Endocr Pract. 2018 May;24(5):446-452. doi: 10.4158/EP-2017-0234.
Fasting C-peptide levels are used to differentiate type 1 from type 2 diabetes (T2D), thereby determining eligibility for coverage of continuous subcutaneous insulin infusion (CSII) for patients with T2D.
A total of 168 patients (74 female/94 male, aged 55.5 ± 9.7 years) were randomized to CSII, and 163 patients (77 female/86 male, aged 56.4 ± 9.5 years) were randomized to multiple daily injections (MDI) of insulin and grouped by baseline C-peptide level: group A (≤183 pmol/L [≤0.55 ng/mL]); group B (>183 pmol/L [>0.55 ng/mL]). At 6 months, the MDI group crossed over to CSII. Within- and between-group comparisons were recorded at 6 and 12 months in the entire group and separately for those patients aged ≥65 years.
CSII reduced hemoglobin A1c (A1c) equally in groups A ( P = .0006, P = .0022) and B ( P<.0001, P<.0001) at 6 and 12 months, respectively. There was an increase in weight in group A versus group B at 6 months but not 12 months ( P<.03). CSII therapy reduced total daily dose (TDD) of insulin and improved treatment satisfaction similarly in groups A and B. The results for patients aged ≥65 years displayed a similar trend as the entire group.
A1c, TDD of insulin, and treatment satisfaction improved for T2D patients using CSII versus MDI therapy, irrespective of baseline C-peptide level. A subgroup of patients aged ≥65 years displayed a similar trend. These results support abandoning C-peptide as a criterion for reimbursing CSII therapy in patients with diabetes.
A1c = hemoglobin A1c; CMS = Centers for Medicare and Medicaid Services; CSII = continuous subcutaneous insulin infusion; DTSQ = Diabetes Treatment Satisfaction Questionnaire; MDI = multiple daily injections; RCT = randomized controlled trials; T1D = type 1 diabetes; T2D = type 2 diabetes; TDD = total daily dose.
空腹 C 肽水平用于区分 1 型糖尿病（T1D）和 2 型糖尿病（T2D），从而确定 T2D 患者接受连续皮下胰岛素输注（CSII）治疗的资格。
共 168 例患者（74 例女性/94 例男性，年龄 55.5±9.7 岁）被随机分配至 CSII 组，163 例患者（77 例女性/86 例男性，年龄 56.4±9.5 岁）被随机分配至胰岛素多次皮下注射（MDI）组，并按基线 C 肽水平分组：A 组（≤183 pmol/L [≤0.55ng/mL]）；B 组（＞183 pmol/L [＞0.55ng/mL]）。6 个月时，MDI 组交叉至 CSII 组。在整个组和年龄≥65 岁的患者中，分别在 6 个月和 12 个月时记录组内和组间比较。
CSII 在 6 个月和 12 个月时分别使 A 组（P=0.0006，P=0.0022）和 B 组（P＜0.0001，P＜0.0001）的糖化血红蛋白（A1c）均降低。A 组在 6 个月时体重增加，但 12 个月时未增加（P＜0.03）。CSII 治疗降低了 A 组和 B 组的胰岛素总日剂量（TDD），并改善了治疗满意度。年龄≥65 岁患者的结果与整个组相似。
与 MDI 治疗相比，CSII 治疗可改善 T2D 患者的 A1c、胰岛素 TDD 和治疗满意度，与基线 C 肽水平无关。年龄≥65 岁的亚组患者显示出相似的趋势。这些结果支持不再将 C 肽作为糖尿病患者报销 CSII 治疗的标准。
