Low levels of C-peptide have clinical significance for established Type 1 diabetes.
Low levels of C-peptide have clinical significance for established Type 1 diabetes.
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DOI：
10.1111/dme.12850
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发表时间：
2015-10
期刊：
影响因子：
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通讯作者：
Faustman DL
中科院分区：
文献类型：
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作者：
Kuhtreiber WM;Washer SL;Hsu E;Zhao M;Reinhold P 3rd;Burger D;Zheng H;Faustman DL
确定1型糖尿病发病后数十年胰腺产生的低C肽水平（<50 pmol/l）是否具有临床意义。我们在一个大型横断面系列（n=1272）的1型糖尿病患者中评估了空腹C肽水平、疾病持续时间和发病年龄。然后，我们扩大了研究范围，包括C肽和HbA 1c控制（n=1273），以及糖尿病并发症（n=324）和低血糖（n=323）之间的关系。还将C肽水平的全范围与葡萄糖响应标记物1，5-脱水葡萄糖醇进行比较。C肽水平在诊断后数十年内下降，在调整疾病持续时间后，下降率与发病年龄显著相关（P<0.0001）。C肽水平> 10 pmol/l与并发症（如肾病、神经病变、足溃疡和视网膜病变; P=0.03）的保护有关。低C肽水平与HbA 1c测量的代谢控制不良相关（P<0.0001）。与轻度（P=0.049）或中度（P=0.04）低血糖相比，重度低血糖与最低C肽水平相关。所有可测量的C肽水平均响应于通过1，5-脱水葡萄糖醇评估的血糖水平的急性波动（P<0.0001）。低C肽水平具有临床意义，似乎有助于描述C肽下降更快、并发症、代谢控制较差和严重低血糖的风险人群。低C肽水平可能是表征1型糖尿病高危患者的生物标志物。
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. 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. 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). 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.