Insulin-requiring diabetes mellitus (also known as insulin-dependent or Type I diabetes) accounts for approximately 15 per cent of all human diabetes. It has been recognized since antiquity. However, as Cahill and McDevitt recently observed in the Journal, the cause of the disease remains unknown.1 Despite this uncertainty, some clinical investigators are now attempting to treat acute insulin-requiring diabetes with immunosuppression. It seems appropriate to ask whether such treatments are warranted, given our current knowledge of the disorder and of the risks of immunotherapy. Three key factors in the pathogenesis of the disease have been identified: heredity, environment, and autoimmunity. . . .
