Postprandial serum C‐peptide value is the optimal index to identify patients with non‐obese type 2 diabetes who require multiple daily insulin injection: Analysis of C‐peptide values before and after short‐term intensive insulin therapy

Abstract

Aims/Introduction: Type 2 diabetes is a progressive disease characterized by a yearly decline in insulin secretion; however, no definitive evidence exists showing the relationship between decreased insulin secretion and the need for insulin treatment. To determine the optimal insulin secretory index for identifying patients with non-obese type 2 diabetes who require multiple daily insulin injection (MDI), we evaluated various serum C-peptide immunoreactivity (CPR) values. Materials and Methods: We near-normalized blood glucose with intensive insulin therapy (IIT) over a 2-week period in 291 patients with non-obese type 2 diabetes, based on our treatment protocol. After improving hyperglycemia, we challenged with oral hypoglycemic agent (OHA), and according to the responsiveness to OHA, patients were classified into three therapy groups: OHA alone (n = 103), basal insulin plus OHA (basal insulin-supported oral therapy [BOT]; n = 56) and MDI (n = 132). Glucagon-loading CPR increment (DCPR), fasting CPR (FCPR), CPR 2 h after breakfast (CPR2h), the ratio of FCPR to FPG (CPI), CPI 2 h after breakfast (CPI2h) and secretory unit of islets in transplantation (SUIT) were submitted for the analyses. Receiver operating characteristic (ROC) and multiple logistic analyses for these CPR indices were carried out. Results: Many CPR values were significantly lower in the MDI group compared with the OHA alone or BOT groups. ROC and multiple logistic analyses disclosed that post-prandial CPR indices (CPR2h and CPI2h) were the most reliable CPR markers to identify patients requiring MDI. Conclusions: Postprandial CPR level after breakfast is the most useful index for identifying patients with non-obese type 2 diabetes who require MDI therapy. (J Diabetes Invest,

Pathophysiology‐based phenotyping in type 2 diabetes: A clinical classification tool

“…Nevertheless, in type 2 diabetes, such characterizations are scarce and have only focused on mean values—not the heterogeneity . Some studies have investigated the utility of C‐peptide level in order to identify selected patients with an absolute need for insulin . These studies did not relate beta cell function to insulin resistance.…”

“…[24][25][26] Some studies have investigated the utility of C-peptide level in order to identify selected patients with an absolute need for insulin. [27][28][29][30][31][32] These studies did not relate beta cell function to insulin resistance. Furthermore Cpeptide measurements were not standardized which reduces the generalizability.…”

Clinical Utility of the Meal Tolerance Test in the Care of Patients with Type 2 Diabetes Mellitus

“…However, a full-scale mixed MTT is not often performed in routine clinical practice because of frequent blood samplings, long test time up to five hours and need for minimal model approaches for the data analysis. The simplified MTT was reported to be useful, in which the CPR level at 120 minutes after calorie-controlled breakfast was suggested to be a good index for identifying patients with non-obese type 2 diabetes requiring multiple daily insulin injections during hospitalization ( 7 ).…”

“…The present study differs from previous ones in the patient background characteristics, test meal preparation, sampling times in the MTT and evaluation of insulin therapy. Many previous studies used a calorie-controlled breakfast for stimulation and performed 2 blood samplings (before and 120 minutes after breakfast) ( 3 , 7 , 10 ). In the present study, by contrast, we prepared a test meal for standardization instead of a calorie-controlled meal.…”

Efficacy of lixisenatide in patients with type 2 diabetes: A post hoc analysis of patients with diverse β-cell function in the GetGoal-M and GetGoal-S trials

“…ACCEPTED MANUSCRIPT 13 scores could be used to identify patients with T2D who may respond well to potential basal insulin/lixisenatide combination therapy, as has been used previously to identify patients requiring multiple daily insulin injections [27]. Further investigation to validate the association between SUIT index and response to lixisenatide/OADs or basal insulin/lixisenatide combination therapy is warranted.…”