelo sistema imunológico. Durante a progressão do DM1, as ilhotas de Langherhans são invadidas por células do sistema imune que secretam citocinas pró-inflamatórias, gerando um quadro denominado insulite. A exposição das células &#946 a essas citocinas leva a ativação de diversas vias de sinalização que aumentam o estresse oxidativo e de retículo endoplasmático, contribuindo para a indução da morte das células &#946. Existem muitos estudos que investigam as vias moleculares que levam à destruição da célula durante o DM1, contudo é necessário um melhor entendimento da regulação e contribuição dessas diferentes vias para o desenvolvimento dessa patologia para que se possa desenhar terapias mais apropriadas para impedir seu desenvolvimento ou até mesmo para se atingir uma cura. Algumas das dificuldades encontradas na aplicação desses estudos estão relacionadas ao fato de que eles são conduzidos em sua maioria em células &#946 ou ilhotas isoladas em cultura. Sabe-se que há uma importante regulação entre os diferentes tipos celulares presentes na ilhota e também entre as células da ilhota e as células adjacentes a ela, o que, sem dúvida, influencia no destino da célula &#946 frente a um ataque autoimune. Este trabalho visou aperfeiçoar o conhecimento acerca do comportamento das células da ilhota pancreática frente ao desenvolvimento do DM1, utilizando técnicas de imunomarcação em cortes histológicos pancreáticos de três modelos animais de DM1. No primeiro modelo: Influência do exercício físico na indução do DM1, mostramos que o exercício físico é capaz de prevenir a destruição das células &#946 e potencialmente estar envolvido na transdiferenciação celular para recuperação de células endócrinas na ilhota desses animais. No segundo modelo: Efeito de NOX1 e NOX2 na viabilidade e função de células &#946 \", observamos que a presença dessas NADPH oxidases parece ter influência na estrutura e provavelmente na viabilidade de células &#946. No terceiro modelo: Papel de HNF4 &#945 na viabilidade e função das células &#946, mostramos que a imunomarcação das ilhotas de animais KO para esse fator de transcrição nas células &#946 é uma ferramenta de extrema importância para esse estudo. O desenvolvimento desse trabalho possibilita que a investigação de diferentes vias envolvidas na destruição das células &#946 seja realizada no ambiente em que essas células se encontram, permitindo avaliar a ativação de vias especificas, como por exemplo ativação de NF-kB e validar os resultados observados em células isoladas. / Type 1 Diabetes Mellitus (DM1) is a multifactorial metabolic disease characterized by chronic hyperglycemia and hypoinsulinemia, which is due to the progressive and specific destruction of &#946 cells by the immune system. During the progression of DM1, the islets of Langherhans are invaded by cells of the immune system that secrete proinflammatory cytokines, in a process called insulitis. Exposure of &#946 cells to these cytokines leads to the activation of several signaling pathways that increase oxidative and endoplasmic reticulum stress, contributing to the -cell death. There are many studies that investigate the molecular pathways that lead to the destruction of the &#946-cell during DM1, but a better understanding of the regulation and contribution of these different pathways to the development of this pathology is necessary in order to design more appropriate therapies to prevent their development or even to achieve a cure. Some of the difficulties encountered in the application of these studies are related to the fact that they are conducted mostly on &#946-cells or isolated islets in cell culture. It is known that there is an important regulation between the different cell types present in the islet and also between the islet cells and the cells adjacent to it, which undoubtedly influences the fate of the &#946-cell against an autoimmune attack. This work aimed to improve the knowledge about the behavior of pancreatic islet cells in the development of DM1, using immunostaining techniques in pancreatic histological sections of three animal models of DM1. In the first model, \"Influence of physical exercise on the induction of DM1\", we showed that physical exercise is able to prevent the destruction of &#946 cells and potentially be involved in cell transdifferentiation for the recovery of endocrine cells in the islet of these animals. In the second model, \"Effect of NOX1 and NOX2 on viability and &#946 cell function\", we observed that the presence of these NADPH oxidases appears to influence the structure and probably the viability of &#946 cells. \"In the third model:\" Role of HNF4&#945 in viability and &#946 cell function, we show that the immunostaining of islets of KO animals for this transcription factor in &#946 cells is a tool of paramount importance for this study. The development of this work enables the investigation to be performed in the environment of these cells, allowing to evaluate the activation of specific pathways and validate the results observed in isolated cells.

Le diabète de type 1 (DT1) est une maladie auto-immune caractérisée par la destruction sélective des cellules β pancréatiques entraînant une hyperglycémie et nécessitant un traitement par insulinothérapie à vie. La physiopathologie du DT1 est complexe et fait intervenir les cellules immunitaires innées et adaptatives dans la pathogenèse et la régulation du DT1. Alors que le développement du diabète peut être associé à des facteurs génétiques, des facteurs environnementaux sont également impliqués dans le déclenchement de cette maladie. Des études récentes ont mis en évidence le rôle du microbiote intestinal dans le développement ou la protection du DT1. Des modifications du microbiote ont par ailleurs été observées chez les patients DT1 avant le déclenchement de la maladie. Plusieurs études ont également décrit des altérations de la muqueuse intestinale chez les souris NOD et chez les patients DT1. Les cellules MAIT sont des lymphocytes T de type inné reconnaissant la molécule de MR1 et exprimant un TCR Va semi-invariant (Vα7.2-Jα33 chez l'homme et Vα19-Jα33 chez la souris). Les cellules MAIT sont activées par des métabolites bactériens, dérivés de la synthèse de la riboflavine. Leur particularité est de produire rapidement diverses cytokines telles que le TNF-α, l’IFN-γ et l’IL-17 et le granzyme B. La localisation et la fonction des cellules MAIT suggèrent qu'elles pourraient jouer un rôle clé dans le maintien de l'intégrité intestinale et le développement des réponses auto-immunes dirigées contre les cellules β. Dans l’ensemble, nos résultats chez les patients DT1 et chez les souris NOD montrent une activation anormale des cellules MAIT chez les patients DT1. Ces anomalies peuvent être détectées avant le déclenchement de la maladie. L'analyse des tissus périphériques de souris NOD souligne le rôle des cellules MAIT dans deux tissus, le pancréas et la muqueuse intestinale. Dans le pancréas, la fréquence des cellules MAIT est augmentée. Dans ce tissu les cellules MAIT semblent participer à la destruction des cellules β. Contrairement au pancréas, les cellules MAIT situées dans la muqueuse intestinale semblent jouer un rôle protecteur grâce à leur production de cytokines IL-22 et IL-17. Nos données chez les souris NOD Mr1-/-, dépourvues de cellules MAIT, soulignent le rôle protecteur des cellules MAIT lors du développement du DT1 en participant au maintien de l'intégrité intestinale. En outre, la présence d'altérations intestinales à mesure que la maladie progresse chez les souris NOD souligne l'importance des cellules MAIT dans le maintien de l'homéostasie intestinale. De manière intéressante, les cellules MAIT pourraient représenter un nouveau biomarqueur de la maladie et permettre de développer des stratégies thérapeutiques innovantes basées sur l’activation locale des cellules MAIT. / Type 1 diabetes (T1D) is an auto-immune disease characterized by the selective destruction of pancreatic islet β cells resulting in hyperglycemia and requiring a life-long insulin replacement therapy. The physiopathology of T1D is complex and still not entirely understood. Both innate and adaptive immune cells are involved in the pathogenesis and the regulation of T1D. While diabetes development can clearly be associated with genetic inheritance, environmental factors were also implicated in this autoimmune diseases. Recent studies have highlighted the role of the intestinal microbiota in the development or protection against T1D. Gut microbiota analyses in patients have shown differences before the onset of T1D. Moreover, several studies also described gut mucosa alterations in NOD mice and in T1D patients. MAIT (Mucosal Associated Invariant T) cells are innate-like T cells recognizing the MR1 molecule and expressing a semi-invariant receptor Vα chain (Vα7.2-Jα33 and Vα19-Jα33 in mice). MAIT cells are activated by bacterial metabolites, derived from the synthesis of riboflavin. Their particularity is to rapidly produce various cytokines such as TNF-α IFN-γ, IL-17 and granzyme B. The localization and the function of MAIT cells suggest that they could exert a key role in the maintenance of gut integrity, thereby controlling the development of autoimmune responses against pancreatic β cells. To summarize, our results in T1D patients and in NOD mice indicate an abnormal MAIT cell activation in this pathology, which occurs before disease onset. The analysis of peripheral tissues from NOD mice highlights the role of MAIT cells in two tissues, the pancreas and the gut mucosa. In the pancreas, MAIT cells frequency is elevated and they could participate to the β cells death. In contrast to the pancreas, in the gut mucosa MAIT cells could play a protective role through their cytokines production of IL-22 and IL-17. Our data in Mr1-/- NOD mice, lacking MAIT cells, reveal that these cells play a protective role against diabetes development and in the maintenance of gut mucosa integrity. Moreover, the presence of gut alteration as T1D progress in NOD mice underscores the importance of MAIT cells in maintaining gut mucosa homeostasis. Interestingly, MAIT cells could represent a new biomarker towards T1D progression and open new avenues for innovative therapeutic strategies based on their local triggering.

Exercise has a wide range of benefits for patients with type 1 diabetes, including improvements in body composition, cardiovascular risk profile and glycaemic control. Unfortunately, exercise also increases the risk of hypoglycaemia in children with type 1 diabetes, both at the time of exercise and for many hours afterwards. The availability of clear, evidence-based guidelines regarding appropriate adjustments in carbohydrate intake or insulin doses may help to prevent this exercise associated hypoglycaemia. However, current guidelines regarding exercise in children with type 1 diabetes rely heavily on adult literature or the consensus of experts. Therefore, further studies are needed in young people with diabetes to document the metabolic responses during and following exercise. In particular, the mechanisms underlying hypoglycaemia occurring many hours after exercise require further exploration. In addition, as children often exercise in the afternoon, studies performed at this time of the day are more likely to be transferrable to a real life situation. For this reason, we studied adolescents with type 1 diabetes to investigate physiological responses to exercise, focusing on afternoon activity and employing a novel variation of the euglycaemic insulin clamp technique. The core experiments involved studying diabetic adolescents on two occasions in a counterbalanced, paired design during and after afternoon exercise. Insulin was infused at a constant rate based on the subjects' usual daily insulin dose and glucose was infused to maintain euglycaemia. At 1600 hrs subjects either exercised at a moderate intensity (95% of their lactate threshold) for 45 minutes on a cycle ergometer (exercise study), or sat on the ergometer without exercising (rest study). Using this experimental design, it was found that glucose infusion rates (GIR) to maintain euglycaemia were elevated during and shortly following exercise and again from 7-11 hours after exercise compared with the rest study. Counterregulatory hormone levels were similar between the exercise and rest studies except for peaks in noradrenaline, cortisol and growth hormone levels at the end of exercise. Glucagon and adrenaline levels did not increase with exercise. The observed biphasic increase in glucose requirements paralleled the observed clinical risk of hypoglycaemia immediately during exercise and the delayed risk of hypoglycaemia which often occurs overnight.

<p>Variation of diabetes incidence over time in countries with different incidence levels and socio-economic conditions, and in an age span beyond the childhood years, may give clues for diabetes causes.</p><p><i>Materials:</i> Data from prospective type 1 diabetes registers in Sweden and Lithuania in children (0-14 years) and young adults (15-34 and 15-39 years, respectively). Number of infections recorded in health care booklets (117 cases; 270 controls); interview about the dietary intake one-year before the diagnosis and routinely recorded growth data (99 cases; 180 controls). </p><p><i>Results:</i> The incidence of type 1 diabetes in Sweden and Lithuania differed most in the younger age groups, 28.9 and 7.5/100,000/year in 0-14-year group, respectively. During 1983-2000 incidence increased in 0-14-year old children in both countries, but the pattern of change differed. During 1983-1998 the incidence increased in Swedish children, but tended to decrease in young adults, with no increase in the age group below 35 years, indicating that the increase of childhood diabetes may be due to a shift towards a younger age at diagnosis. Within a low-incidence country Lithuania there was an urban-rural gradient of incidence, especially in the younger age groups, that seemed to follow poverty distribution: incidence in the 0-39-year group was 7.1, 9.0 and 8.8/100,000/year in rural areas, towns and cities, respectively, p<0.001.</p><p>Exposure to one or more non-specific infection during the first half-year of life reduced diabetes risk: odds ratios (95%-CI) in 0-14 and 5-14-year groups were (0.60; 0.37-0.98) and (0.47; 0.26-0.87), respectively. Higher energy intake and weight-for-age were independent diabetes risk factors: odds ratios for medium and high levels of energy were 1.33 (0.52-3.42) and 5.23 (1.67-16.38), and for weight-for-age 3.20 (1.30-7.88) and 3.09 (1.16-8.22), respectively. High intake of carbohydrates, disaccharides and sucrose in particular, increased diabetes risk independently of the high intake of energy.</p><p><i>Conclusion:</i> Environmental factors associated with socio-economic conditions in childhood may be important for the occurrence of type 1 diabetes. Lack of exposure to microbial antigens early in life, higher intake of energy and more rapid growth may contribute to the increase of childhood-onset diabetes observed in many countries.</p>

<p>Type 1 diabetes is resulting from the selective destruction of insulin-producing beta-cells within the pancreatic islets. Somatostatin acts as an inhibitor of hormone secretion through specific receptors (sst1-5).</p><p>All ssts were expressed in normal rat and mouse pancreatic islets, although the expression intensity and the co-expression pattern varied between ssts as well as between species. This may reflect a difference in response to somatostatin in islet cells of the two species.</p><p>The Non-Obese Diabetic (NOD) mouse model is an experimental model of type 1 diabetes, with insulitis accompanied by spontaneous hyperglycaemia. Pancreatic specimens from NOD mice at different age and stage of disease were stained for ssts. The islet cells of diabetic NOD mice showed increased islet expression of sst2-5 compared to normoglycemic NOD mice. The increase in sst2-5 expression in the islets cells may suggest either a contributing factor in the process leading to diabetes, or a defense response against ongoing beta-cell destruction.</p><p>Somatostatin analogues were tested on a human endocrine pancreatic tumour cell line and cultured pancreatic islets. Somatostatin analogues had an effect on cAMP accumulation, chromogranin A secretion and MAP kinase activity in the cell line. Treatment of rat pancreatic islets with somatostatin analogues with selective receptor affinity was not sufficient to induce an inhibition of insulin and glucagon secretion. However, a combination of selective analogues or non-selective analogues via co-stimulation of receptors can cause inhibition of hormone production. For insulin and glucagon, combinations of sst2 + sst5 and sst1 + sst2, respectively, showed a biological effect.</p><p>In summary, knowledge of islet cell ssts expression and the effect of somatostatin analogues with high affinity to ssts may be valuable in the future attempts to influence beta-cell function in type 1 diabetes mellitus, since down-regulation of beta-cell function may promote survival of these cells during the autoimmune attack. </p>

<p>Transplanting pancreatic islets into the liver through the portal vein is currently the most common procedure in clinical islet transplantations for treating patients with brittle type 1 diabetes. However, most islet grafts fail within a 5-year period necessitating retransplantation. The vascular connections are disrupted at islet isolation and implanted islets depend on diffusion of oxygen and nutrients in the immediate posttransplantation period. Rapid and efficient revascularization is of utmost importance for the survival and long-term function of transplanted islets. </p><p>In this thesis, the influence of the implantation microenvironment for islet engraftment and function was studied. Islets were transplanted into the liver, the renal subcapsular site or the pancreas. Islets implanted into the liver contained fewer glucagon-positive cells than islets implanted to the kidney and endogenous islets. Intraportally transplanted islets responded with insulin and glucagon release to secretagogues, but only when stimulated through the hepatic artery. Thus, the intrahepatic grafts were selectively revascularized from the hepatic artery. The vascular density in human islets transplanted into the liver of athymic mice was markedly lower when compared to human islets grafted to the kidney. Islets implanted into their physiological environment, the pancreas, were markedly better revascularized. Insulin content, glucose-stimulated insulin release, (pro)insulin biosynthesis and glucose oxidation rate were markedly decreased in transplanted islets retrieved from the liver, both when compared to endogenous and transplanted islets retrieved from the pancreas. Only minor changes in metabolic functions were observed in islets implanted into the pancreas when compared to endogenous islets. </p><p>The present findings demonstrate that the microenvironment has a major impact on the engraftment of transplanted islets. Elucidating the beneficial factors that promote engraftment would improve the survival and long-term function of transplanted islets. Ultimately, islet transplantation may be provided to an increased number of patients with type 1 diabetes.</p>

The mouse pancreas is a mixed exocrine and endocrine glandconsisting of three lobular compartments: the splenic, duodenal and gastric lobes. During embryogenesis, the pancreas forms from two progenitor populations located on the dorsal and ventral side of the primitive gut tube. These anlagen are brought in close proximity as the gut elongates and rotates, and fuse to form a single organ. The splenic and duodenal lobes develop from the dorsal and ventral anlagen, respectively. In the adult pancreas, exocrine tissue secretes digestive enzymes intothe gut lumen to support nutrient uptake. The endocrine Islets of Langerhans are scattered throughout the exocrine tissue and aid in regulation of energy homeostasis through the secretion of hormones. One of the key players in energy homeostasis is the pancreatic ß-cell, which is the most abundant cell type of the islets. The β-cells regulates blood glucose levels through the action of insulin. Conditions where this regulation does not function properly are gathered under the common name of Diabetes mellitus. Type 1 diabetes (T1D) is characterized by insulin deficiency due to autoimmune destruction of the ß-cells. Using recently developed protocols for optical projection tomography (OPT) whole-organ imaging, we have revealed new spatial and quantitative aspects on ß-cell mass dynamics and immune infiltration during the course of T1D development in the non-obese diabetic (NOD) mouse model. We show that although immune infiltration appears to occur asynchronously throughout the organ, smaller islets, mainly located in the periphery of the organ, preferentially loose their ß-cells during early stages of disease progression. Larger islets appear more resistant to the autoimmune attack and our data indicate the existence of a compensatory proliferative capacity within these islets. We also report the appearance of structures resembling tertiary lymphoid organs (TLOs) in association with the remaining islets during later phases of T1D progression. OPT has already proven to be a useful tool for assessments of ß-cellmass in the adult mouse pancreas. However, as with other techniques, previous protocols have relied on a tedious degree of manual postivacquisition editing. To further refine OPT-based assessment of pancreatic ß-cell mass distribution in the murine pancreas, we implemented a computational statistical approach, Contrast-Limited Adaptive Histogram Normalisation (CLAHE), to the OPT projection data of pancreata from C57Bl/6 mice. This methodology provided increased islet detection sensitivity, improved islet morphology and diminished subjectivity in thresholding for reconstruction and quantification. Using this approach, we could report a substantially higher number of islets than previously described for this strain and provide evidence of significant differences in islet mass distribution between the pancreatic lobes. The gastric lobe stood out in particular and contained a 75% higher islet density as compared to the splenic lobe. Although the development of the early pancreatic buds has been relatively well studied, later morphogenetic events are less clear and information regarding the formation of the gastric lobe has largely been missing. Using OPT we have generated a quantitative three-dimensional road map of pancreatic morphogenesis in the mouse. We show that the gastric lobe forms as a perpendicular outgrowth fromthe stem of the dorsal pancreas at around embryonic day (e) 13.5, which grows into a mesenchymal domain overlaying the pyloric sphincter and proximal part of the glandular stomach. By analyzing mutant mice with aberrant spleen development, we further demonstrate that proper formation of the gastric lobe is dependent on the initial formation of the closely positioned spleen, indicating a close interplay between pancreatic and splenic mesenchyme during development. Additionally, we show that the expression profile of markers for pancreatic multipotent progenitors within the pancreas is heterogenous with regards to lobular origin. Altogether, our studies regarding the morphogenesis and adult constitution of the mouse pancreas recognize lobular heterogeneities that add important information for future interpretations of this organ.