Tatovic D, Luzio S, Dunseath G, Liu Y, Alhadj Ali M, Peakman M, Dayan C M
Diabetes Research Group, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK.
Institute for Life Sciences, Swansea University, Swansea, UK.
Diabet Med. 2016 Nov;33(11):1564-1568. doi: 10.1111/dme.13186. Epub 2016 Aug 8.
To determine if urine C-peptide/creatinine ratio is a useful tool for monitoring β-cell function in new-onset Type 1 diabetes.
Data were obtained from a prospective immunomodulation study in people with Type 1 diabetes ≤ 3 months from diagnosis, with a standard mixed-meal tolerance test and measurement of urine C-peptide/creatinine ratio carried out at 0, 3, 6, 9 and 12 months. The change in the insulin-dose-adjusted HbA level was also correlated with the change in serum/urine C-peptide level during the 12-month follow-up period.
A significant reduction in urine C-peptide/creatinine ratio, measured after a mixed-meal, was reached at 9 months (-45.4%), whilst the reduction in stimulated serum C-peptide level reached significance after 3 months (-54.7%) in placebo-treated participants. Neither change in stimulated serum C-peptide nor change in urine C-peptide level correlated with each other, and nor did change in insulin-dose-adjusted HbA level in the first 6 months, but all measures correlated significantly in the second half of the 12-month follow-up period.
Mixed-meal-stimulated urine C-peptide/creatinine ratio was similar to, although less sensitive than, stimulated serum C-peptide level in monitoring β-cell function during the first year after diagnosis. Because the former is significantly less invasive, it warrants inclusion in further studies in Type 1 diabetes and may represent an attractive alternative outcome measure in cohort studies and in children.
确定尿C肽/肌酐比值是否为监测新诊断1型糖尿病患者β细胞功能的有用工具。
数据来自一项针对诊断后≤3个月的1型糖尿病患者的前瞻性免疫调节研究，在0、3、6、9和12个月时进行标准混合餐耐量试验并测量尿C肽/肌酐比值。在12个月的随访期内，还将胰岛素剂量调整后的HbA水平变化与血清/尿C肽水平变化进行了相关性分析。
在安慰剂治疗的参与者中，混合餐后测量的尿C肽/肌酐比值在9个月时显著降低（-45.4%），而刺激后血清C肽水平在3个月后显著降低（-54.7%）。刺激后血清C肽的变化与尿C肽水平的变化之间没有相关性，在最初6个月内胰岛素剂量调整后的HbA水平变化也没有相关性，但在12个月随访期的后半段，所有测量指标均显著相关。
在诊断后的第一年，混合餐刺激后的尿C肽/肌酐比值在监测β细胞功能方面与刺激后血清C肽水平相似，尽管敏感性较低。由于前者的侵入性明显较小，因此值得在1型糖尿病的进一步研究中纳入，并且可能是队列研究和儿童研究中有吸引力的替代结局指标。
