Postprandial <scp>C</scp>‐peptide to glucose ratio as a predictor of β‐cell function and its usefulness for staged management of type 2 diabetes

Lee, Eun Young; Hwang, Sun Mi; Lee, Seo Hee; Choi, Ae Jin; Lee, Mi Kyung; Lee, Byung Wan; Kang, Eun Seok; Ahn, Chul Woo; Soo, Bong

doi:10.1111/jdi.12187

Cited by 25 publications

(23 citation statements)

References 28 publications

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“…Pancreatic beta cell function and insulin sensitivity were assessed by using the following indices [9]: Homeostatic model assessment of pancreatic β-cell function (HOMA-β) =[(basal insulin [pM]×0.48)/(basal glucose [mM]-3.5)]; HOMA-IR=[(basal insulin [pM] × glucose [mM]) / 156.3]; C-peptide increment (ΔC-peptide=[stimulated C-peptide (pmol/mL)-basal C-peptide (pmol/mL)]; and insulin increment (Δinsulin=[stimulated insulin (pmol/L)-basal insulin (pmol/L)]. PCGR was defined as follows [10]: [(stimulated C-peptide [ng/mL]/stimulated glucose [mg/dL])×100]. The eGFR was derived from the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine-based equation [11].…”

Section: Methodsmentioning

confidence: 99%

Morning Spot Urine Glucose-to-Creatinine Ratios Predict Overnight Urinary Glucose Excretion in Patients With Type 2 Diabetes

Kim

Lee

et al. 2017

Ann Lab Med

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BackgroundWith the advent of sodium glucose co-transporter 2 inhibitors to control glucose and treat diabetes, laboratory data aided by either timed or spot glucose levels in the urine could be used as an alternative marker of drug response. The aim of this study was to assess the agreement between overnight urinary glucose excretion (UGE) and morning spot urinary glucose-to-creatinine ratio (UGCR).MethodsIn this prospective cross-sectional study, we enrolled a total of 215 participants with either normal glucose tolerance (NGT), pre-diabetes, or type 2 diabetes mellitus (T2DM). To exclude external factors such as food intake and physical activity, urine samples collected overnight at an 8-hr interval and the first-voided morning spot urine were collected and compared.ResultsThe median values of overnight 8-hr UGE in participants with NGT (N=14), pre-diabetes (N=41), and T2DM (N=160) were 35.0 mg, 35.6 mg, and 653.4 mg, respectively. In participants with T2DM, the median values of overnight 8-hr UGCR and first-voided morning spot UGCR (M-UGCR) were 1.37 mg/mg and 0.16 mg/mg, respectively. Quantitative analyses using an intraclass correlation coefficient (ICC) demonstrated a good reliability of measurement of the overnight 8-hr UGCR and M-UGCR (ICC=0.943, P<0.001). The M-UGCR was also significantly related to the overnight 8-hr UGE (r=0.828, P<0.001).ConclusionsM-UGCR and overnight 8-hr UGCR showed good agreement, suggesting that M-UGCR be used as a simple index for estimating overnight amounts of UGE in patients with T2DM.

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Section: Methodsmentioning

confidence: 99%

Morning Spot Urine Glucose-to-Creatinine Ratios Predict Overnight Urinary Glucose Excretion in Patients With Type 2 Diabetes

Kim

Lee

et al. 2017

Ann Lab Med

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“…Pancreatic β-cell function and insulin sensitivity were assessed using the following indices [ 16 ] : homeostasis model assessment (HOMA)-β = ([basal insulin (pmol/L) × 3.33]/[basal glucose (mmol/L) − 3.5]), homeostasis model assessment of insulin resistance = ([basal insulin (pmol/L) × basal glucose (mmol/L)]/135), C-peptide increment (ΔC-peptide = [stimulated C-peptide (nmol/L) − basal C-peptide (nmol/L)]), and insulin increment (Δinsulin = [stimulated insulin (pmol/L) − basal insulin (pmol/L)]). Postprandial C-peptide-to-glucose ratio (PCGR) was defined as follows [ 17 ] : (stimulated C-peptide [ng/mL]/stimulated glucose [mg/dL]) × 100. The eGFR was derived from the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and also from the Modification of Diet in Renal Disease (MDRD) equation for the Korean population.…”

Section: Methodsmentioning

confidence: 99%

Urinary N-acetyl-β-D-glucosaminidase, an early marker of diabetic kidney disease, might reflect glucose excursion in patients with type 2 diabetes

Kim

Lee

et al. 2016

Medicine

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Recently, several renal tubular damage markers have gained considerable attention because of their clinical implications as sensitive and specific biomarkers for early stage diabetic kidney disease. However, little is known about the demographic and glucometabolic factors affecting levels of urinary N-acetyl-β-d-glucosaminidase (NAG), a marker of proximal tubular damage, in type 2 diabetes mellitus (T2DM).The aim of this study was to investigate the clinical relevance of urinary NAG with regard to demographic and glucometabolic parameters, as well as nephropathic parameters, by comparing the glomerulopathic marker of albuminuria.In this retrospective cross-sectional study, we enrolled a total of 592 patients with either prediabetes (N = 29) or T2DM (N = 563). Glucometabolic parameters (glucose, hemoglobin A1c, glycated albumin [GA], insulin, C-peptide, homeostasis model assessment [HOMA] of insulin resistance, HOMA-β, postprandial C-peptide-to-glucose ratio [PCGR], and urinary glucose-to-creatinine ratio) and nephropathic parameters (urinary NAG, albumin-to-creatinine ratio [ACR], and estimated glomerular filtration rate) were measured.The levels of urinary NAG showed moderate positive correlation with the levels of urinary ACR in T2DM (r = 0.46). In correlation analysis, urinary NAG was more strongly correlated with body mass index (BMI) (r = −0.22; P < 0.001 vs. r = −0.02; P = 0.74), plasma stimulated glucose (r = 0.25; P < 0.001 vs. r = 0.08; P = 0.10), GA (r = 0.20; P < 0.001 vs. r = 0.13; P = 0.01), PCGR (r = −0.17; P = 0.001 vs. r = −0.09; P = 0.11), and HOMA-β (r = −0.10; P = 0.05 vs. r = −0.02; P = 0.79) than urinary ACR. In multiple regression analysis, age, lower BMI, stimulated glucose, GA, and urinary ACR predicted increased urinary NAG.In conclusion, increase in urinary NAG may be related to glycemic parameters reflecting glucose fluctuation and decreased insulin secretory capacity in patients with T2DM. Further longitudinal, prospective studies are needed to investigate a causal relationship between glucose fluctuations, renal tubular damage, and other vascular complications of diabetes.

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“…CPI is formed by dividing the C-peptide level into fasting blood glucose (Lee et al 2014). In many studies, CPI has been found to be more closely associated with beta cell function, insulin requirement, and microvascular complications (Saisho et al 2013;Lee et al 2014;Saisho 2016;Bando et al 2018). In our study, we could not demonstrate that CPI is used to predict proteinuria in anemic patients.…”

Section: Discussionmentioning

confidence: 99%

May C-peptide index be a new marker to predict proteinuria in anemic patients with type 2 diabetes mellitus?

Katipoğlu

Çomoğlu

Ateş

et al. 2020

Endocrine Regulations

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Objective. C-peptide is a reliable marker of beta cell reserve and is associated with diabetic complications. Furthermore, HbA1c level is associated with micro- and macro-vascular complications in diabetic patients. HbA1c measurement of diabetic patients with anemia may be misleading because HbA1c is calculated in percent by taking reference to hemoglobin measurements. We hypothesized that there may be a relationship between C-peptide index (CPI) and proteinuria in anemic patients with type 2 diabetes mellitus (T2DM). Therefore, the aim of the present study was to investigate the association between C-peptide levels and CPI in anemic patients with T2DM and proteinuria.Methods. The patients over 18 years of age with T2DM whose C-peptide levels were analyzed in Endocrinology and Internal medicine clinics between 2014 and 2018 with normal kidney functions (GFR>60 ml/min) and who do not use any insulin secretagogue oral antidiabetic agent (i.e. sulfonylurea) were enrolled into the study.Results. Hemoglobin levels were present in 342 patients with T2DM. Among these 342 cases, 258 (75.4%) were non-anemic whereas 84 (24.6%) were anemic. The median DM duration of the anemic group was statistically significantly higher in T2DM (p=0.003). There was no statistically significant difference found in proteinuria prevalence between non-anemic and anemic patient groups (p=0.690 and p=0.748, respectively). Anemic T2DM cases were corrected according to the age, gender, and duration of DM. C-peptide and CPI levels were not statistically significant to predict proteinuria (p=0.449 and p=0.465, respectively).Conclusion. The present study sheds light to the association between C-peptide, CPI, and anemic diabetic nephropathy in T2DM patients and indicates that further prospective studies are needed to clarify this issue.

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Postprandial C‐peptide to glucose ratio as a predictor of β‐cell function and its usefulness for staged management of type 2 diabetes

Cited by 25 publications

References 28 publications

Morning Spot Urine Glucose-to-Creatinine Ratios Predict Overnight Urinary Glucose Excretion in Patients With Type 2 Diabetes

Morning Spot Urine Glucose-to-Creatinine Ratios Predict Overnight Urinary Glucose Excretion in Patients With Type 2 Diabetes

Urinary N-acetyl-β-D-glucosaminidase, an early marker of diabetic kidney disease, might reflect glucose excursion in patients with type 2 diabetes

May C-peptide index be a new marker to predict proteinuria in anemic patients with type 2 diabetes mellitus?

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