Better HbA1c during the first years after diagnosis of type 1 diabetes is associated with residual C peptide 10 years later

Grönberg, Annika; Espes, Daniel; Carlsson, Per‐Ola

doi:10.1136/bmjdrc-2019-000819

Cited by 17 publications

(18 citation statements)

References 25 publications

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“…However, other studies showed that BMI might be a risk factor for developing T1DM and for accelerating T1DM progression (19)(20)(21). Better HbA1c levels were associated with higher C-peptide concentrations at diagnosis and could predict residual beta cell function and long-term diabetes control after follow-up (22)(23)(24).…”

Section: Discussionmentioning

confidence: 97%

A clinical diagnostic model based on an eXtreme Gradient Boosting algorithm to distinguish type 1 diabetes

Tang¹,

Tang²,

Sun³

et al. 2021

Ann Transl Med

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Background: Accurate classification of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in the early phase is crucial for individual precision treatment. This study aimed to develop a classification model having fewer and easier to access clinical variables to distinguish T1DM in newly diagnosed diabetes in adults.Methods: Clinical and laboratory data were collected from 15,206 adults with newly diagnosed diabetes in this cross-sectional study. This cohort represented 20 provinces and 4 municipalities in China. Types of diabetes were determined based on postprandial C-peptide (PCP) level and glutamic acid decarboxylase autoantibody (GADA) titer. We developed multivariable clinical diagnostic models using the eXtreme Gradient Boosting (XGBoost) algorithm. Classification variables included in the final model were based on their scores of importance. Model performance was evaluated by area under the receiver operating characteristic curve (ROC AUC), sensitivity, and specificity. The performance of models with different variable combinations was compared. Calibration intercept and slope were evaluated for the final model.Results: Among the newly diagnosed diabetes cohort, 1,465 (9.63%) persons had T1DM and 13,741 (90.37%) had T2DM. Body mass index (BMI) contributed the most to the model, followed by age of onset and hemoglobin A1c (HbA1c). Compared with models with other clinical variable combinations, a final model that integrated age of onset, BMI and HbA1c had relatively higher performance. The ROC AUC, sensitivity, and specificity for this model were 0.83 (95% CI, 0.80 to 0.85), 0.77, and 0.76, respectively.The calibration intercept and slope were 0.02 (95% CI, -0.03 to 0.06) and 0.90 (95% CI, 0.79 to 1.02), respectively, which suggested a good calibration performance.Conclusions: Our classification model that integrated age of onset, BMI, and HbA1c could distinguish T1DM from T2DM, which provides a useful tool in assisting physicians in subtyping and precising treatment in diabetes.

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Section: Discussionmentioning

confidence: 97%

A clinical diagnostic model based on an eXtreme Gradient Boosting algorithm to distinguish type 1 diabetes

Tang¹,

Tang²,

Sun³

et al. 2021

Ann Transl Med

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“…A number of previous studies reported that the insulin secreting capacity becomes depleted in T1DM patients soon after diagnosis ( 14 , 15 ), but results from the Joslin Medalist Study showed persistent insulin production in 67.4% of participants at 50 years after diagnosis ( 16 ). Also, several recent studies presented a slow decline of serum C-peptide levels and preservation of the insulin secreting capacity ( 17 – 19 ). Previously, a preliminary study conducted with a small number of T1DM patients and showed a slight increase in serum C-peptide levels after diagnosis followed by significant decrease 5 years later ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Insulin Requirement and Complications Associated With Serum C-Peptide Decline in Patients With Type 1 Diabetes Mellitus During 15 Years After Diagnosis

Suh

Lee

et al. 2022

Front. Endocrinol.

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ObjectiveC-peptide is conventionally used in assessing pancreatic function in patients with diabetes mellitus. The clinical significance of this molecule during the course of type 1 diabetes mellitus (T1DM) has been recently revisited. This study aimed to investigate the natural course of C-peptide in T1DM patients over the period of 15 years and analyze the association between the residual C-peptide and diabetes complications.MethodsThis retrospective study included a total of 234 children and adolescents with T1DM. Patient data including sex, age at diagnosis, anthropometric measures, daily insulin dose, serum HbA1c, post-prandial serum C-peptide levels, lipid profiles, and diabetic complications at the time of diagnosis and 1, 3, 5, 10, and 15 years after diagnosis were retrospectively collected.ResultsAmong the 234 patients, 101 were men and 133 were women, and the mean patient age at initial diagnosis was 8.3 years. Serum C-peptide decreased constantly since the initial diagnosis, and showed a significant decline at 3 years after diagnosis. At 15 years after diagnosis, only 26.2% of patients had detectable serum C-peptide levels. The subgroup with older patients and patients with higher BMI standard deviation score showed higher mean serum C-peptide, but the group-by-time results were not significant, respectively. Patients with higher serum C-peptide required lower doses of insulin and had fewer events of diabetic ketoacidosis.ConclusionSerum C-peptide decreased consistently since diagnosis of T1DM, showing a significant decline after 3 years. Patients with residual C-peptide required a lower dose of insulin and had a lower risk for diabetic ketoacidosis.

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“…In the control group (n = 19), an increased level of antibodies was not revealed. Fasting C-peptide levels were as follows: in group «A» -0.86 ng / ml [0.53; 1.4], «B» -0.65 ng / ml [0.27; 0.98], « B «-0.19 ng / ml [0.17; 0.33],» D «-0.01 ng / ml [0.01; 0.01].…”

Section: оригинальное исследованиеmentioning

confidence: 80%

“…В течение более чем 10-летнего наблюдения за 73 пациентами с ежегодными измерениями уровня С-пептида и HbA 1c выявлено, что определяемые (или остаточные) уровни С-пептида более характерны для лиц женского пола и тех, у кого показатель уровня HbA 1c был ниже в течение первых 3 лет от дебюта СД1 [19]. Подобной взаимосвязи нами отмечено не было, однако в нашем случае это было однократное измерение, а не длительное наблюдение в течение 5-10 лет.…”

Section: обсуждение основного результата исследованияunclassified

Long-term β-cells autoimmune destruction markers persistence and residual C-peptide secretion in type 1 diabetes mellitus

et al. 2021

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Backgraund: It believed that autoimmune process maintained only during the first 5 years of diabetes mellitus type 1 (T1D). Recently scientists discovered the high levels of islet autoantibodies (Ab) in long-standing T1D and some of these patients had residual insulin secretion, determined by the level of C-peptide. According to various sources, the prevalence of such observations ranges from 12 to 48%.Aims: The aim of our study was to assess the duration of autoimmune β-cells destruction markers persistence and residual fasting C-peptide secretion in the long-standing T1D, as well as to determine the possible causes and patterns of these processes.Materials and methods: In the study included 237 patients (91 men, 146 women) with T1D. Patients divided in 4 groups, according to disease duration: а — up to 1 year, n=69 (29%); b — 1–5 years, 52 (22%); c — 5–10 years, 57 (24%); d — more than 10 years, 59 (25%). Ab to glutamic acid decarboxylase (GADA), tyrosine phosphatase-like IA-2 (IA2) and zinc T8 (ZnT8A) were detected by Enzyme Immunoassay. Also detected C-peptide levels and retrospectively HbA1с.Results: Antibodies to antigens of β-cell components were detected in 26 (37%) patients in group A, in 17 patients (33%) in group B, in 15 (29%) in group C and in 14 (23%) — G.In the control group (n = 19), an increased level of antibodies was not revealed. Fasting C-peptide levels were as follows: in group «A» — 0.86 ng / ml [0.53; 1.4], «B» — 0.65 ng / ml [0.27; 0.98], « B «- 0.19 ng / ml [0.17; 0.33],» D «- 0.01 ng / ml [0.01; 0.01]. However, in 13 (22%) patients in group D, fasting C-peptide levels were more than 0.09 ng / ml.Conclusion: The data obtained indicate a long-term persistence of markers of the autoimmune process in patients with T1DM. In groups with a long (more than 5 years) course of T1DM, levels of fasting C-peptide more than 30 pmol/L (0.09 ng / ml or 0.03 nmol / L) were noted in 39 (33.6%) cases.

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Better HbA1c during the first years after diagnosis of type 1 diabetes is associated with residual C peptide 10 years later

Cited by 17 publications

References 25 publications

A clinical diagnostic model based on an eXtreme Gradient Boosting algorithm to distinguish type 1 diabetes

A clinical diagnostic model based on an eXtreme Gradient Boosting algorithm to distinguish type 1 diabetes

Insulin Requirement and Complications Associated With Serum C-Peptide Decline in Patients With Type 1 Diabetes Mellitus During 15 Years After Diagnosis

Long-term β-cells autoimmune destruction markers persistence and residual C-peptide secretion in type 1 diabetes mellitus

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