Preserved C-peptide secretion is associated with fewer low-glucose events and lower glucose variability on flash glucose monitoring in adults with type 1 diabetes

被引:50
作者
Gibb, Fraser W. [1 ,2 ]
McKnight, John A. [3 ]
Clarke, Catriona [4 ]
Strachan, Mark W. J. [3 ]
机构
[1] Royal Infirm Edinburgh NHS Trust, Edinburgh Ctr Endocrinol & Diabet, Edinburgh EH16 4SA, Midlothian, Scotland
[2] Univ Edinburgh, Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland
[3] Western Gen Hosp, Edinburgh Ctr Endocrinol & Diabet, Edinburgh, Midlothian, Scotland
[4] Western Gen Hosp, Dept Clin Biochem, Edinburgh, Midlothian, Scotland
关键词
Clinical diabetes; Continuous glucose monitoring; C-peptide; Devices; Hypoglycaemia; GLUCAGON-RESPONSE; INTRAISLET INSULIN; HYPOGLYCEMIA; COMPLICATIONS; FREQUENCY; DIAGNOSIS; AWARENESS; DECREMENT; DURATION; ONSET;
D O I
10.1007/s00125-020-05099-3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims/hypothesis We aimed to assess whether persistence of C-peptide secretion is associated with less glucose variability and fewer low-glucose events in adults with type 1 diabetes who use flash monitoring. Methods We performed a cross-sectional study of 290 adults attending a university teaching hospital diabetes clinic, with type 1 diabetes, who use flash monitoring and in whom a random plasma C-peptide was available in the past 2 years. Variables relating to flash monitoring were compared between individuals with low C-peptide (<10 pmol/l) and those with persistent C-peptide (either 10-200 pmol/l or 10-50 pmol/l). In addition, the relationship between self-reported hypoglycaemia and C-peptide was assessed (n = 167). Data are median (interquartile range). Results Individuals with preserved C-peptide secretion (10-200 pmol/l) had shorter duration of diabetes (15 [9-24] vs 25 [15-34] years, p < 0.001) and older age at diagnosis (23 [14-28] vs 15 [9-25] years, p < 0.001), although current age did not differ in this cohort. Preserved C-peptide was associated with lower time with glucose <3.9 mmol/l (3% [2-6%] vs 5% [3-9%], p < 0.001), fewer low-glucose events per 2 week period (7 [4-10] vs 10 [5-16], p < 0.001), lower SD of glucose (3.8 [3.4-4.2] vs 4.1 [3.5-4.7] mmol/l, p = 0.017) and lower CV of glucose (38.0 [35.0-41.6] vs 41.8 [36.5-45.8], p < 0.001). These differences were also present in those with C-peptide 10-50 pmol/l and associations were independent of diabetes duration and estimated HbA(1c) in logistic regression analysis. Preserved C-peptide was also associated with lower rates of self-reported asymptomatic hypoglycaemia (8.0% vs 22.8% in the past month, p = 0.028). Conclusions/interpretation Preserved C-peptide secretion is associated with fewer low-glucose events and lower glucose variability on flash monitoring. This suggests that individuals with preserved C-peptide may more safely achieve intensive glycaemic targets.
引用
收藏
页码:906 / 914
页数:9
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