Feasibility of using urinary c‐peptide to guide diabetes management in a district general hospital type 1 diabetes population

Abstract

AbstractBackground: C‐peptide measurement is a well‐recognised tool for distinguishing individuals with insulin deficiency from those with retained insulin secretion; however, it is not routinely performed across the UK.Aims: This study aimed to evaluate the feasibility and efficacy of routine urinary c‐peptide testing in a district general hospital type 1 diabetes clinic.Methods: In this single‐centre study, adults with type 1 diabetes for at least 3 years were offered random urine c‐peptide–to–creatinine ratio (UCPCR) testing during routine clinic review. A UCPCR of >0.2 prompted further evaluation of the individual and their diabetes treatment.Results: Of 200 recruited individuals, 172 (87%) submitted a urine sample. Of the 172 individuals, 26 (15%) had a UCPCR of >0.2, which prompted a review of their diagnosis and treatment strategies, and 12 (7%) had a UCPCR of >0.6, suggesting significant inherent insulin secretion and a likelihood of positive response to alternative or additional pharmacological agents.Conclusions: Urinary c‐peptide level testing performed routinely at a district general hospital type 1 diabetes clinic is practical. It can alter patient clinical outcomes, lead to more appropriate and effective pharmacological treatments and ensure appropriate use of expensive technologies.