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Diabetologia. 2020 Feb 7. doi: 10.1007/s00125-020-05099-3. [Epub ahead of print]

Preserved C-peptide secretion is associated with fewer low-glucose events and lower glucose variability on flash glucose monitoring in adults with type 1 diabetes.

Author information

1
Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, UK. fraser.gibb@ed.ac.uk.
2
Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK. fraser.gibb@ed.ac.uk.
3
Edinburgh Centre for Endocrinology & Diabetes, Western General Hospital, Edinburgh, UK.
4
Department of Clinical Biochemistry, Western General Hospital, Edinburgh, UK.

Abstract

AIMS/HYPOTHESIS:

We aimed to assess whether persistence of C-peptide secretion is associated with less glucose variability and fewer low-glucose events in adults with type 1 diabetes who use flash monitoring.

METHODS:

We performed a cross-sectional study of 290 adults attending a university teaching hospital diabetes clinic, with type 1 diabetes, who use flash monitoring and in whom a random plasma C-peptide was available in the past 2 years. Variables relating to flash monitoring were compared between individuals with low C-peptide (<10 pmol/l) and those with persistent C-peptide (either 10-200 pmol/l or 10-50 pmol/l). In addition, the relationship between self-reported hypoglycaemia and C-peptide was assessed (n = 167). Data are median (interquartile range).

RESULTS:

Individuals with preserved C-peptide secretion (10-200 pmol/l) had shorter duration of diabetes (15 [9-24] vs 25 [15-34] years, p < 0.001) and older age at diagnosis (23 [14-28] vs 15 [9-25] years, p < 0.001), although current age did not differ in this cohort. Preserved C-peptide was associated with lower time with glucose <3.9 mmol/l (3% [2-6%] vs 5% [3-9%], p < 0.001), fewer low-glucose events per 2 week period (7 [4-10] vs 10 [5-16], p < 0.001), lower SD of glucose (3.8 [3.4-4.2] vs 4.1 [3.5-4.7] mmol/l, p = 0.017) and lower CV of glucose (38.0 [35.0-41.6] vs 41.8 [36.5-45.8], p < 0.001). These differences were also present in those with C-peptide 10-50 pmol/l and associations were independent of diabetes duration and estimated HbA1c in logistic regression analysis. Preserved C-peptide was also associated with lower rates of self-reported asymptomatic hypoglycaemia (8.0% vs 22.8% in the past month, p = 0.028).

CONCLUSIONS/INTERPRETATION:

Preserved C-peptide secretion is associated with fewer low-glucose events and lower glucose variability on flash monitoring. This suggests that individuals with preserved C-peptide may more safely achieve intensive glycaemic targets.

KEYWORDS:

C-peptide; Clinical diabetes; Continuous glucose monitoring; Devices; Hypoglycaemia

PMID:
32034440
DOI:
10.1007/s00125-020-05099-3

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