Immune cell infiltration into pancreatic islets (termed insulitis) has been linked with destruction of pancreatic β-cells and thus with onset of diabetes mellitus. Recently published guidelines for reporting insulitis may generate some deliberation on pancreatic islet inflammation and a re-examination of the role that immune cells play in the process of β-cell death and dysfunction. Herein, we offer the viewpoint that a mild insulitis (e.g., 2-fold increase in leukocytic infiltration) would be sufficient to produce an adequate supply of inflammatory molecules capable of initiating and maintaining an inflammatory state within the pancreatic islets.Recent guidelines recommend that a >2-fold increase in CD45+ immune cell infiltrates into islets be the minimum threshold for reporting insulitis [1]. While standardization of the criteria for reporting insulitis is an excellent idea, these new parameters may raise questions about whether a mild leukocyte infiltration (e.g., 2-fold increase) into the pancreas and targeted towards islets is responsible for reductions in β-cell mass and function. Since pro-inflammatory cytokines are a common link to both T1DM and T2DM [2-4], we propose herein that the secreted factors from the leukocytic infiltrates, in combination with the activity of the islet resident immune cells, ultimately determine the rate of decline of β-cell mass and function. Therefore, in our opinion, a 2-fold increase in insulitis would be sufficient to promote losses in functional β-cell mass, if the immune cells present near or within islets were in a pro-inflammatory state. Thus, the quantity and array of pro-inflammatory mediators produced by the immune cell population within the islets will almost certainly produce alterations in insulin secretion, changes in β-cell mass, and the development of diabetes while the total immune cell numbers per se may or may not offer any specific indication of disease progression.