2-hour Postprandial C-peptide Research Articles

Prevalence and influencing factors of pulmonary nodules in hospitalized patients with diabetes.

Pulmonary nodules are an early manifestation of many lung cancers, and patients with diabetes are at high risk for lung cancer. However, there is a lack of epidemiological data on pulmonary nodules in patients with diabetes. This study investigated the prevalence rate of pulmonary nodules in hospitalized patients with diabetes and analyzed its influencing factors, with the aim of generating data to inform the management of pulmonary nodules in patients with diabetes. This retrospective study included 1,864 patients with diabetes admitted to the Department of Endocrinology and Metabolism in the North District of Suzhou City Hospital from January 2020 to November 2022. According to the chest computed tomography (CT) examination, the patients were divided into two groups: a no pulmonary nodules group and a pulmonary nodules group. The prevalence rate of pulmonary nodules was calculated, and the number, size, nature, and other imaging characteristics of pulmonary nodules were compared. The pulmonary nodule group was divided into three subgroups according to the following nodule diameters: <5, ≥5 and <10, and ≥10 and ≤30 mm. The clinical data, blood biochemistry, insulin resistance index, and serum tumor marker levels were recorded. A multinomial logistic regression model was used to analyze the influencing factors of pulmonary nodule in diabetic patients. Among the 1,864 hospitalized patients with diabetes, 1,407 were found to have pulmonary nodules, representing a total prevalence rate of 75.48%. Compared with the pulmonary nodules subgroups, the no pulmonary nodules group had a higher proportion of males, a lower smoking rate, and higher incidence of proteinuria (all P values <0.05). Compared with the group with a nodule diameter ≥5 and <10 mm and that with a nodule diameter ≥10 and ≤30 mm, the no pulmonary nodules group had a lower age, insulin use rate, and homocysteine (Hcy) levels but higher fasting and 2-hour postprandial C-peptide level, low-density lipoprotein cholesterol (LDL-C) level and insulin resistance index [Homeostatic Model Assessment for Insulin Resistance 2 (HOMA2IR)] (all P values <0.05). The usage rate of dipeptidyl peptidase 4 (DPP4) inhibitor in the no pulmonary nodules group was lower than that in the subgroup with a nodule diameter ≥5 and <10 mm (P<0.05). Multinomial logistic regression analysis showed that age, smoking, and use of DPP4 inhibitors were independent risk factors for pulmonary nodules. DPP4 inhibitors increased the risk of nodules ≥5 and <10 mm in size, while older age and smoking increased the risk of nodules ≥5 mm in size (all P values <0.05). The prevalence of pulmonary nodules in hospitalized patients with diabetes is up to 75.48%. Older age, smoking, and use of DPP4 inhibitors were found to be independent risk factors for pulmonary nodule development in diabetic patients.

Clinical application of cluster analysis in patients with newly diagnosed type 2 diabetes.

Early prevention and treatment of type 2 diabetes mellitus (T2DM) is still a huge challenge for patients and clinicians. Recently, a novel cluster-based diabetes classification was proposed which may offer the possibility to solve this problem. In this study, we report our performance of cluster analysis of individuals newly diagnosed with T2DM, our exploration of each subtype's clinical characteristics and medication treatment, and the comparison carried out concerning the risk for diabetes complications and comorbidities among subtypes by adjusting for influencing factors. We hope to promote the further application of cluster analysis in individuals with early-stage T2DM. In this study, a k-means cluster algorithm was applied based on five indicators, namely, age, body mass index (BMI), glycosylated hemoglobin (HbA1c), homeostasis model assessment-2 insulin resistance (HOMA2-IR), and homeostasis model assessment-2 β-cell function (HOMA2-β), in order to perform the cluster analysis among 567 newly diagnosed participants with T2DM. The clinical characteristics and medication of each subtype were analyzed. The risk for diabetes complications and comorbidities in each subtype was compared by logistic regression analysis. The 567 patients were clustered into four subtypes, as follows: severe insulin-deficient diabetes (SIDD, 24.46%), age-related diabetes (MARD, 30.86%), mild obesity-related diabetes (MOD, 25.57%), and severe insulin-resistant diabetes (SIRD, 20.11%). According to the results of the oral glucose tolerance test (OGTT) and biochemical indices, fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hBG), HbA1c, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglyceride-glucose index (TyG) were higher in SIDD and SIRD than in MARD and MOD. MOD had the highest fasting C-peptide (FCP), 2-hour postprandial C-peptide (2hCP), fasting insulin (FINS), 2-hour postprandial insulin (2hINS), serum creatinine (SCr), and uric acid (UA), while SIRD had the highest triglycerides (TGs) and TyG-BMI. Albumin transaminase (ALT) and albumin transaminase (AST) were higher in MOD and SIRD. As concerms medications, compared to the other subtypes, SIDD had a lower rate of metformin use (39.1%) and a higher rate of α-glucosidase inhibitor (AGI, 61.7%) and insulin (74.4%) use. SIRD showed the highest frequency of use of sodium-glucose cotransporter-2 inhibitors (SGLT-2i, 36.0%) and glucagon-like peptide-1 receptor agonists (GLP-1RA, 19.3%). Concerning diabetic complications and comorbidities, the prevalence of diabetic kidney disease (DKD), cardiovascular disease (CVD), non-alcoholic fatty liver disease (NAFLD), dyslipidemia, and hypertension differed significantly among subtypes. Employing logistic regression analysis, after adjusting for unmodifiable (sex and age) and modifiable related influences (e.g., BMI, HbA1c, and smoking), it was found that SIRD had the highest risk of developing DKD (odds ratio, OR = 2.001, 95% confidence interval (CI): 1.125-3.559) and dyslipidemia (OR = 3.550, 95% CI: 1.534-8.215). MOD was more likely to suffer from NAFLD (OR = 3.301, 95%CI: 1.586-6.870). Patients with newly diagnosed T2DM can be successfully clustered into four subtypes with different clinical characteristics, medication treatment, and risks for diabetes-related complications and comorbidities, the cluster-based diabetes classification possibly being beneficial both for prevention of secondary diabetes and for establishment of a theoretical basis for precision medicine.

Development and Validation of a Risk Prediction Model for Ketosis-Prone Type 2 Diabetes Mellitus Among Patients Newly Diagnosed with Type 2 Diabetes Mellitus in China.

We established a nomogram for ketosis-prone type 2 diabetes mellitus (KP-T2DM) in the Chinese adult population in order to identify high-risk groups early and intervene in the disease progression in a timely manner. We reviewed the medical records of 924 adults with newly diagnosed T2DM from January 2018 to June 2021. All patients were randomly divided into the training and validation sets at a ratio of 7:3. The least absolute shrinkage and selection operator regression analysis method was used to screen the predictors of the training set, and the multivariable logistic regression analysis was used to establish the nomogram prediction model. We verified the prediction model using the receiver operating characteristic (ROC) curve, judged the model's goodness-of-fit using the Hosmer-Lemeshow goodness-of-fit test, and predicted the risk of ketosis using the decision curve analysis. A total of 21 variables were analyzed, and four predictors-hemoglobin A1C, 2-hour postprandial blood glucose, 2-hour postprandial C-peptide, and age-were established. The area under the ROC curve for the training and validation sets were 0.8172 and 0.8084, respectively. The Hosmer-Lemeshow test showed that the prediction model and validation set have a high degree of fit. The decision curve analysis curve showed that the nomogram had better clinical applicability when the threshold probability of the patients was 0.03-0.79. The nomogram based on hemoglobin A1C, 2-hour postprandial blood glucose, 2-hour postprandial C-peptide, and age has good performance and can serve as a favorable tool for clinicians to predict KP-T2DM.

The impact of family history of type 2 diabetes on clinical heterogeneity in idiopathic type 1 diabetes.

To investigate the impact of family history of type 2 diabetes (T2D) on the clinical phenotypes of patients with idiopathic type 1 diabetes (T1D). In clinically diagnosed T1D cases, a total of 335 idopathic T1D patients were included in the study, after excluding autoimmune T1D using islet autoantibody testing and monogenic diabetes using a custom monogenic diabetes gene panel obtained from clinically diagnosed T1D cases. A semi-structured questionnaire was used to collect information on the presence of T2D in first-degree relatives. The demographic and metabolic markers of idiopathic T1D patients were analysed. Subgroup analysis was performed to investigate potential interactions between T2D family history and human leukocyte antigen (HLA) genotypes. A total of 18.2% of individuals with idiopathic T1D had a T2D family history, and these individuals were more likely to have features associated with T2D, such as older age of onset, higher body mass index at diagnosis, lower insulin dosage and better beta-cell function, as indicated by higher levels of fasting C-peptide and 2-hour postprandial C-peptide (all P < 0.05). Additionally, regardless of HLA susceptible genotypes, the impact of family history of T2D was consistently observed in idiopathic T1D patients. Multivariable analyses showed that T2D family history was negatively correlated with the risk of beta-cell function failure in idiopathic T1D patients (P < 0.05). Family history of T2D may be implicated in the heterogeneity of idiopathic T1D patients.

Analysis of detrended fluctuation function derived from continuous glucose monitoring may assist in distinguishing latent autoimmune diabetes in adults from T2DM.

BackgroundWe aimed to explore the performance of detrended fluctuation function (DFF) in distinguishing patients with latent autoimmune diabetes in adults (LADA) from type 2 diabetes mellitus (T2DM) with glucose data derived from continuous glucose monitoring.MethodsIn total, 71 LADA and 152 T2DM patients were enrolled. Correlations between glucose parameters including time in range (TIR), mean glucose, standard deviation (SD), mean amplitude of glucose excursions (MAGE), coefficient of variation (CV), DFF and fasting and 2-hour postprandial C-peptide (FCP, 2hCP) were analyzed and compared. Receiver operating characteristics curve (ROC) analysis and 10-fold cross-validation were employed to explore and validate the performance of DFF in diabetes classification respectively.ResultsPatients with LADA had a higher mean glucose, lower TIR, greater SD, MAGE and CV than those of T2DM (P<0.001). DFF achieved the strongest correlation with FCP (r = -0.705, P<0.001) as compared with TIR (r = 0.485, P<0.001), mean glucose (r = -0.337, P<0.001), SD (r = -0.645, P<0.001), MAGE (r = -0.663, P<0.001) and CV (r = -0.639, P<0.001). ROC analysis showed that DFF yielded the greatest area under the curve (AUC) of 0.862 (sensitivity: 71.2%, specificity: 84.9%) in differentiating LADA from T2DM as compared with TIR, mean glucose, SD, MAGE and CV (AUC: 0.722, 0.650, 0.800, 0.820 and 0.807, sensitivity: 71.8%, 47.9%, 63.6%, 72.7% and 78.8%, specificity: 67.8%, 83.6%, 80.9%, 80.3% and 72.4%, respectively). The kappa test indicated a good consistency between DFF and the actual diagnosis (kappa = 0.551, P<0.001). Ten-fold cross-validation showed a stable performance of DFF with a mean AUC of 0.863 (sensitivity: 78.8%, specificity: 77.8%) in 10 training sets and a mean AUC of 0.866 (sensitivity: 80.9%, specificity: 84.1%) in 10 test sets.ConclusionsA more violent glucose fluctuation pattern was marked in patients with LADA than T2DM. We first proposed the possible role of DFF in distinguishing patients with LADA from T2DM in our study population, which may assist in diabetes classification.

Enhanced T Cell Glucose Uptake Is Associated With Progression of Beta-Cell Function in Type 1 Diabetes.

BackgroundAbnormal intracellular glucose/fatty acid metabolism of T cells has tremendous effects on their immuno-modulatory function, which is related to the pathogenesis of autoimmune diseases. However, the association between the status of intracellular metabolism of T cells and type 1 diabetes is unclear. This study aimed to investigate the uptake of glucose and fatty acids in T cells and its relationship with disease progression in type 1 diabetes.MethodsA total of 86 individuals with type 1 diabetes were recruited to detect the uptake of glucose and fatty acids in T cells. 2-NBDG uptake and expression of glucose transporter 1 (GLUT1); or BODIPY uptake and expression of carnitine palmitoyltransferase 1A(CPT1A) were used to assess the status of glucose or fatty acid uptake in T cells. Patients with type 1 diabetes were followed up every 3-6 months for 36 months, the progression of beta-cell function was assessed using generalized estimating equations, and survival analysis was performed to determine the status of beta-cell function preservation (defined as 2-hour postprandial C-peptide >200 pmol/L).ResultsPatients with type 1 diabetes demonstrated enhanced intracellular glucose uptake of T cells as indicated by higher 2NBDG uptake and GLUT1 expression, while no significant differences in fatty acid uptake were observed. The increased T cells glucose uptake is associated with lower C-peptide and higher hemoglobin A1c levels. Notably, patients with low T cell glucose uptake at onset maintained high levels of C-peptide within 36 months of the disease course [fasting C-petite and 2-hour postprandial C-peptide are 60.6 (95%CI: 21.1-99.8) pmol/L and 146.3 (95%CI: 14.1-278.5) pmol/L higher respectively], And they also have a higher proportion of beta-cell function preservation during this follow-up period (P<0.001).ConclusionsIntracellular glucose uptake of T cells is abnormally enhanced in type 1 diabetes and is associated with beta-cell function and its progression.

The relation between residual β-cell function and autoimmune status in long-term type 1 diabetes patients

Objective: We aimed to investigate the autoimmune status of long-term type 1 diabetes mellitus (T1DM) patients with residual β-cell function. Methods: The residual β-cell function of long-term (disease duration≥10 years) autoimmune T1DM patients from the T1DM Integrated Management Clinic of the Second Xiangya Hospital was assessed by serum C-peptide levels. Patients with fasting or 2-hour postprandial C-peptide levels over the lower sensitivity limit of detection (16.7 pmol/L) were grouped as C-peptide-positive, and others were grouped as C-peptide-negative. We screened and enrolled all the C-peptide-positive patients (n=19). C-peptide-negative patients with matched sex, age, duration, BMI (n=19) and healthy controls (n=19) were recruited at the same time. The frequencies of CD4+T cell (Th1/Th2/Th17/Treg) and B cell (MZB/FoB/B10) subsets, the expression of PD-1/PD-L1 on T and B lymphocytes, and the levels of T1DM related cytokines including IFN-γ, TNF-α, IL-1β, IL-1RA, IL-4, IL-6, IL-10, IL-12p40, IL-12p70, IL-23 and IP-10 were tested. We compared these parameters in patients with different levels of β-cell function. Results: In healthy controls, C-peptide-negative and C-peptide-positive patients, the frequencies M (Q1, Q3) of Th1 cells were 9.93% (7.45%, 15.20%), 14.90% (11.70%, 18.00%) and 10.20% (6.93%, 15.80%) (P=0.015), and the frequencies M (Q1, Q3) of Treg cells were 3.52% (2.92%, 5.68%),2.88% (1.64%, 3.22%) and 3.12% (2.81%, 4.81%) (P=0.005), and the frequencies M(Q1,Q3) of PD-1+B cells were 4.69% (2.64%, 6.37%), 2.11% (1.45%, 3.63%) and 4.20% (2.53%, 6.01%) (P=0.003), respectively. The levels of IL-6 M(Q1,Q3)were 26.43(18.06, 33.35) ng/L, 42.97 (25.52, 66.30) ng/L, and 22.07 (14.85, 34.45) ng/L (P=0.006), and the levels of IP-10 M(Q1,Q3) were 107.39 (76.19, 126.07) ng/L, 188.82 (131.27, 348.18) ng/L and 128.26 (114.31, 136.50) ng/L (P<0.001) in healthy controls, C-peptide-negative and C-peptide-positive patients, respectively. Compared with C-peptide-positive patients, the frequency of Th1 cells and the levels of IL-6 and IP-10 cytokines were higher, while the frequencies of Treg cells and PD-1+B cells were lower in C-peptide-negative patients (all P<0.05). Conclusions: Long-term T1DM patients with residual β-cell function had lower frequency of Th1 cells, lower levels of IL-6, IP-10 cytokines, and higher frequencies of Treg and PD-1+B cells, which indicated a pronounced autoimmune tolerance.

Effects of incretin-based therapies on β-cell function in type 1 diabetes mellitus: a systematic review and meta-analysis.

AimTo assess the effects of incretin-based therapies on β-cell function in patients with type 1 diabetes mellitus (T1DM).MethodsWe searched the PubMed, Cochrane Library, Embase, and Web of Knowledge databases for eligible randomized clinical trials published up to July 2021. The inclusion criteria were patients with T1DM or latent autoimmune diabetes in adults, patients treated with dipeptidyl peptidase-4 inhibitors or glucagon like peptide-1 receptor agonists, and outcomes included one of the following: fasting plasma glucose, fasting C-peptide, postprandial C-peptide, C-peptide area under the curve (AUC), homeostasis model assessment for β cell function, and insulin resistance. The effects were analyzed using a random effect model with STATA 11.0.ResultsEight trials including 427 participants were included in the final analysis. A pooled analysis found no significant difference in fasting plasma glucose, fasting C-peptide, postprandial C-peptide, or C-peptide AUC between patients treated with incretin-based therapies and placebo. The two trials that reported changes in 2-hour postprandial C-peptide and two of the four trials that reported changes in C-peptide AUC reported increases after incretin-based therapies.ConclusionThis meta-analysis showed that incretin-based therapies did not preserve β-cell function in patients with T1DM.

Islet Function and Insulin Sensitivity in Latent Autoimmune Diabetes in Adults Taking Sitagliptin: A Randomized Trial.

ContextThe long-term effects of dipeptidyl peptidase-4 inhibitors on β-cell function and insulin sensitivity in latent autoimmune diabetes in adults (LADA) are unclear.ObjectiveTo investigate the effects of sitagliptin on β-cell function and insulin sensitivity in LADA patients receiving insulin.Design and SettingA randomized controlled trial at the Second Xiangya Hospital.MethodsFifty-one patients with LADA were randomized to sitagliptin + insulin (SITA) group or insulin alone (CONT) group for 24 months.Main Outcome MeasuresFasting C-peptide (FCP), 2-hour postprandial C-peptide (2hCP) during mixed-meal tolerance test, △CP (2hCP – FCP), and updated homeostatic model assessment of β-cell function (HOMA2-B) were determined every 6 months. In 12 subjects, hyperglycemic clamp and hyperinsulinemic euglycemic clamp (HEC) tests were further conducted at 12-month intervals.ResultsDuring the 24-month follow-up, there were no significant changes in β-cell function in the SITA group, whereas the levels of 2hCP and △CP in the CONT group were reduced at 24 months. Meanwhile, the changes in HOMA2-B from baseline were larger in the SITA group than in the CONT group. At 24 months, first-phase insulin secretion was improved in the SITA group by hyperglycemia clamp, which was higher than in the CONT group (P < .001), while glucose metabolized (M), insulin sensitivity index, and M over logarithmical insulin ratio in HEC were increased in the SITA group (all P < .01 vs baseline), which were higher than in the CONT group.ConclusionCompared with insulin intervention alone, sitagliptin plus insulin treatment appeared to maintain β-cell function and improve insulin sensitivity in LADA to some extent.

Adding vitamin D3 to the dipeptidyl peptidase-4 inhibitor saxagliptin has the potential to protect β-cell function in LADA patients: A 1-year pilot study.

This trial was conducted to explore the protective effect on β-cell function of adding vitamin D3 to DPP-4 inhibitors to treat patients with latent autoimmune diabetes in adults (LADA). 60 LADA patients were randomized to group A (n = 21) - conventional therapy with metformin (1-1.7 g/day) and/or insulin treatment; group B (n = 20) - saxagliptin (5 mg/day) plus conventional therapy; and group C (n = 19) - vitamin D3 (2000 IU/day) plus saxagliptin and conventional therapy for 12 months. Fasting and 2-hour postprandial blood samples were collected to measure blood glucose, glycosylated hemoglobin and C-peptide levels at baseline and after 3, 6 and 12 months of treatment. During the 12 months of follow-up, the levels of fasting C-peptide (FCP), 2-hour postprandial C-peptide (PCP) and the C-peptide index (CPI, serum C-peptide-to-plasma glucose level ratio) were maintained in group C. In contrast to those in group A and group B, FCP levels decreased significantly in group B, and CPI levels declined significantly in group A during the 1-year treatment (P < .05). Additionally, the levels of GADA titers in group C significantly decreased compared with those at baseline (P < .05), but no significant differences in GADA titers levels were detected in group A and group B. No significant differences were found among the three groups in the levels of FCP, PCP, the CPI or GADA titers. The data suggested that adding 2000 IU/day vitamin D3 to saxagliptin might preserve β-cell function in patients with LADA.

Short-term intensive combined therapy with metformin, sagliptin and dapagliflozin for newly diagnosed type 2 diabetes: efficacy, weight control and safety

To assess the efficacy and safety of short- term intensive hypoglycemic therapy with a triple regimen consisting of metformin, sagliptin and dapagliflozin in patients with newly diagnosed type 2 diabetes mellitus with hemoglobin Alc (HbA1c) of 9%-12%. We prospectively enrolled 58 patients with newly diagnosed type 2 diabetes, who were treated with metformin combined with sagliptin and dapagliflozin for 12 weeks on the basis of diabetic diet and regular exercise. Blood glucose was monitored during the treatment and the changes in HbA1c, fasting blood glucose (FBG), 2-hour postprandial blood glucose (2 hPBG), fasting insulin (FINS), 2-hour postprandial insulin (2 hPINS), fasting C-peptide (F-CP), 2-hour postprandial C-peptide (2 hP-CP), and body weight after treatment as well as the incidence of hypoglycemia and adverse events associated with the treatment were recorded. Two patients withdrew from the study for intolerance of gastrointestinal reactions, and another 2 withdrew for inconvenience of access to the medicines. Fifty-four of the patients finally completed the study, including 34 male and 20 female patients. After 12 weeks of therapy, all the patients showed significant improvements in FBG, 2 hPBG, HbA1c, HOMA-beta and HOMA-IR (P < 0.001) with a mean reduction of HbA1c level by (4.19 ± 1.07)%, and the goal of HbA1c control to below 7.0% was achieved in 83.33% of the patients. The reduction of HbA1c was correlated with FBG (r=0.487, P=0.000), 2 hPBG (r=0.310, P=0.023), and HOMA-β (r=-0.398, P=0.003). The patients had a mean body weight loss by 2.47±3.38 kg (P < 0.001) and a mean decrease of body mass index (BMI) by 0.90± 1.18 kg/m2 (P < 0.001) after the therapy. The body weight-reducing effect was associated with the patients' baseline body weight (r=0.678, P=0.000), BMI (r=0.818, P=0.000), F-CP (r=0.282, P=0.039) and HOMA-IR (r=0.297, P=0.029). During the therapy 8 patients experienced hypoglycemic symptoms (10 times, 14.81%); 3 patients were diagnosed with hypoglycemia (blood glucose ≤3.9 mmol/L, 3 times), and the overall incidence of hypoglycemia was 5.56%. No serious hypoglycemia or infections of the urinary and reproductive systems occurred in these patients. Short-term intensive oral hypoglycemic therapy with metformin combined with sagliptin and dapagliflozin is effective for treatment of patients with newly diagnosed type 2 diabetes with HbA1c of 9%-12% and shows a good weight-reducing effect with a low risk of hypoglycemia. The combined therapy can effectively improve β-cell insulin secretion function, and is suitable for treatment of newly diagnosed type 2 diabetic patients with high blood glucose.

Association Between Serum C-Peptide Level and Cardiovascular Autonomic Neuropathy According to Estimated Glomerular Filtration Rate in Individuals with Type 2 Diabetes.

To investigate the association between serum C-peptide level and cardiovascular autonomic neuropathy (CAN) in individuals with type 2 diabetes mellitus (DM) according to estimated glomerular filtration rate (eGFR) METHODS: In a cross-sectional study, we examined 939 individuals with type 2 DM. We measured fasting C-peptide, 2-hour postprandial C-peptide, and ΔC-peptide (postprandial C-peptide minus fasting C-peptide) levels. The individuals were classified into 2 groups based on eGFR: individuals without impaired renal function (eGFR ≥60 ml∙min-1 1.73m-2) and those with impaired renal function (eGFR <60 ml∙min-1 1.73m-2). Individuals with CAN had lower fasting C-peptide, postprandial C-peptide, and ΔC-peptide levels in patients both with and without impaired renal function. Multivariate logistic regression analyses adjusted for gender, age, and other confounders, including eGFR, showed that serum C-peptide level was significantly associated with CAN (odds ratio [OR] per standard deviation increase in the log-transformed value, 0.67; 95% confidence interval [CI], 0.52-0.87 for fasting C-peptide, P < 0.01; OR, 0.62; 95% CI, 0.47-0.83 for postprandial C-peptide, P < 0.01; OR, 0.71; 95% CI, 0.54-0.93 for ΔC-peptide, P < 0.05). Serum C-peptide level was negatively associated with CAN in individuals with type 2 DM independent of eGFR.

561-P: Serum C-Peptide Concentrations Are Inversely Associated with Cardiovascular Autonomic Neuropathy in Type 2 Diabetic Individuals With and Without Renal Impairment Independently of Estimated Glomerular Filtration Rate

Cardiovascular autonomic neuropathy (CAN) is a significant cause of cardiovascular morbidity and mortality in patients with type 2 DM. C-peptide is suggested as a bioactive peptide with protective roles on microangiopathy. However, due to renal metabolism of C-peptide, previous studies have been limited to diabetic patients without renal impairment. Serum C-peptide levels might be increased despite reduced beta cell function in patients with renal impairment. Therefore, we tested the hypothesis that C peptide would relate to the risk of CAN in patients with type 2 DM independently of renal function. A total of 1070 type 2 diabetic patients were investigated in this cross-sectional study. Prior dialysis or renal transplantation was excluded. CAN was diagnosed by a cardiovascular reflex test. Fasting C-peptide, 2-hour postprandial C-peptide, and ΔC-peptide levels were measured. The estimated glomerular filtration rate (eGFR) was calculated from CKD-EPI equation. In individuals with and without renal impairment, patients with CAN showed lower levels of fasting C-peptide, postprandial C-peptide and ΔC-peptide. In multivariate analysis, serum C-peptide levels were significantly associated with CAN (OR, 0.80; 95% CI, 0.67-0.96 for fasting C-peptide, p=0.014; OR, 0.78; 95% CI, 0.64-0.95 for postprandial C-peptide, p=0.013; OR, 0.80; 95% CI, 0.66-0.97 for ΔC-peptide, p=0.023) after adjustment for age, gender and other confounders including eGFR. Our results show that serum C-peptide levels are inversely associated with CAN in type 2 diabetic patients with and without renal impairment independently of eGFR. These findings might suggest the beneficial effects of serum C-peptide levels on CAN independently of eGFR. Disclosure J. Chung: None. S. Park: None. D. Cho: None. D. Chung: None. M. Chung: None.

Diagnostic Significance of Serum Levels of Nerve Growth Factor and Brain Derived Neurotrophic Factor in Diabetic Peripheral Neuropathy.

BackgroundOur study aimed to explore the levels of nerve growth factor (NGF) and brain derived neurotrophic factor (BDNF) in healthy participants, type 2 diabetes mellitus (T2DM) patients, and diabetic peripheral neuropathy (DPN) patients in order to find their effects on DPN.Material/MethodsThe clinical data of 110 healthy participants (age: 57.3±8.2 year, height: 165.4±5.5 cm, weight: 64.1±7.5 kg), 83 T2DM patients (age: 56.5±7.9 year, height: 164.8±6.2 cm, and weight: 63.6±6.6 kg), and 65 DPN patients (age: 58.2±7.3 year, height: 166.7±6.7 cm, weight: 63.1±5.8 kg) were observed. ELISA was applied to detect serum NGF and BDNF levels. Receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic value of serum NGF and BDNF levels in DPN. Logistic regression analysis was performed to analyze risk factors for DPN.ResultsSerum NGF and BDNF levels decreased most in DPN patients. Subsequently, we determined that serum NGF and BDNF levels were correlated with: the course of disease for patients, fasting C-peptide (FCP), 2-hour postprandial C-peptide level (2-h PCP), glycosylated hemoglobin level (HbAlc), and 24-hour urinary microalbumin excretion (24-h UME). ROC curve analysis identified high sensitivity, specificity, and accuracy of NGF and BDNF levels on DPN. Serum levels of NGF and BDNF, course of disease, 2-h PCP level, and postprandial blood glucose level were determined to be risk factors for DPN.ConclusionsOur study highlights that serum levels of NGF and BDNF might be associated with the occurrence and development of DPN.

Anemia is inversely associated with serum C-peptide concentrations in individuals with type 2 diabetes.

The purpose of the study was to test the hypothesis that anemia is related with serum C-peptide concentrations in individuals with type 2 diabetes mellitus (DM).This cross-sectional study was carried out in 1300 individuals with type 2 DM. We measured fasting C-peptide, 2-hour postprandial C-peptide, and postprandial C-peptide minus fasting C-peptide (ΔC-peptide) concentrations. Anemia was defined as hemoglobin (Hb) concentrations <130 g/L in men and <120 g/L in women. Anemia was graded into 2 groups: grade I anemia of Hb concentrations ≥110 g/L and grade II anemia of Hb concentrations <110 g/L.Fasting C-peptide, postprandial C-peptide, and ΔC-peptide concentrations were lower in individuals with anemia. According to the grade of anemia, the average C-peptide concentrations differed significantly after adjusting for other covariates. In the multivariable model, the statistically significant relation between anemia and serum C-peptide concentrations remained after adjusting for confounders, including age, gender, family history of diabetes, body mass index, duration of diabetes, glycated Hb, free fatty acids, hypertension, and hyperlipidemia (fasting C-peptide concentration: β = –0.057, P = .032; postprandial C-peptide concentration: β = –0.098, P < .001; ΔC-peptide concentration: β = –0.095, P < .001).Anemia was inversely associated with serum C-peptide concentrations in individuals with type 2 DM.

Anemia Is Inversely Associated with Serum C-Peptide Concentrations in Patients with Type 2 Diabetes

Results: The aim of the study was to investigate the relationship between anemia and serum C-peptide concentrations in Korean patients with type 2 diabetes. A total of 1,300 subjects with type 2 diabetes were investigated in this cross-sectional study. Fasting C-peptide concentration, 2-hour postprandial C-peptide concentration, and δC-peptide (postprandial C-peptide minus fasting C-peptide) concentration were measured in all patients. Anemia was defined according to the World Health Organization. Fasting C-peptide level, postprandial C-peptide level, and δC-peptide level was lesser in subjects with anemia. According to the grade of anemia, the average C-peptide levels were significantly different after adjusting for other covariates (fasting C-peptide level: no anemia, 0.73 mmol/l; grade I anemia, 0.66 mmol/l; grade II anemia, 0.62 mmol/l; P for trend = 0.002; postprandial C-peptide level: no anemia, 1.54 mmol/l; grade I anemia, 1.36 mmol/l; grade II anemia, 1.32 mmol/l; P for trend &amp;lt; 0.001; δC-peptide level: no anemia, 0.75 mmol/l; grade I anemia, 0.64 mmol/l; grade II anemia, 0.60 mmol/l; P for trend = 0.001). In the multivariate model, the association between anemia and serum C-peptide concentrations remained significant, after adjustment for confounding factors including age, gender, familial diabetes, body mass index, duration of diabetes, glycated hemoglobin, free fatty acid, hypertension, and hyperlipidemia (fasting C-peptide level: β= -0.057, P =0.032; postprandial C-peptide level: β= -0.098, P &amp;lt;0.001; δC-peptide level: β= -0.095, P &amp;lt;0.001, respectively). Our results showed that anemia was inversely associated with serum C-peptide concentrations in subjects with type 2 diabetes. Disclosure J. Chung: None. S. Park: None. D. Cho: None. D. Chung: None. M. Chung: None.

Nutrition management in obese patients with type 2 diabetes mellitus after laparoscopic sleeve gastrectomy

To explore the value of nutrition management in obese patients with type 2 diabetes mellitus(T2DM) after laparoscopic sleeve gastrectomy(LSG). Clinical data of 22 obese T2DM patients undergoing LSG from March 2013 to July 2015 in Fudan University Pudong Medical Center were collected. All the patients strictly followed the specialized instruction by nutritionists: diabetic and low calorie diet 3347.2 to 5020.8 kJ (800 to 1200 kcal) per day before the operation; low calorie liquid diet 2510.4 kJ(600 kcal) per day before operation for promoting gastric emptying; fasting diet before postoperative ventilation; clear liquid diet 1673.6 to 2510.4 kJ (400 to 600 kcal) per day after postoperative ventilation (liquid intake >2000 ml); low fat liquid diet 2928.8 to 3765.6 kJ (700 to 900 kcal) per day (protein 60 g per day at least, 2000 ml liquid) 2 weeks after the operation; semi-liquid diet 1 month after operation and gradually normal diet. All the 22 patients were followed up at 1 week, 1, 3, 6 months after operation on time. Changes of body weight, waist circumference, hip circumference, body mass index(BMI), blood glucose indexes induding fasting blood glucose(FBG), 2-hour postparandial blood glucose(PBG), fasting C-peptide, 2-hour postprandial C-peptide, fasting serum inculin(FINS), 2-hour postprandial inculin(INS), HbAlc, blood pressure and blood lipid indexes were observed and analyzed before and 1 week, 1, 3, 6 months after operation. The average age of 22 patients (10 men and 12 women) was 38.6 years (18 to 66 years). The duration of diabetes varied from 1 month to 15 years. Comorbidity included 12 patients of high blood pressure, 14 of fatty liver, 1 of coronary heart disease, 1 of gout, 1 of chronic thyroiditis and 1 of menstrual disorder. LSG was performed successfully in all the patients and no severe complications and transference to laparotomy occurred. As compared to pre-operation, at 6 months after operation, the average body weight decreased from (103.9±20.2) kg to (80.9±12.6) kg (t=6.294, P=0.000), waist circumference from (118.6±13.8) cm to (96.4±8.0) cm (t=6.331, P=0.000), hip circumference from (116.9±12.6) cm to (104.0±7.7) cm (t=3.854, P=0.000), BMI from (36.2±5.9) kg/m2 to (27.9±3.5) kg/m2 (t=5.630, P=0.000), showing a decreasing trend over time. There was no underweight patient after 6 months follow-up. As compared to pre-operation, at 6 months after operation, the average FBG reduced from (7.4±1.4) mmol/L to (6.0±0.9) mmol/L (t=3.172, P=0.003), 2 h PBG from (14.1±4.9) mmol/L to (7.5±2.2) mmol/L (t=7.026, P=0.000), FINS from (160.0±71.9) mIU/L to (43.8±20.8) mIU/L (t=7.259, P=0.000), 2-hour postprandial INS from (437.6±261.4) mIU/L to (140.5±104.6) mIU/L (t=5.858, P=0.000), fasting C-peptide from (1.1±0.6) μg/L to (0.7±0.3) μg/L (t=3.560, P=0.000), 2-hour postprandial C-peptide from (2.5±0.9) μg/L to (1.5±0.7) μg/L (t=3.865, P=0.000), HbAlc from (8.0±1.6)% to (5.9±0.6)% (t=5.953, P=0.000), showing a decreasing trend over time except FBG, 2h postprandial C-peptide and HbAlc(all P<0.05). FBG and 2-hour PBG of 16 patients returned to normal 3 months after the operation. Blood pressure and trigly ceride decreased obviously 6 months after operation compared to pre-operation with significant difference(P<0.05). At 6 months after operation, blood pressure of 8 comorbidity patients with high blood pressure became normal (8/12, 66.7%) and of 4 patients improved(4/12, 33.3%); B ultrasound examination revealed normal in 11 comorbidity patients with fatty liver(11/14,78.6%) and improvement in 3 patients (3/14,15.4%). Blood uric acid of the gout patient and the menstruation of the menstrual disorder patient returned to normal 3 months and 1 month after the operation respectively. As for obese patients with T2DM undergoing LSG, reasonable nutrition management is helpful to decrease body weight, and to obtain an ideal improvement of blood glucose and blood lipid levels.

Relationship between serum C-peptide level and diabetic retinopathy according to estimated glomerular filtration rate in patients with type 2 diabetes

ObjectiveTo test the hypothesis that serum C-peptide level would relate to the risk of diabetic retinopathy (DR) in type 2 diabetic patients independently of estimated glomerular filtration rate (eGFR). DesignA total of 2,062 patients with type 2 diabetes were investigated in this cross-sectional study. Fasting C-peptide, 2-hour postprandial C-peptide, and ΔC-peptide (postprandial C-peptide minus fasting C-peptide) levels were measured. The patients were divided into two groups according to eGFR (ml∙min−11.73m−2): patients without renal impairment (eGFR ≥60) and those with renal impairment (eGFR <60). ResultsIn subjects both with and without renal impairment, patients with DR showed lower levels of fasting C-peptide, postprandial C-peptide and ΔC-peptide. In multivariate analysis, serum C-peptide levels were significantly associated with DR (odds ratio [OR] of each standard deviation increase in the logarithmic value, 0.85; 95% confidence interval [CI], 0.78–0.92 for fasting C-peptide, P<0.001; OR, 0.87; 95% CI, 0.82–0.92 for postprandial C-peptide, P<0.001; OR, 0.88; 95% CI, 0.82–0.94 for ΔC-peptide, P<0.001) after adjustment for age, gender, and other confounding factors including eGFR. ConclusionsSerum C-peptide levels are inversely associated with the prevalence of DR in type 2 diabetic patients independently of eGFR.

Dipeptidyl Peptidase 4 Inhibitor Sitagliptin Maintains β-Cell Function in Patients With Recent-Onset Latent Autoimmune Diabetes in Adults: One Year Prospective Study

Dipeptidyl peptidase 4 (DPP-4) inhibitors have been widely used in type 2 diabetes. An important unanswered question concerns the effect of DPP-4 inhibition on β-cell function in patients with autoimmune diabetes. The objective of the study was to investigate the effects of the DPP-4 inhibitor on β-cell function in patients with recent-onset latent autoimmune diabetes in adults (LADA). This study was an open-label, randomized-controlled study conducted in the Department of Endocrinology at the Second Xiangya Hospital. Thirty recently diagnosed LADA patients were randomized 1:1 to receive insulin therapy with 100 mg/d sitagliptin (group A, n = 15) or without sitagliptin (group B, n = 15) for 12 months. Fasting and 2-hour postprandial blood samples were obtained at baseline and after 3, 6, 9, and 12 months of treatment to determine blood glucose, glycosylated hemoglobin, and C-peptide levels. There were no differences in the clinical baseline data between the two groups. During the 12 months of follow-up, there were no significant differences in glucose and glycosylated hemoglobin levels between the two groups. At 12 months, fasting C-peptide (FCP), 2-hour postprandial C-peptide (CP), and ΔCP (ΔCP = 2 h CP-FCP) levels were not different in group A (P > .05) compared with baseline, whereas in group B the levels of FCP, 2-hour CP and ΔCP were significantly decreased compared with baseline (P < .05). Levels of 2-hour CP were higher in group A than group B at 12 months (P < .05). LADA patients treated with sitagliptin and insulin maintained β-cell function by comparison with insulin alone.

A Phase I/II Study of Ling Zhi Mushroom Ganoderma lucidum (W.Curt.:Fr.)Lloyd (Aphyllophoromycetideae) Extract in Patients with Type II Diabetes Mellitus

Animal studies have demonstrated that the polysaccharide fractions of Ganoderma lucidum (Ling Zhi, reishi mushroom) have potential hypoglycemic and hypolipidemic activities. This clinical study aimed to evaluate the efficacy and safety of Ganopoly (polysaccharide fractions extracted from G. lucidum by patented technique) in 71 patients with confirmed type II diabetes mellitus (DM). Eligibility criteria included type II DM of >3 months' duration for which patients were not receiving insulin; age >18 years; normal vital signs for age and disease state; normal electrocardiogram (ECG); and fasting plasma glucose (FPG) level of 8.9.16.7 mmol/L in sulfonylurea-naive patients or an FPG <10 mmol/L before washout in sulfonylurea-treated patients. Patients were randomly grouped to be given either Ganopoly or placebo orally at 1800 mg three times daily for 12 weeks. Patients underwent 4 weeks of dose adjustment followed by 8 weeks of dose maintenance. Fasting and stimulated glycosylated hemoglobin (HbA1c), plasma glucose, insulin, and C-peptide were monitered at predetermined intervals. Adverse events and hypoglycemic episodes were recorded. The treatment of Ganopoly significantly decreased the mean HbA1c from 8.4 at baseline to 7.6% at 12 weeks. Significant changes in mean FPG and PPG levels at the last visit paralleled the changes in mean HbA1c levels. At baseline, the mean FPG and PPG values in patients treated with Ganopoly were 12.0 and 13.6 mmol/L, respectively. At week 12, mean PPG values had decreased to 11.8 mmol/L. However, these parameters did not change or slightly increased in patients receiving placebo. The between-group difference in PPG levels at week 12 was significant (p < 0.05). Changes in fasting insulin, 2-hour post-prandial insulin, fasting C-peptide, and 2-hour post-prandial C-peptide were consistent, with the between-group differences in these end points being significant at the last visit. Overall, Ganopoly was well tolerated.