Department of Pediatrics and Child Health, Nihon University School of Medicine, 1-6 Kandasurugadai, Chiyoda-ku, Japan.
Pediatr Int. 2021 May;63(5):536-542. doi: 10.1111/ped.14462. Epub 2021 May 7.
We aimed to investigate the significance of the C-peptide levels on a glucagon stimulation test (GST) conducted soon after diagnosis as a predictive marker for residual β-cell function over time in Japanese children with type 1 diabetes (TD1).
We retrospectively enrolled 65 Japanese children (25 male, 40 female; age <16 years) with new-onset TD1. A GST was conducted within 1 month of diagnosis, when glucose toxicity improved. One- to 2-h postprandial serum C-peptide values were measured at 0, 3, 6, 12, 24, 36, 60, and 120 months after diagnosis.
Receiver operating characteristic analysis showed that the cutoff values of peak serum C-peptide levels used to predict the complete destruction of β-cells at 3, 6, and 12 months after diagnosis were all 0.20 ng/mL (area under the curve [AUC] 0.867, 95% confidence interval [CI] 0.745-0.990; AUC 0.774, 95% CI 0.634-0.914; and AUC 0.804, 95% CI 0.695-0.914, respectively); the values at 24, 36, and 60 months were 0.69 ng/mL (AUC 0.828, 95% CI 0.721-0.936), 0.60 ng/mL (AUC 0.777, 95% CI 0.636-0.918), and 0.70 ng/mL (AUC 0.848, 95% CI 0.715-0.982), respectively. On multivariate analysis, peak serum C-peptide level on a GST, diabetic ketoacidosis, age, and HbA1c level at diagnosis were associated with residual β-cell function over time.
Peak serum C-peptide levels on a GST conducted soon after diagnosis in Japanese children with TD1 could predict the time to decrease in postprandial serum C-peptide values to < 0.20 ng/mL.
我们旨在研究在日本 1 型糖尿病（TD1）患者确诊后不久进行的胰高血糖素刺激试验（GST）中 C 肽水平的意义，作为随时间推移β细胞功能残留的预测标志物。
我们回顾性纳入了 65 例新诊断的日本 TD1 儿童（男 25 例，女 40 例；年龄<16 岁）。在诊断后 1 个月内进行 GST，此时葡萄糖毒性得到改善。在诊断后 0、3、6、12、24、36、60 和 120 个月时，检测餐后 1-2 小时的血清 C 肽值。
受试者工作特征分析显示，用于预测诊断后 3、6 和 12 个月时β细胞完全破坏的峰值血清 C 肽水平的截断值均为 0.20ng/mL（曲线下面积 [AUC] 0.867，95%置信区间 [CI] 0.745-0.990；AUC 0.774，95% CI 0.634-0.914；AUC 0.804，95% CI 0.695-0.914）；24、36 和 60 个月时的截断值为 0.69ng/mL（AUC 0.828，95% CI 0.721-0.936）、0.60ng/mL（AUC 0.777，95% CI 0.636-0.918）和 0.70ng/mL（AUC 0.848，95% CI 0.715-0.982）。多变量分析显示，GST 时的峰值血清 C 肽水平、糖尿病酮症酸中毒、年龄和诊断时的 HbA1c 水平与随时间推移的β细胞功能有关。
在日本 TD1 儿童确诊后不久进行的 GST 中，峰值血清 C 肽水平可预测餐后血清 C 肽值降至<0.20ng/mL 的时间。
