Department of Internal Medicine, Ankara Numune Training and Research Hospital, Ankara, Turkey.
Department of Endocrinology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
Endocr Regul. 2020 Jan 1;54(1):1-5. doi: 10.2478/enr-2020-0001.
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.
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.
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).
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.
C 肽是胰岛β细胞储备功能的可靠标志物，与糖尿病并发症相关。此外，糖化血红蛋白（HbA1c）水平与糖尿病患者的微血管和大血管并发症相关。对于贫血的糖尿病患者，HbA1c 的测量可能会产生误导，因为 HbA1c 的计算是通过参考血红蛋白测量值的百分比得出的。我们假设在患有 2 型糖尿病（T2DM）的贫血患者中，C 肽指数（CPI）与蛋白尿之间可能存在关系。因此，本研究旨在探讨 T2DM 合并蛋白尿的贫血患者的 C 肽水平与 CPI 之间的关系。
本研究纳入了 2014 年至 2018 年期间在内分泌和内科诊所进行 C 肽分析且肾功能正常（GFR＞60ml/min）且未使用任何胰岛素促分泌剂口服降糖药（即磺脲类药物）的年龄在 18 岁以上的 T2DM 患者。
在 342 例 T2DM 患者中，血红蛋白水平正常。在这 342 例患者中，258 例（75.4%）非贫血，84 例（24.6%）贫血。贫血组的 T2DM 患者 DM 病程中位数显著高于非贫血组（p=0.003）。非贫血组和贫血组患者蛋白尿患病率无统计学差异（分别为 p=0.690 和 p=0.748）。根据年龄、性别和 DM 病程对贫血 T2DM 患者进行校正。C 肽和 CPI 水平对预测蛋白尿均无统计学意义（分别为 p=0.449 和 p=0.465）。
本研究提示 C 肽、CPI 与 T2DM 患者贫血性糖尿病肾病之间存在关联，并表明需要进一步的前瞻性研究来阐明这一问题。
