Long-duration type 1 diabetes: persistent C-peptide levels tied to reduced hypoglycaemia but not HbA1c

  • Marren SM & al.
  • Diabet Med
  • 6 Apr 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • In adults with long-duration type 1 diabetes (T1D), persistent C-peptide level (>200 pmol/L) is associated with reduced self-reported hypoglycaemia and insulin doses but not with glycated haemoglobin (HbA1c) level.

Why this matters

  • Findings suggest that individuals with persistent C-peptide receiving routine care are potentially under-treated and routinely testing C-peptide and subsequently setting personalised targets for treatment intensification may improve glycaemic control and complication rates.

Study design

  • This cross-sectional case-control study determined ongoing endogenous insulin secretion of 221 patients with T1D by measuring C-peptide levels after mixed-meal tolerance test.
  • Self-reported hypoglycaemia, HbA1c (visit and historic), insulin dose and microvascular complications were compared in patients with preserved (n=70) and low C-peptide (n=151) levels.
  • Funding: Juvenille Diabetes Research Foundation.

Key results

  • Median C-peptide level was 114 (interquartile range [IQR], 43-273) pmol/L and
  • Preserved vs low C-peptide group had lower symptomatic (5.9 vs 7.5 episodes/month; incidence rate ratio [IRR], 0.79; P=.001) and asymptomatic episodes of hypoglycaemia per month (1.0 vs 2.9 episodes/month; IRR, 0.35; P<.001>
  • Visit HbA1c level was marginally higher in the preserved vs low C-peptide group (69 vs 67 mmol/mol; P=.06), but no significant difference was observed in historic HbA1c level between 2 groups (P=.4).
  • Compared with low C-peptide group, preserved C-peptide group had lower daily insulin doses (0.68 vs 0.81 units/kg; P=.01).

Limitations

  • Self-reported hypoglycaemia.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit