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- Title
Urine C-peptide creatinine ratio is an alternative to stimulated serum C-peptide measurement in late-onset, insulin-treated diabetes.
- Authors
Jones, A. G.; Besser, R. E. J.; McDonald, T. J.; Shields, B. M.; Hope, S. V.; Bowman, P.; Oram, R. A.; Knight, B. A.; Hattersley, A. T.
- Abstract
Diabet. Med. 28, 1034-1038 (2011) Abstract Aims Serum C-peptide measurement can assist clinical management of diabetes, but practicalities of collection limit widespread use. Urine C-peptide creatinine ratio may be a non-invasive practical alternative. The stability of C-peptide in urine allows outpatient or community testing. We aimed to assess how urine C-peptide creatinine ratio compared with serum C-peptide measurement during a mixed-meal tolerance test in individuals with late-onset, insulin-treated diabetes. Methods We correlated the gold standard of a stimulated serum C-peptide in a mixed-meal tolerance test with fasting and stimulated (mixed-meal tolerance test, standard home meal and largest home meal) urine C-peptide creatinine ratio in 51 subjects with insulin-treated diabetes (diagnosis after age 30 years, median age 66 years, median age at diagnosis 54, 42 with Type 2 diabetes, estimated glomerular filtration rate > 60 ml min−1 1.73 m−2). Results Ninety-minute mixed-meal tolerance test serum C-peptide is correlated with mixed-meal tolerance test-stimulated urine C-peptide creatinine ratio ( r = 0.82), urine C-peptide creatinine ratio after a standard breakfast at home ( r = 0.73) and urine C-peptide creatinine ratio after largest home meal ( r = 0.71). A stimulated (largest home meal) urine C-peptide creatinine ratio cut-off of 0.3 nmol/mmol had a 100% sensitivity and 96% specificity (area under receiver operating characteristic curve = 0.99) in identifying subjects without clinically significant endogenous insulin secretion (mixed-meal tolerance test-stimulated C-peptide < 0.2 nmol/l). In detecting a proposed serum C-peptide threshold for insulin requirement (stimulated serum C-peptide < 0.6 nmol/l), a stimulated (largest home meal) urine C-peptide creatinine ratio cut-off of 0.6 nmol/mmol had a sensitivity and specificity of 92%. Conclusion In patients with insulin-treated diabetes diagnosed after age 30 years, urine C-peptide creatinine ratio is well correlated with serum C-peptide and may provide a practical alternative measure to detect insulin deficiency for use in routine clinical practice.
- Subjects
URINE collection &; preservation; TREATMENT of diabetes; PANCREATIC physiology; URINE; C-peptide; CREATININE; PEOPLE with diabetes; FASTING; GLYCOSYLATED hemoglobin; INSULIN; STATISTICS; URINALYSIS; DATA analysis; BODY mass index; HUMAN research subjects; PATIENT selection; DISEASE duration; PHYSIOLOGY
- Publication
Diabetic Medicine, 2011, Vol 28, Issue 9, p1034
- ISSN
0742-3071
- Publication type
Article
- DOI
10.1111/j.1464-5491.2011.03272.x