Fasting C‐peptide, a biomarker for hypoglycaemia risk in insulin‐naïve people with type 2 diabetes initiating basal insulin glargine 100 U/mL

Landgraf, Wolfgang; Owens, David R.; Frier, Brian M.; Zhang, Mei; Bolli, Geremia B.

doi:10.1111/dom.13897

Cited by 15 publications

(12 citation statements)

References 33 publications

(73 reference statements)

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“…After adjusting for covariates, severity of illness (marked as APACHE II score) had the strongest effect on dysglycemia among all the endogenous factors, followed by duration of diabetes. Prolonged diabetes can lead to worsening dysglycemia through increased insulin resistance and reduced β-cell secretory function [ 38 ]. Elevated procalcitonin level, used as a clinical marker for infection or inflammation in critically ill patients, was significantly associated with dysglycemia.…”

Section: Discussionmentioning

confidence: 99%

Association between dysglycemia and mortality by diabetes status and risk factors of dysglycemia in critically ill patients: a retrospective study

Guo

Wang

et al. 2021

Acta Diabetol

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Aims Dysglycemia, including the three domains hyperglycemia, hypoglycemia, and increased glycemic variability (GV), is associated with high mortality among critically ill patients. However, this association differs by diabetes status, and reports in this regard are limited. This study aimed to evaluate the associations between the three dysglycemia domains and mortality in critically ill patients by diabetes status and determined the contributing factors for dysglycemia. Methods This retrospective study included 958 critically ill patients (admitted to the ICU) with or without DM. Dysglycemia was defined as abnormality of any of the three dimensions. We evaluated the effects of the three domains of glucose control on mortality using binary logistic regression and then adjusted for confounders. The associations between dysglycemia and other variables were investigated using cumulative logistic regression analysis. Result GV independently and similarly affected mortality in both groups after adjustment for confounders (DM: odds ratio [OR], 1.05; 95% confidence interval [CI]: 1.03-1.08; p <0.001; non-DM: OR, 1.07; 95% CI, 1.03-1.11; p = 0.002). Hypoglycemia was strongly associated with ICU mortality among patients without DM (3.12; 1.76-5.53; p <0.001) and less so among those with DM (1.18; 0.49-2.83; p = 0.72). Hyperglycemia was non-significantly associated with mortality in both groups. However, the effects of dysglycemia seemed cumulative. The factors contributing to dysglycemia included disease severity, insulin treatment, glucocorticoid use, serum albumin level, total parenteral nutrition, duration of diabetes, elevated procalcitonin level, and need for mechanical ventilation and renal replacement therapy. Conclusion The association between the three dimensions of dysglycemia and mortality varied by diabetes status. Dysglycemia in critical patients is associated with excess mortality; however, glucose management in patients should be specific to the patient’s need considering the diabetes status and broader dimensions. The identified factors for dysglycemia could be used for risk assessment in glucose management requirement in critically ill patients, which may improve clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Association between dysglycemia and mortality by diabetes status and risk factors of dysglycemia in critically ill patients: a retrospective study

Guo

Wang

et al. 2021

Acta Diabetol

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“…levels, there is no consensus on what is considered normal and abnormal FCP concentration ranges in T2DM. 7 To investigate if FCP can predict outcomes in persons with T2DM of insulin-naive nature who are taking various oral hypoglycemic medications, including metformin 'MT', sulphonylurea 'SU', thiazolidinediones 'TZD', dipeptidyl peptidase 4 inhibitors 'DPP4', glinides 'GL'; whether alone or combined) after starting basal insulin therapy, we further conducted a post hoc analysis on participant levels from large insulin-naïve cohorts. 7 In this work we aimed to assess the relationship between baseline fasting C-peptide (FCP) and hypoglycemia risk at basal insulin initiation in insulinnaïve people with type 2 diabetes.…”

Section: Contemporarymentioning

confidence: 99%

Relation of Fasting C-peptide Level and Occurrence of Hypoglycemia at Insulin Initiation among Patients with Immune Mediated Diseases

Khedr

Raafat²,

Zedan³

et al. 2022

Al-Azhar International Medical Journal

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Background: Controlling diabetes is a challenging mission specifically in patients who have an immune-mediated disease. Hypoglycemia is one of the common complications especially during shifting from oral to insulin treatment. So, the Prediction of hypoglycemia may ease diabetes control. C-peptide may have a role in the occurrence of hypoglycemia. Aim of the study: To assess the relationship between baselines fasting Cpeptide (FCP) and hypoglycemia risk at basal insulin initiation in insulinnaïve people with type 2 diabetes. Patients and Methods: This study was a prospective study conducted on 60 subjects (their age ranging between 40 -60 years), in which they were divided into 2 groups: Group (A): patients group included 30 patients suffering from type 2 diabetes mellitus with a high level of plasma fasting c-peptide ( ≥ 2 nmol/L). Group (B): patients group included 30 patients suffering from type 2 diabetes mellitus with a low level of plasma fasting c-peptide (≤ 0.4 nmol/L). Overall Hypoglycemia, nocturnal, and severity of Hypoglycemia were assessed. All patients were selected from the internal medicine department and outpatient clinic (at both Al Hussein and Sayed Jalal University Hospitals). Results: the comparison between both groups at baseline and after 24 weeks was done regarding Hypoglycemia, overall Hypoglycemia, nocturnal, and severity of Hypoglycemia. Hypoglycemia was statistically significantly found in patients with low plasma fasting C-peptide rather than the patients who had high levels of plasma fasting C-peptide. Conclusion: Low fasting plasma C-peptide is associated with the risk of hypoglycemia in diabetic patients with the immune-mediated disease who started insulin therapy.

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“…Therapeutic hyperinsulinemia along with persistent hepatic insulin sensitivity (Fig. 6) explain the risk of hypoglycaemia in people with type 1 diabetes on insulin especially in those with impaired counterregulatory responses of glucagon and adrenaline [21,24,25], as well in those with type 2 diabetes of long duration and low plasma C-peptide [47,48]. Because of the high hepatic sensitivity, insulin has a really narrow therapeutic window which makes its s.c. replacement challenging [21][22][23][24][25], especially in the fasting state.…”

Section: 9mentioning

confidence: 99%

The physiological basis of insulin therapy in people with diabetes mellitus

Bolli

Porcellati

Lucidi

et al. 2021

Diabetes Research and Clinical Practice

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Insulin therapy has been in use now for 100 years, but only recently insulin replacement has been based on physiology. The pancreas secretes insulin at continuously variable rates, finely regulated by sensitive arterial glucose sensing. Pancreatic insulin is delivered directlyin the portal blood to insulinize preferentially the liver. In the fasting state, insulin is secreted at a low rate to modulate hepatic glucose output. After liver extraction (50%), insulin concentrations in peripheral plasma are 2.4-4 times lower than in portal, but still efficacious to restrain lipolysis. In the prandial condition, insulin is secreted rapidly in large amounts to increase portal and peripheral concentrations to peaks 10-20 times greater vs the values of fasting within 30-40 min from meal ingestion. The prandial portal hyperinsulinemia fully suppresses hepatic glucose production while peripheral hyperinsulinemia increases glucose utilization, thus limitating the post-prandial plasma glucose elevation. Physiology of insulin indicates that insulin should be replaced in people with diabetes mimicking the pancreas, i.e. in a basal-bolus mode, for fasting and prandial state, respectively. Despite the presently ongoing limitations (subcutaneous and peripheral rather than portal and intravenous insulin delivery), basal-bolus insulin allows people with diabetes to achieve A1c in the range with minimal risk of hypoglycaemia, to prevent vascular complications and to ensure good quality of life.

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Fasting C‐peptide, a biomarker for hypoglycaemia risk in insulin‐naïve people with type 2 diabetes initiating basal insulin glargine 100 U/mL

Cited by 15 publications

References 33 publications

Association between dysglycemia and mortality by diabetes status and risk factors of dysglycemia in critically ill patients: a retrospective study

Association between dysglycemia and mortality by diabetes status and risk factors of dysglycemia in critically ill patients: a retrospective study

Relation of Fasting C-peptide Level and Occurrence of Hypoglycemia at Insulin Initiation among Patients with Immune Mediated Diseases

The physiological basis of insulin therapy in people with diabetes mellitus

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