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- Title
Clinical Impact of Residual C-Peptide Secretion in Type 1 Diabetes on Glycemia and Microvascular Complications.
- Authors
Jeyam, Anita; Colhoun, Helen; McGurnaghan, Stuart; Blackbourn, Luke; McDonald, Timothy J.; Palmer, Colin N.A.; McKnight, John A.; Strachan, Mark W.J.; Patrick, Alan W.; Chalmers, John; Lindsay, Robert S.; Petrie, John R.; Thekkepat, Sandeep; Collier, Andrew; MacRury, Sandra; McKeigue, Paul M.; SDRNT1BIO Investigators
- Abstract
<bold>Objective: </bold>To quantify the relationship of residual C-peptide secretion to glycemic outcomes and microvascular complications in type 1 diabetes.<bold>Research Design and Methods: </bold>C-peptide was measured in an untimed blood sample in the Scottish Diabetes Research Network Type 1 Bioresource (SDRNT1BIO) cohort of 6,076 people with type 1 diabetes monitored for an average of 5.2 years.<bold>Results: </bold>In regression models adjusted for age at onset and duration, effect sizes for C-peptide ≥200 vs. <5 pmol/L were as follows: insulin dose at baseline, 27% lower (P = 2 × 10-39); HbA1c during follow-up, 4.9 mmol/mol lower (P = 3 × 10-13); hazard ratio for hospital admission for diabetic ketoacidosis during follow-up, 0.44 (P = 0.0001); odds ratio for incident retinopathy, 0.51 (P = 0.0003). Effects on the risk of serious hypoglycemic episodes were detectable at lower levels of C-peptide, and the form of the relationship was continuous down to the limit of detection (3 pmol/L). In regression models contrasting C-peptide 30 to <200 pmol/L with <5 pmol/L, the odds ratio for self-report of at least one serious hypoglycemic episode in the last year was 0.56 (P = 6 × 10-8), and the hazard ratio for hospital admission for hypoglycemia during follow-up was 0.52 (P = 0.03).<bold>Conclusions: </bold>These results in a large representative cohort suggest that even minimal residual C-peptide secretion could have clinical benefit in type 1 diabetes, in contrast to a follow-up study of the Diabetes Control and Complications Trial (DCCT) intensively treated cohort where an effect on hypoglycemia was seen only at C-peptide levels ≥130 pmol/L. This has obvious implications for the design and evaluation of trials of interventions to preserve or restore pancreatic islet function in type 1 diabetes.
- Subjects
TYPE 1 diabetes; INSULIN pumps; GLUCOSE clamp technique; DIABETES complications; C-peptide; SECRETION; INSULIN aspart; DIABETIC acidosis; BLOOD sugar; HYPOGLYCEMIC agents; INSULIN; HYPOGLYCEMIA; LONGITUDINAL method; DISEASE complications
- Publication
Diabetes Care, 2021, Vol 44, Issue 2, p390
- ISSN
0149-5992
- Publication type
journal article
- DOI
10.2337/dc20-0567