Pancreatic islet -cell death occurs in type 1 and 2 diabetes mellitus, leading to absolute or relative insulin deficiency. -cell death in type 1 diabetes is due predominantly to autoimmunity. In type 2 diabetes -cell death occurs as the combined consequence of increased circulating glucose and saturated fatty acids together with adipocyte secreted factors and chronic activation of the innate immune system. In both diabetes types intra-islet inflammatory mediators seem to trigger a final common pathway leading to -cell apoptosis. Therefore anti-inflammatory therapeutic approaches designed to block -cell apoptosis could be a significant new development in type 1 and 2 diabetes.