C‐peptide, glycaemic control, and diabetic complications in type 2 diabetes mellitus: A real‐world study

Abstract

Objective: To explore the relationship between C-peptide and glycaemic control rate and diabetic complications (microvascular complication and cerebral infarction) and provide evidence for stratified treatment of type 2 diabetes mellitus (T2DM)based C-peptide.Method: This is a cross-sectional real-world observational study. According to the inclusion and exclusion criteria, we studied 1377 patients with T2DM, grouped by fasting C-peptide and HOMA-IR. Blood samples were collected after fasting overnight. Logistic regression was used to analyse the relationship among fasting Cpeptide, HOMA-IR, C2/C0 ratio (the ratio of 2 h postprandial C-peptide to fasting C-peptide), glycaemic control rate, and occurrence of diabetic complications.Restricted cubic spline (RCS) curves based on logistic regression were used to evaluate the relationship between C-peptide, glycaemic control rate, and diabetic kidney disease (DKD).Results: Patients were subdivided according to their fasting C-peptide in 4 groups (Q1,Q2,Q3,Q4). Patients of group Q3 (1.71 ≤ C-peptide < 2.51 ng/ml) showed the lowest incidence of DKD, diabetic retinopathy (DR), and rate of insulin absorption as welll as higher glycaemic control rate. Logistic regression shows that the probability of reaching glycemic control increased with higher levels of C-peptide, compared with group Q1, after adjusting for age, gender, duration of diabetes, body mass index, systolic blood pressure, diastolic blood pressure, creatinine, low-density lipoprotein, triglyceride, total cholesterol, and high-density lipoprotein. RCS curve shows that, when C-peptide is ≤2.68 ng/ml, the incidence of not reaching glycaemic control decreases with increasing C-peptide. The possibility of not reaching glycaemic control decreased with increasing C2/C0, when C-peptide is ≥1.71 ng/ml. RCS curve shows that the relationship between C-peptide and DKD follows a Ustyle curve. When C-peptide is <2.84 ng/ml, the incidence of DKD decreased with increasing C-peptide. With the increase in the C2/C0 ratio, the incidence of DKD, DR, and fatty liver did not decrease. Conclusion:When C-peptide is ≥ 1.71 and < 2.51 ng/ml, patients with T2DM had a higher glycemic control rate. Excessive C-peptide plays different roles in DKD and Yajing Huang and Yahao Wang contributed equally to this work.

A novel refined classification system for type 2 diabetes in adults: A Chinese retrospective cohort study

“…The relationship between insulin resistance and kidney disease is complex. A similar real‐world study 22 also from Chinese T2DM patients showed that the relationship between C‐peptide and diabetic kidney disease follows a U‐style curve. Insulin resistance is a common early change in CKD and is almost universal in end‐stage renal disease 25 .…”

“…21 This study classified patients based on specific FCP levels, a specific phenotypic measure. In addition, Yajing Huang et al 22 neuropathy in patients with T1 and T2DM was significantly higher than that in patients with the other two types of T2DM. Insulin deficiency or hyperglycaemia seems to be an important cause of retinopathy.…”

“…This study classified patients based on specific FCP levels, a specific phenotypic measure. In addition, Yajing Huang et al 22 also classified 1377 T2DM into four categories based on the FCP levels. Their Q1 group (FCP ≤ 1.12 µg/L) is equivalent to our T1 group, Q2 and Q3 are equivalent to our T2 group, and Q4 group (FCP ≥ 2.51 µg/L) is equivalent to our T3.…”

Prediction models for risk of diabetic kidney disease in Chinese patients with type 2 diabetes mellitus

“…The elevated serum level of Lp(a) was associated with renal impairment in T2DM patients independent of albuminuria and insulin resistance [ 29 ]. Excessive C-peptide may promote renal function loss and the incidence of DKD [ 30 ].…”

Different Associations of Anthropometric Indices with Diabetic Retinopathy and Diabetic Kidney Disease in Chinese Patients with Type 2 Diabetes Mellitus

“…The copyright holder for this this version posted October 8, 2022. ; https://doi.org/10.1101/2022.10.07.22280304 doi: medRxiv preprint features of DR and DKD: DR is characterized by vascular permeability and retinal neovascularization, while DKD is featured with glomerular sclerosis. It has been revealed that the associations of several clinical indicators with DR and DKD are different, for example, C peptide 6 , glycated albumin to glycated hemoglobin (HbA1c) ratio 7 , and age 8 .…”