Carr Alice L J, Oram Richard A, Marren Shannon M, McDonald Timothy J, Narendran Parth, Andrews Robert C
Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, Devon EX2 5DW, UK.
Great Western Hospitals NHS Foundation Trust, Swindon, SN3 6BB, UK.
J Endocr Soc. 2021 Jul 17;5(10):bvab127. doi: 10.1210/jendso/bvab127. eCollection 2021 Oct 1.
High-residual C-peptide in longer-duration type 1 diabetes (T1D) is associated with fewer hypoglycemic events and reduced glycemic variability. Little is known about the impact of C-peptide close to diagnosis.
Using continuous glucose monitoring (CGM) data from a study of newly diagnosed adults with T1D, we aimed to explore if variation in C-peptide close to diagnosis influenced glycemic variability and risk of hypoglycemia.
We studied newly diagnosed adults with T1D who wore a Dexcom G4 CGM for 7 days as part of the Exercise in Type 1 Diabetes (EXTOD) study. We examined the relationship between peak stimulated C-peptide and glycemic metrics of variability and hypoglycemia for 36 CGM traces from 23 participants.
For every 100 pmol/L-increase in peak C-peptide, the percentage of time spent in the range 3.9 to 10 mmol/L increased by 2.4% (95% CI, 0.5-4.3), = .01) with a reduction in time spent at level 1 hyperglycemia (> 10 mmol/L) and level 2 hyperglycemia (> 13.9 mmol/L) by 2.6% (95% CI, -4.9 to -0.4, = .02) and 1.3% (95% CI, -2.7 to -0.006, = .04), respectively. Glucose levels were on average lower by 0.19 mmol/L (95% CI, -0.4 to 0.02, = .06) and SD reduced by 0.14 (95% CI, -0.3 to -0.02, = .02). Hypoglycemia was not common in this group and no association was observed between time spent in hypoglycemia ( = .97) or hypoglycemic risk ( = .72). There was no association between peak C-peptide and insulin dose-adjusted glycated hemoglobin A ( = .45).
C-peptide is associated with time spent in the normal glucose range and with less hyperglycemia, but not risk of hypoglycemia in newly diagnosed people with T1D.
病程较长的1型糖尿病（T1D）患者体内高残留C肽与较少的低血糖事件及较低的血糖变异性相关。关于诊断时C肽水平的影响，人们了解甚少。
利用一项针对新诊断的成年T1D患者的研究中的连续血糖监测（CGM）数据，我们旨在探讨诊断时C肽水平的变化是否会影响血糖变异性和低血糖风险。
作为1型糖尿病运动研究（EXTOD）的一部分，我们研究了新诊断的成年T1D患者，这些患者佩戴德康G4 CGM 7天。我们检查了23名参与者的36条CGM记录中，峰值刺激C肽与血糖变异性和低血糖指标之间的关系。
峰值C肽每增加100 pmol/L，血糖在3.9至10 mmol/L范围内的时间百分比增加2.4%（95%CI，0.5 - 4.3），P = 0.01），1级高血糖（>10 mmol/L）和2级高血糖（>13.9 mmol/L）的时间分别减少2.6%（95%CI，-4.9至-0.4，P = 0.02）和1.3%（95%CI，-2.7至-0.006，P = 0.04）。血糖水平平均降低0.19 mmol/L（95%CI，-0.4至0.02，P = 0.06），标准差降低0.14（95%CI，-0.3至-0.02，P = 0.02）。该组中低血糖并不常见，且未观察到低血糖时间（P = 0.97）或低血糖风险（P = 0.72）之间存在关联。峰值C肽与胰岛素剂量调整的糖化血红蛋白A之间无关联（P = 0.45）。
C肽与新诊断的T1D患者在正常血糖范围内的时间以及较少的高血糖相关，但与低血糖风险无关。
