Experimental Medicine Department, Sapienza University of Rome, Rome, Italy.
Department of Medicine and Surgery, Section of Endocrinology and Metabolism, University of Perugia, Perugia, Italy.
Diabetes Obes Metab. 2022 Oct;24(10):1912-1926. doi: 10.1111/dom.14785. Epub 2022 Jun 28.
Impaired beta-cell function is a recognized cornerstone of diabetes pathophysiology. Estimates of insulin secretory capacity are useful to inform clinical practice, helping to classify types of diabetes, complication risk stratification and to guide treatment decisions. Because C-peptide secretion mirrors beta-cell function, it has emerged as a valuable clinical biomarker, mainly in autoimmune diabetes and especially in adult-onset diabetes. Nonetheless, the lack of robust evidence about the clinical utility of C-peptide measurement in type 2 diabetes, where insulin resistance is a major confounder, limits its use in such cases. Furthermore, problems remain in the standardization of the assay for C-peptide, raising concerns about comparability of measurements between different laboratories. To approach the heterogeneity and complexity of diabetes, reliable, simple and inexpensive clinical markers are required that can inform clinicians about probable pathophysiology and disease progression, and so enable personalization of management and therapy. This review summarizes the current evidence base about the potential value of C-peptide in the management of the two most prevalent forms of diabetes (type 2 diabetes and autoimmune diabetes) to address how its measurement may assist daily clinical practice and to highlight current limitations and areas of uncertainties to be covered by future research.
β细胞功能障碍是糖尿病病理生理学的公认基石。胰岛素分泌能力的评估对于指导临床实践很有用，有助于对糖尿病的类型进行分类、对并发症风险进行分层，并指导治疗决策。由于 C 肽的分泌反映了β细胞的功能，它已成为一种有价值的临床生物标志物，主要在自身免疫性糖尿病中，特别是在成年发病的糖尿病中。然而，由于胰岛素抵抗是 2 型糖尿病的主要混杂因素，缺乏关于 C 肽测量在 2 型糖尿病中临床应用的有力证据，限制了其在这种情况下的应用。此外，C 肽测定的标准化仍然存在问题，这引发了对不同实验室之间测量值可比性的担忧。为了应对糖尿病的异质性和复杂性，需要可靠、简单和廉价的临床标志物，这些标志物可以向临床医生提供关于可能的病理生理学和疾病进展的信息，从而实现管理和治疗的个体化。这篇综述总结了 C 肽在管理两种最常见的糖尿病（2 型糖尿病和自身免疫性糖尿病）方面的潜在价值的现有证据，以探讨其测量值如何有助于日常临床实践，并强调当前的局限性和不确定性领域，需要未来的研究来解决。
