A comparison of glycemic parameters and their relationship with C-peptide and Proinsulin levels during partial remission and non-remission periods in children with type 1 diabetes mellitus - a cross-sectional study

Gül Yeşiltepe-Mutlu,Serra Muradoğlu,Ecem Can,Tuğba Gökçe,Şükrü Hatun,Said İncir,Esra Papatya Çakır,Merve Çapacı,Gizem Bayrakçı

doi:10.1186/s12902-021-00681-1

Gül Yeşiltepe-Mutlu, Serra Muradoğlu + Show 7 more

Open Access

https://doi.org/10.1186/s12902-021-00681-1

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Abstract

BackgroundCurrently, there is a lack of data relating to glycemic parameters and their relationship with C-peptide (CP) and proinsulin (PI) during the partial remission period (PRP) in type 1 diabetes mellitus (T1D). The aim of this study was to evaluate glycemic parameters in children with T1D who are in the PRP using intermittently scanned continuous glucose monitoring systems (isCGMS) and to investigate any relationships between CP and PI levels.MethodsThe study included 21 children who were in the PRP and 31 children who were not. A cross-sectional, non-randomized study was performed. Demographic, clinical data were collected and 2 week- isCGMS data were retrieved.ResultsThe Serum CP showed a positive correlation with time-in-range in the PRP (p:0.03), however PI showed no correlations with glycemic parameters in both periods. The Serum CP and PI levels and the PI:CP ratio were significantly higher in the PRP group than in the non-PRP group. In the non-PRP group, the PI level was below 0.1 pmol/L (which is the detectable limit) in only 2 of the 17 cases as compared with none in the PRP group. Similarly, only 2 of the 17 children in the non-PRP group had CP levels of less than 0.2 nmol / L, although both had detectable PI levels. Overall time-in-range (3. 9-1.0 mmol/L) was significantly high in the PRP group. In contrast, the mean sensor glucose levels, time spent in hyperglycemia, and coefficient of variation levels (32.2vs 40.5%) were significantly lower in the PRP group.ConclusionsAlthough the mean glucose and time in range during the PRP was better than that in the non-PRP group, the glycemic variability during this period was not as low as expected. While the CP levels showed an association with TIR during the PRP, there was no correlation between PI levels and glycemic parameters. Further studies are needed to determine if PI might prove to be a useful parameter in clinical follow-up.

Highlights

There is a lack of data relating to glycemic parameters and their relationship with C-peptide (CP) and proinsulin (PI) during the partial remission period (PRP) in type 1 diabetes mellitus (T1D)
While the CP levels showed an association with TIR during the PRP, there was no correlation between PI levels and glycemic parameters
PRP is defined as an insulin dose-adjusted hemoglobin A1c (HbA1c) (IDAA1c) of equal to or less than 9, where insulin dose adjusted HbA1c (IDAA1c) is equal to the sum of HbA1c (% and mmol/ mol) and 4 times the insulin dose [3]

Summary

Introduction

There is a lack of data relating to glycemic parameters and their relationship with C-peptide (CP) and proinsulin (PI) during the partial remission period (PRP) in type 1 diabetes mellitus (T1D). The transient recovery period of beta-cell function, after initiation of insulin therapy in patients with newly diagnosed type 1 diabetes mellitus, is referred to as the ‘honeymoon’ or partial remission phase (PRP). PRP is defined as an insulin dose-adjusted hemoglobin A1c (HbA1c) (IDAA1c) of equal to or less than 9, where IDAA1c is equal to the sum of HbA1c (% and mmol/ mol) and 4 times the insulin dose (units/kg/day) [3] This definition based on insulin doses and HbA1c is not sufficient in terms of glycemic variability, insulin sensitivity, and episodes of hypoglycemia and hyperglycemia. An IDAA1C level of 9 has been shown to correspond to a substantially increased predicted stimulated C-peptide (CP) level of 300 pmol / l [3]

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