C-peptide determination in the choice of treatment in diabetes mellitus

Koskinen, P; Viikari, Jorma; Irjala, Kerttu; Kaihola, Helena; Seppälä, P

doi:10.3109/00365518509155265

Cited by 33 publications

(21 citation statements)

References 25 publications

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“…Although previous studies have investigated the association between markers of beta-cell function and future insulin use, to the best of our knowledge, none has comprehensively examined the relationships of various clinical variables, including body mass index, fasting plasma glucose levels, and serum and urinary c-peptide levels with future insulin use [4,5,7,8,11,[14][15][16]. As expected, we found that increased FPG was associated with future insulin use.…”

Section: Discussionsupporting

confidence: 70%

“…sulin resistance play critical roles in the development of hyperglycemia in patients of type 2 diabetes, measurement of the serum c-peptide levels (scPr) and urinary c-peptide levels (ucPr), which are known to be useful markers of beta-cell function, may also provide important information for the choice of therapy [3][4][5][6][7][8][9][10][11][12][13]. However, few studies have been conducted to identify factors that might determine or predict the therapy of choice in type 2 diabetic patients.…”

mentioning

confidence: 99%

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Body Mass Index, Fasting Plasma Glucose Levels, and C-peptide Levels as Predictors of the Future Insulin Use in Japanese Type 2 Diabetic Patients

et al. 2010

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Section: Discussionsupporting

confidence: 70%

mentioning

confidence: 99%

Body Mass Index, Fasting Plasma Glucose Levels, and C-peptide Levels as Predictors of the Future Insulin Use in Japanese Type 2 Diabetic Patients

et al. 2010

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“…The scatter of the values in each group was, however, wide. This finding is in accord with observations from previous studies where C-peptide concentrations in younger type 2 diabetic patients have been determined [7,12,18,23], Very low values were found only in diabetics treated with insulin, and it is obvious that patients with a disease resembling type 1 diabetes are in cluded in this group. On the other hand, exog enous insulin may suppress endogenous insu lin production and thus lead to low C-peptide concentrations [5], Our observations about the lowered diurnal C-peptide profile during insulin therapy in 1 elderly diabetic patient gives further support to this view.…”

Section: Discussionsupporting

confidence: 82%

“…Most elderly diabetics have the type 2 disease (noninsulin-dependent dia betes mellitus, NIDDM) where both insulin deficiency and insulin resistance may act as underlying pathogenetic mechanisms; which of them predominates may largely determine the optimum treatment. Recently, measure ment of serum C-peptide has been demon strated to allow for increased confidence in Kyllâslincn assessing the degree of dependence on insu lin treatment in diabetics [4,7,11,12,15,21,23]. Proinsulin is converted to insulin and C-peptide in pancreatic (3-cells and sub sequently these are secreted in equimolar concentrations.…”

mentioning

confidence: 99%

Serum C-Peptide Concentrations and Their Value in Evaluating the Usefulness of Insulin Therapy in Elderly Diabetics

Kyllästinen¹,

S²

1986

Gerontology

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Serum C-peptide concentrations were determined in 121 elderly subjects: 25 nondiabetic controls aged 69–86 years, and 96 type 2 (noninsulin-dependent diabetes mellitus) diabetics aged 64–96 years. Forty-seven of the diabetics were treated with tablets, 35 with insulin, and 14 with diet alone. Fasting serum C-peptide concentrations (nmol/l; means ± SD) were 0.51 ± 0.20 for controls; 0.60 ± 0.16 for diabetics on diet alone; 0.72 ± 0.33 for diabetics on tablets and 0.46 ± 0.23 for diabetics on insulin (p < 0.001 for diabetics on tablets vs. controls and diabetics on tablets vs. diabetics on insulin). The glucagon-stimulated C-peptide concentrations were similar in all groups; the increment after glucagon was less in the diabetic patients on tablets or on insulin than in the nondiabetics. In 10 patients on insulin treatment and with fasting C-peptide of 0.24–1.46 nmol/l an attempt was made to withdraw insulin. In 4 subjects the transfer to tablets was possible. Serum C-peptide level did not predict the outcome of the attempt to change the therapy, but the possibility of an adequate dietary regimen seemed to be important. The results demonstrate a wide range of basal C-peptide concentrations in elderly diabetics on different treatments, which may indicate varying pathogenetic contributions of insulin deficiency and resistance in these patients. Our observations emphasize the necessity for regular re-evaluation of the therapeutic management of elderly diabetic patients.

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“…)• The median potentiation of plasma C-peptide concentration 6 min post glucagon was 120-140% at the two levels of hyperglycemia. This finding is of clinical interest since plasma C-peptide concen¬ tration 6 min post glucagon has been used in the discrimination between diabetes types (17)(18)(19)(20).…”

Section: Discussionmentioning

confidence: 89%

The effect of acute hyperglycemia on the plasma C-peptide response to intravenous glucagon or to a mixed meal in insulin-dependent diabetes mellitus

Gjessing¹,

Reinholdt²,

Faber³

et al. 1991

Acta Endocrinologica

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The dose-response relationships between prestimulatory blood glucose concentration and the plasma C-peptide responses to stimulation with 1 mg of glucagon iv or a standard mixed meal were studied in 8 C-peptide positive patients with insulin-dependent diabetes mellitus. Hyperglycemia was maintained for 90 min before stimulation using a hyperglycemic clamp technique. Each test was performed at the steady state blood glucose levels~5 ,~12, and~20 mmol/l. The glucose potentiation of the incremental plasma C-peptide area under the curve at the two levels of hyperglycemia in percent of the area at normoglycemia (median and range) was 343% (53-1053) (p<0.05) and 341% (267-1027) (p<0.05) after glucagon and 140% (76-227) (NS) and 251% (95-1700) (p<0.05) after the meal. The corresponding relative glucose potentiation of plasma C-peptide 6 min after stimulation with glucagon was 124% (100\ x=req-\ 427) (p<0.02) and 144% (100-209) (p<0.05). There was no significant difference in the degree of glucose potentiation at~12 or~2 0 mmol/l. Furthermore, there was no significant difference in the degree of glucose potentiation of the different estimated values of B-cell function.In conclusion, the plasma C-peptide responses to iv glucagon or to a standard test meal were markedly potentiated by acute hyperglycemia in insulin-dependent diabetes mellitus. No further potentiation was, however, obtained when the prestimulatory blood glucose concentration was raised above 12 mmol/l. These findings contrast those reported in non-insulin-dependent diabetes, where endogenous insulin secretion is potentiated further when the blood glucose concentration is raised tõ 20 mmol/l. More than a decade ago, the plasma C-peptide re¬ sponse to 1 mg glucagon iv was introduced as an estimate of islet B-cell function in insulin-depen¬ dent diabetes mellitus (IDDM) (1). The plasma C-peptide response to iv glucagon reaches a max¬ imum after 6 min and is of a similar magnitude as the response to a standard test meal. The plasma C-peptide concentration 6 min after iv injection of 1 mg glucagon has, therefore, gained use as an estimate of residual B-cell function in IDDM (2-10).By applying the hyperglycémie clamp technique (11), a very pronounced potentiation of B-cell re¬ sponsiveness to both glucose and other secretagogues is induced by acute hyperglycemia in noninsulin-dependent diabetes mellitus (NIDDM), with a continued potentiation along with an in¬ crease in prestimulatory blood glucose concentra¬ tion from normoglycemia to 20-25 mmol/1 (12,13).In IDDM, the B-cell responsiveness also depends on the concomitant blood glucose concentration (2,3). However, the degree of potentiation induced by different levels of hyperglycemia is not known. Hence, the aim of the present study was to describe the dose-response relationships between different prestimulatory glycémie levels and the plasma C-peptide responses to iv glucagon or to a standard mixed meal in patients with IDDM by use of the hyperglycémie clamp technique.

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C-peptide determination in the choice of treatment in diabetes mellitus

Cited by 33 publications

References 25 publications

Body Mass Index, Fasting Plasma Glucose Levels, and C-peptide Levels as Predictors of the Future Insulin Use in Japanese Type 2 Diabetic Patients

Body Mass Index, Fasting Plasma Glucose Levels, and C-peptide Levels as Predictors of the Future Insulin Use in Japanese Type 2 Diabetic Patients

Serum C-Peptide Concentrations and Their Value in Evaluating the Usefulness of Insulin Therapy in Elderly Diabetics

The effect of acute hyperglycemia on the plasma C-peptide response to intravenous glucagon or to a mixed meal in insulin-dependent diabetes mellitus

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