Abstract | AIM: To determine whether the low C-peptide levels (< 50 pmol/l) produced by the pancreas for decades after onset of Type 1 diabetes have clinical significance. METHODS: We evaluated fasting C-peptide levels, duration of disease and age of onset in a large cross-sectional series (n = 1272) of people with Type 1 diabetes. We then expanded the scope of the study to include the relationship between C-peptide and HbA1c control (n = 1273), as well as diabetic complications (n = 324) and presence of hypoglycaemia (n = 323). The full range of C-peptide levels was also compared with 1,5-Anhydroglucitol, a glucose responsive marker. RESULTS:
C-peptide levels declined for decades after diagnosis, and the rate of decline was significantly related to age of onset (P < 0.0001), after adjusting for disease duration. C-peptide levels > 10 pmol/l were associated with protection from complications (e.g. nephropathy, neuropathy, foot ulcers and retinopathy; P = 0.03). Low C-peptide levels were associated with poor metabolic control measured by HbA1c (P < 0.0001). Severe hypoglycaemia was associated with the lowest C-peptide levels compared with mild (P = 0.049) or moderate (P = 0.04) hypoglycaemia. All levels of measurable C-peptide were responsive to acute fluctuations in blood glucose levels as assessed by 1,5-Anhydroglucitol (P < 0.0001). CONCLUSIONS: Low C-peptide levels have clinical significance and appear helpful in characterizing groups at-risk for faster C-peptide decline, complications, poorer metabolic control and severe hypoglycaemia. Low C-peptide levels may be a biomarker for characterizing at-risk patients with Type 1 diabetes.
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Authors | W M Kuhtreiber, S L L Washer, E Hsu, M Zhao, P Reinhold 3rd, D Burger, H Zheng, D L Faustman |
Journal | Diabetic medicine : a journal of the British Diabetic Association
(Diabet Med)
Vol. 32
Issue 10
Pg. 1346-53
(Oct 2015)
ISSN: 1464-5491 [Electronic] England |
PMID | 26172028
(Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Copyright | © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK. |
Chemical References |
- Blood Glucose
- C-Peptide
- Glycated Hemoglobin A
- 1,5-anhydroglucitol
- Deoxyglucose
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Topics |
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Blood Glucose
(metabolism)
- C-Peptide
(blood)
- Child
- Cross-Sectional Studies
- Deoxyglucose
(blood, metabolism)
- Diabetes Mellitus, Type 1
(blood, complications, diagnosis, epidemiology)
- Glycated Hemoglobin
(metabolism)
- Humans
- Middle Aged
- Prognosis
- Young Adult
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