Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Białystok, Polska.
Pediatr Endocrinol Diabetes Metab. 2021;27(2):123-133. doi: 10.5114/pedm.2021.107165.
C-peptide, the molecule produced in an equimolar concentration to insulin, has become an established insulin secretion biomarker in diabetic patients. Measurement of C-peptide level can be helpful in clinical practice for assessing insulin-producing b-cells residual function, especially in the patients who have already started exogenous insulin therapy. Advances in assays have made measurement of C-peptide more reliable and inexpensive. Traditionally, C-peptide is widely used to differentiate between type 1, type 2 and monogenic types in diabetic patients of all ages, both when the diabetes occurs and even months and years after the initial diagnosis. Moreover, in the patients with type 1 diabetes, the C-peptide secretion can become a reliable predictor of the clinical partial remission in the first months after diagnosis, although noteworthy, its' any specified level is not included in the definition of this phase of the disease. Many other clinical factors such as age, use of innovative technologies, the intensity of physical activity or body mass influence the concentration of C-peptide as well as diabetes remission occurrence and duration. They may interfere the interpretation of C-peptide level in the diabetes course. There is a great need to assess the new, adjusted C-peptide levels in these situations. A multitude novel therapies including immunomodulative factors and stem cell transplants can also use C-peptide in the patient selection and post-therapeutic monitoring of the outcome in researches aimed in extension of remission period. Recent research proves C-peptide presence and preserved function and being the possible important player in better metabolic control in long-lasting diabetes type 1. These findings may open the area for trials to regenerate b-cells and save endogenous insulin secretion for many years after diagnosis. Last but not the least, C-peptide presents its own physiological effect on other tissues, among others on the endothelial function, thus participates in inhibiting micro- and macrovascular diabetes complications. The idea of C-peptide as a new, additional to insulin cure remains as much attractive as elusive.
C 肽是与胰岛素等摩尔浓度产生的分子，已成为糖尿病患者中一种既定的胰岛素分泌生物标志物。C 肽水平的测量在临床实践中有助于评估产生胰岛素的β细胞的残留功能，特别是在已经开始外源性胰岛素治疗的患者中。检测方法的进步使得 C 肽的测量更加可靠和廉价。传统上，C 肽广泛用于区分 1 型、2 型和单基因糖尿病患者，无论糖尿病发生时，甚至在初始诊断后的数月和数年内都可以使用。此外，在 1 型糖尿病患者中，C 肽分泌可以成为诊断后最初几个月临床部分缓解的可靠预测指标，尽管值得注意的是，其任何特定水平都不包括在该疾病阶段的定义中。许多其他临床因素，如年龄、使用创新技术、身体活动强度或体重，都会影响 C 肽的浓度以及糖尿病缓解的发生和持续时间。它们可能会干扰对糖尿病病程中 C 肽水平的解释。在这些情况下，非常有必要评估新的、调整后的 C 肽水平。许多新型疗法，包括免疫调节因子和干细胞移植，也可以在患者选择和研究中使用 C 肽，以延长缓解期。最近的研究证明了 C 肽的存在和功能保留，以及在长期 1 型糖尿病中更好的代谢控制中的可能重要作用。这些发现可能为再生β细胞并在诊断后多年内保存内源性胰岛素分泌开辟试验领域。最后但并非最不重要的是，C 肽对其他组织具有自身的生理作用，其中包括对内皮功能的作用，从而参与抑制微血管和大血管糖尿病并发症。C 肽作为胰岛素治疗的新补充，其想法仍然既吸引人又难以捉摸。
