Can PET/CT Imaging Reveal Beta-Cell Mass Changes in T1D?
Sevilay Tokgöz, Pleun de Groen, Theodorus J.P. Jansen, Coco M. Fuhri Snethlage, Marti Boss, Hajime Yamazaki, Max Nieuwdorp, Martin Gotthardt, Nordin M.J. Hanssen and Rick I. Meijer.
Beta-Cell Mass and Function, Pancreatic Volume, and Fat Differences Between Short- and Long-Duration Type 1 Diabetes: A Detailed PET/CT Imaging Study. J Nucl Med. 2026 Oct 8:jnumed.126.272915. Online ahead of print.
In type 1 diabetes (T1D), the immune system progressively destroys insulin-producing beta cells in the pancreas. Although C-peptide measurements provide information about remaining insulin production, they do not directly reveal how many beta cells are still present. Understanding the relationship between beta-cell mass and function could help researchers better understand disease progression and evaluate future treatments aimed at preserving beta cells.
In this study, Tokgöz and colleagues used an advanced PET/CT imaging technique to compare beta-cell mass, beta-cell function, pancreatic volume and pancreatic fat in 26 adults with T1D. The researchers compared 16 participants with a diabetes duration of less than seven years with 10 participants who had lived with T1D for seven years or longer.
Key findings:
- Higher beta-cell mass in people with shorter diabetes duration: Participants diagnosed less than seven years earlier had significantly higher estimated beta-cell mass than those with longer-duration T1D (4.4 versus 2.8 kBq/MBq; p=0.012).|
- Better remaining beta-cell function: C-peptide responses were higher in the shorter-duration group, indicating greater remaining insulin production. However, this difference was no longer statistically significant after adjustment for age and sex.
- Differences in pancreatic volume and fat: Participants with shorter-duration T1D had a larger pancreas (61.2 versus 45.3 mL) and lower estimated pancreatic fat deposition than those with longer-duration T1D.
- Beta-cell mass and function were related, but not identical: Higher estimated beta-cell mass was associated with better beta-cell function (r=0.46). Importantly, PET/CT imaging detects both functional and potentially non-functional beta cells, providing information that C-peptide measurements alone cannot capture.
- Imaging may help monitor disease progression: The PET/CT technique, using a radiolabelled exendin tracer targeting GLP-1 receptors, allowed researchers to visualise and estimate beta-cell mass in people with both shorter- and longer-duration T1D.
These findings suggest that combining beta-cell imaging with C-peptide measurements could provide a more complete picture of changes in the pancreas during T1D progression. This may eventually help researchers evaluate treatments designed to preserve or restore beta-cell function.
However, this was a small, exploratory analysis comparing different participants rather than following individuals over time. Larger longitudinal studies are needed to establish how beta-cell mass changes throughout the course of T1D and whether imaging can reliably monitor treatment effects.
Concluding, the authors state
“These findings support the significant potential of this imaging technique to monitor disease progression in the future and offer promising insights in the timing for interventions to restore b-cell function or to slow down b-cell destruction.”
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