Abstract
Objective:To determine the relationship of C-peptide levels with duration of type 1 diabetes mellitus.Methods:This prospective study was conducted at Baqai Institute of Diabetology and Endocrinology (BIDE), Baqai Medical University (BMU), Karachi-Pakistan from December 2013 to December 2015. A total of 184 subjects were recruited during the study period, 100 in Group-A and 84 in Group-B. Subjects clinically diagnosed with type 1 diabetes Mellitus (T1DM) were categorized into two groups based on duration of diabetes: Group-A (with ≤1-year duration of diabetes) and Group-B (with >1-year duration of diabetes). Ninety-nine of the 100 enrolled subjects in Group-A were diagnosed as having T1DM, with one subject who presented at 11.9 years of age and diagnosed with T2DM excluded from this study. Blood samples were drawn for biochemical parameters. Data for baseline characteristics and clinical parameters (HbA1c and C-peptide) were obtained from hospital management system of BIDE.Results:Fifty-seven (57.6%) subjects in Group-A, and 39 (46.4%) in Group-B were males. Mean±SD duration of diabetes (years) was 0.64±0.6 (range 0-1) in Group-A, and 7.65±5.5 (range 1-23) in Group-B. Family history of T1DM and T2DM was 1(1%) and 27(27.3%) in Group-A, and 8(9.52%) and 21(25%) in Group-B, respectively. Twenty-one (21.2%) subjects presented in diabetic ketoacidosis (DKA) in Group-A and 18(21.4%), in Group-B. Mean±SD for HbA1c was non-significantly higher in Group-A 11.12±2.31 compared to Group-B 10.42±1.45. Mean±SD for C-peptide was 1.91±1.53 ng/mL (0.60±0.481 nmol/L) in Group-A, and 1.82±1.01 (0.57±0.32 nmol/L) in Group-B (p=0.984).Conclusion:The study found that subjects with longer duration of T1DM had non-significantly decreased C-peptide levels compared to a group in which C-peptide was measured at or soon after diagnosis. Furthermore, C-peptide levels in many subjects with longer duration were higher than expected in classic T1DM.
Highlights
The hallmark of type 1 diabetes mellitus (T1DM) is absence or very low levels of insulin production, which can be indirectly seen by the presence of low C-peptide levels.[1,2] Approximately 40-50% of the risk of disease arises from genetics, while the remaining risk arising from poorly defined environmental etiologies.[3]
Ninety-nine of the 100 enrolled subjects in Group-A were diagnosed as having T1DM, with one subject who presented at 11.9 years of age and diagnosed with T2DM excluded from this study
Data of this study suggests that maintenance of C-peptide levels is much more common in young people with T1DM in Pakistan
Summary
The hallmark of type 1 diabetes mellitus (T1DM) is absence or very low levels of insulin production, which can be indirectly seen by the presence of low C-peptide levels.[1,2] Approximately 40-50% of the risk of disease arises from genetics, while the remaining risk arising from poorly defined environmental etiologies.[3]. One subdivision identifies Type 1A, resulting from autoimmune mediated destruction of β-cells, and Type 1B which is less prevalent and mostly seen. Pak J Med Sci May - June 2020 Vol 36 No 4 www.pjms.org.pk 765 in Asian and African population with unknown etiology, which present with variable degrees of insulin deficit and residual β-cell function.[4,5]. Pancreatic islet-cells of Langerhans secrete insulin and C-peptide in equimolar amounts into the blood in response to hyperglycemia. It is used to assess endogenous insulin secretion in patients with T1DM.[6]. In most of the patients with long-duration of T1DM, very low levels of C-peptide can still be detected. The prevalence of detectable C-peptide in patients with T1DM depends on several factors including duration of diabetes, age at diagnosis, and sensitivity of assays used.[7]
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