Comment on Sakaki et al. From Disease Staging to Early Graft Assessment in β-Cell Replacement Therapy

We read with great interest the recent study by Sakaki et al. (1), evaluating uptake of [¹⁸F]FB(ePEG12)12-exendin-4 (¹⁸F-exendin-4) positron emission tomography/CT of the pancreas as a noninvasive marker of residual β-cell mass (BCM) in type 1 diabetes. A major strength of this work is that the mean standardized uptake value (SUVmean) of the pancreas at 120 min after tracer injection correlated with fasting C-peptide index, fasting serum C-peptide, and urinary C-peptide excretion, while there were inverse associations between SUVmean and HbA_1c and daily insulin dose. In this cohort pancreatic SUVmean appeared to reflect glycemic status more closely in comparison with conventional functional indices. These findings support BCM imaging as a more direct measure of β-cell status than C-peptide–based surrogate markers alone.



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