Factors associated with preservation of C-peptide levels at the diagnosis of type 1 diabetes

Szypowska, Agnieszka; Groele, Lidia; Wysocka‐Mincewicz, Marta; Mazur, Artur; Lisowicz, Lucyna; Beń‐Skowronek, Iwona; Sieniawska, Joanna; Klonowska, Bożenna; Charemska, Dorota; Nawrotek, Jolanta; Jałowiec, Irena; Bossowski, Artur; Noiszewska, Klaudyna; Pyrżak, Beata; Rogozińska, Izabela; Szalecki, Mieczysław

doi:10.1016/j.jdiacomp.2018.03.009

Cited by 13 publications

(18 citation statements)

References 20 publications

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“…In our study children aged over 10 years at time of diagnosis had higher fasting and postprandial C-peptide levels as well as higher C-peptide concentration after two years of observation compared to subjects younger than 10 years. Our observation was consistent with the results of Szypowska et al, who found also that children > 10 years old had higher fasting C-peptide concentration, and moreover their findings were based on a study group with 1098 Polish children [30]. The results of a study performed by Samuelsson et al also confirmed our findings [31].…”

Section: Discussionsupporting

confidence: 93%

“…We observed also a negative correlation between the postprandial C-peptide level and HbA 1c at diabetes diagnosis. In the mentioned study performed by Szypowska et al a negative correlation was noted between the fasting C-peptide concentration and HbA 1c at diabetes diagnosis [30]. In line with other studies, we noted statistically lower fasting (and postprandial) C-peptide levels in children with diabetic ketoacidosis compared to those without [30,33].…”

Section: Discussionsupporting

confidence: 90%

“…In the mentioned study performed by Szypowska et al a negative correlation was noted between the fasting C-peptide concentration and HbA 1c at diabetes diagnosis [30]. In line with other studies, we noted statistically lower fasting (and postprandial) C-peptide levels in children with diabetic ketoacidosis compared to those without [30,33]. When diagnosed with diabetes, if the patient presents with severe ketoacidosis, it seems to negatively impact the onset and duration of remission (49.5% of the patients without DKA had partial remission compared to only 18.3% of patients with DKA) [34,35].…”

Section: Discussionmentioning

confidence: 83%

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Clinical determinants of the remission phase in children with new-onset type 1 diabetes mellitus in two years of observation

Rydzewska¹,

Kulesza²,

Olszewska³

et al. 2019

pedm

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Possibilities of prolonging endogenous insulin production during the "remission phase" of type 1 diabetes (T1DM) have been the focus of much interest in recent research. The aim of the study was to describe the course of clinical remission in children with new-onset type 1 diabetes and to compare the selected markers affecting the presence of partial clinical remission (CR), focusing, among others, on physical activity before/during diagnosis. Material and methods: We recruited 82 children (aged 10 ±3.72 years) with T1DM. We gathered data regarding the course of the disease (two years of observation), insulin treatment, and laboratory results. Endogenous insulin production was assessed on the basis of C-peptide fasting and prandial level. Remission of diabetes was defined according to actual criteria. Information about physical activity (PA) was obtained by telephone interview. Results: Patients with no physical activity, in comparison with those with a high level of PA before the diagnosis, had significantly worse parameters of acid-base balance at admission (p < 0.05). Patients with a higher PA level in the course of T1DM had significantly lower insulin requirements three months after diagnosis (p < 0.05). Patients < 10 years of age presented worse acid-base balance parameters (p < 0.05) at admission, lower fasting and postprandial C-peptide concentrations at admission (p < 0.05) and after two years of observation (p = 0.00), compared to the > 10-year-old group. In a follow-up lower insulin dose on the day of discharge and after 6 and 12 months, and higher postprandial C-peptide concentration was observed in patients with HbA 1c below 11.3% (median) at admission compared to the group with HbA 1c above 11.3%. Patients with remission at discharge from hospital presented fewer metabolic disturbances at admission (p < 0.05) and lower insulin requirements from the date of discharge (p = 0.00) to the end of the first year (p < 0.05). Conclusions: Lower insulin demand at discharge from hospital after diagnosis of T1DM in a child is connected with older age, lower HbA 1c level, and better clinical condition at admission. Higher PA affects better biochemical parameters at diagnosis of T1DM and lower demand for insulin later. During the first two years of the disease clinical remission may be connected with higher physical activity, but longitudinal studies are still required.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 83%

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Clinical determinants of the remission phase in children with new-onset type 1 diabetes mellitus in two years of observation

Rydzewska¹,

Kulesza²,

Olszewska³

et al. 2019

pedm

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“…Several factors such as low age at presentation, ketoacidosis at presentation, high HbA1c at presentation and BMI have been related to C peptide concentrations measured at diagnosis9 12–16 and to the decline of C peptide secretion during the first years of treatment 9 17 18. These factors were not related to the long-term preservation of C peptide secretion in the present study.…”

Section: Discussioncontrasting

confidence: 51%

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

Grönberg

Espes

Carlsson

2020

BMJ Open Diab Res Care

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ObjectiveTo identify the factors associated with residual C peptide production at least 10 years after diagnosis in children and adolescents with type 1 diabetes.Research design and methods73 children and adolescents (<25 years), born in 1988–2005, diagnosed with type 1 diabetes were included during the 4-year study period (2013–2016). At least 10 years after diagnosis, we measured any remaining C peptide concentration using an ultrasensitive C peptide ELISA (≥1.17 pmol/L). The average hemoglobin A1c (HbA1c) was calculated during each of the 10 years after diagnosis and further grand average was calculated for the entire study period.ResultsC peptide was detectable in 38% of participants. The C peptide concentration was 4.3±5.3 pmol/L. At onset of type 1 diabetes, participants were on average approximately 5 years of age, and their average HbA1c was 9.4% (79 mmol/mol). During the first 3 years after diagnosis, HbA1c was lower in the group with detectable C peptide at follow-up ≥10 years later. Moreover, detectable C peptide was more common among female participants. Body mass index SD scores had not increased since the 1-year follow-up, but were higher in patients with measurable C peptide. Nine participants (12%) had been diagnosed with celiac disease and two (3%) with hypothyreosis. Eighteen (25%) participants had retinopathy.ConclusionsChildren and adolescents with detectable C peptide after more than 10 years of diabetes duration were predominantly female and had better HbA1c than others during the first 3 years after diagnosis.

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“…Patients with T1D are varied and quite heterogeneous in β‐cell function and its speed of progression . Several factors including age, sex, duration of disease, glycated haemoglobin (HbA 1c ), BMI, insulin dose, and pancreas autoantibodies affect the trend of β‐cell function declination to different extents . However, the exact influence of BMI at diagnosis on β‐cell function during a long follow‐up period in children and adults remains unclarified.…”

Section: Introductionmentioning

confidence: 99%

Complicated curve association of body weight at diagnosis with C‐peptide in children and adults with new‐onset type 1 diabetes

Gong

Zhong

et al. 2020

Diabetes Metabolism Res

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Aim: To investigate the association of body mass index (BMI) or BMI z-score (BMIz) at diagnosis with β-cell function in new-onset type 1 diabetes (T1D) patients in children and adults.Methods: This was a retrospective cohort study; 256 children (<18 years) and 245 adults (≥18 years) with less than 1-year duration were recruited and followed for 4 years with an interval of 12 months. Smooth curve fitting, a two-piecewise linear model, and Cox proportional hazards models were utilized to investigate the influence of BMI/BMIz on C-peptide levels.Results: Heavier patients (BMIz ≥ −1 in children and BMI in adults ≥20.2 kg/m 2 ) had greater C-peptide with a complicated J curve in all age groups after adjustment for age of onset, sex, and disease duration. Moreover, after 4 years of follow-up, patients with higher BMI/BMIz had a lower risk of β-cell failure (HR = 0.7; 95% CI, 0.6-1.0; P = .026). However, no association was found between baseline BMI/BMIz at diagnosis and C-peptide rate of decline during 1 year follow-up.Conclusion: Association between BMI/BMIz and C-peptide in T1D followed a complicated J curve pattern, and heavier patients had greater C-peptide at diagnosis and a lower risk of β-cell failure at 4 years, suggesting that baseline BMI is a useful predictor for β-cell function in patients with T1D.

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Factors associated with preservation of C-peptide levels at the diagnosis of type 1 diabetes

Cited by 13 publications

References 20 publications

Clinical determinants of the remission phase in children with new-onset type 1 diabetes mellitus in two years of observation

Clinical determinants of the remission phase in children with new-onset type 1 diabetes mellitus in two years of observation

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

Complicated curve association of body weight at diagnosis with C‐peptide in children and adults with new‐onset type 1 diabetes

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