Is Non-Stimulated C-Peptide at Diagnosis a Good Predictive Value for Insulin Use at Two Years after Diagnosis in Pediatric Diabetic Patients?

Wei-Chih Chou,Yen-Yin Chou,Meng-Che Tsai,Yu-Wen Pan

doi:10.3390/medicina57090902

Wei-Chih Chou, Yen-Yin Chou + Show 2 more

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https://doi.org/10.3390/medicina57090902

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Abstract

Background and Objectives: Insulin treatment may be initially required to stabilize patients presenting with metabolic crisis at type 1 and 2 diabetes mellitus (DM) onset. Some patients with type 2 DM may need persistent insulin treatment. This study aimed to examine the predictive performance of non-stimulated C-peptide level at the time of diagnosis for future insulin use in pediatric diabetic patients. Materials and Methods: We reviewed the medical charts of diabetic patients aged 18 years or younger in a medical center in southern Taiwan from January 2000 to December 2019. Clinical and individual data were collected at the time of DM diagnosis. Outcomes were persistent insulin use at the time of diagnosis, as well as at one and two years after diagnosis. Results: The final analysis included a total of 250 patients. The best cut-off point of non-stimulated C-peptide was 0.95 ng/mL, and the predictive indices for the insulin use were 0.84 for sensitivity and 0.94 for specificity at two years after DM diagnosis. Incorporating age at onset and presence of GAD antibodies can further increase the predictive power of non-stimulated C-peptide. Conclusions: The value of non-stimulated C-peptide at diabetic onset was feasible and effective for predicting future insulin treatment up to the time point of two years after diagnosis.

Highlights

Type 1 diabetes mellitus (T1DM) results from autoimmune-mediated destruction of the insulin-producing β-cells, and T1DM patients may require long term insulin treatment [1]
Its pathogenesis is different from type 2 diabetes mellitus (T2DM), which is characterized by increased insulin resistance
We examined the predictive role of gender, age of DM onset, body mass index (BMI) at DM onset, non-stimulated insulin and C-peptide levels, glutamic acid decarboxylase (GAD) antibodies, and ketoacidosis to verify whether the abovementioned parameters are effective in predicting future insulin use [9]

Summary

Introduction

Type 1 diabetes mellitus (T1DM) results from autoimmune-mediated destruction of the insulin-producing β-cells, and T1DM patients may require long term insulin treatment [1]. T1DM patients’ medical expenditure can be reimbursed once their diagnosis is documented Patients and their family are keen to know whether long term insulin therapy is required for this disease. Insulin treatment may be initially required to stabilize patients presenting with metabolic crisis at type 1 and 2 diabetes mellitus (DM) onset. This study aimed to examine the predictive performance of non-stimulated C-peptide level at the time of diagnosis for future insulin use in pediatric diabetic patients. The best cut-off point of non-stimulated C-peptide was 0.95 ng/mL, and the predictive indices for the insulin use were 0.84 for sensitivity and 0.94 for specificity at two years after DM diagnosis. Conclusions: The value of non-stimulated C-peptide at diabetic onset was feasible and effective for predicting future insulin treatment up to the time point of two years after diagnosis

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