Shi Mei, Xie Yuting, Tang Rong, Zhong Ting, Zhou Zhiguang, Li Xia
Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
Diabetes Metab Res Rev. 2021 Nov;37(8):e3461. doi: 10.1002/dmrr.3461. Epub 2021 May 7.
To explore the different patterns of C-peptide decline in patients with and without partial remission of newly diagnosed type 1 diabetes (T1D).
A total of 298 patients with new-onset T1D were followed up regularly at 3 months' interval to investigate the loss of C-peptide. Partial remission was determined by postprandial C-peptide ≥300 pmol/L or insulin dose-adjusted A1c ≤ 9 in the absence of C-peptide. Beta-cell function was defined as preserved, residual or failed by postprandial C-peptide of ≥200 pmol/L, 50-200 pmol/L or ≤50 pmol/L, respectively.
Altogether, 199 out of 298 patients (125 adults) had partial remission. The pattern of C-peptide change in patients with partial remission was three-phasic, demonstrating an upward trend followed by a downward trend of fast first and then slow, while the pattern in patients without partial remission was biphasic, showing an initial fast fall and a subsequent slower decrease. The patterns remained consistent when patients were stratified by the age of onset. At 3 years, there were 71% of the patients with partial remission still had preserved or residual beta-cell function, while 89% of the patients who had no partial remission developed beta-cell function failure. In patients whose partial remission ended, the average C-peptide was still higher than duration-matched patients without partial remission.
Patients with partial remission of T1D have a distinct three-phasic pattern of C-peptide decline, other than the widely recognized biphasic pattern. The effect of partial remission still exists after remission ends.
探讨新诊断的1型糖尿病（T1D）患者中部分缓解和未部分缓解患者C肽下降的不同模式。
共298例新发病的T1D患者每隔3个月定期随访以研究C肽的丢失情况。部分缓解的判定标准为餐后C肽≥300 pmol/L或在无C肽情况下胰岛素剂量调整后的糖化血红蛋白（A1c）≤9。β细胞功能分别根据餐后C肽≥200 pmol/L、50 - 200 pmol/L或≤50 pmol/L定义为保留、残余或衰竭。
298例患者（125例成人）中共有199例出现部分缓解。部分缓解患者的C肽变化模式为三相，呈先上升后下降趋势，先是快速下降，然后缓慢下降，而未部分缓解患者的模式为双相，表现为最初快速下降，随后下降较慢。按发病年龄分层时，这些模式保持一致。3年后，71%的部分缓解患者仍保留或残余β细胞功能，而89%未部分缓解的患者出现β细胞功能衰竭。在部分缓解结束的患者中，平均C肽仍高于与之病程匹配的未部分缓解患者。
T1D部分缓解患者的C肽下降模式为独特的三相模式，而非广泛认可的双相模式。部分缓解的影响在缓解结束后仍然存在。
