Current Status of Serum Insulin and C-Peptide Measurement in Clinical Laboratories: Experience from 94 Laboratories in China

Background: Accurate measurements of serum insulin and C-peptide are needed for the therapy and classification of diabetes. This study investigated the status of serum insulin and C-peptide measurements in China by analyzing the results of five pooled serum samples measured in 94 laboratories. Methods: Patient serum samples were pooled into five groups according to insulin and C peptide concentrations and measured in 94 laboratories using different measurement systems. The inter-and intra-laboratory %CV as well as inter-and intra-measurement system %CV were calculated to assess the status of insulin and C-peptide measurements. To verify whether the disagreement between laboratories was due to different calibrators, as reported in previous studies, one low-level and one high-level sample extracted from the five pooled serum samples were used to recalibrate clinical measurement systems. Results: The mean intra-laboratory, intra-measurement system, inter-laboratory, and inter measurement system %CVs were 2.7%, 4.8%, 21.8%, and 22.4%, respectively, for insulin and 2.3%, 6.7%, 16.4%, and 24.5%, respectively, for C-peptide. The inter-and intralaboratory %CVs for insulin decreased with increasing concentration. After recalibration with low-and high-level samples, the mean inter-measurement %CV decreased from 22.4% to 17.2% for insulin and from 24.5% to 5.7% for C-peptide. Conclusions: The intra-laboratory and intra-measurement system imprecision values are satisfactory for serum insulin and C-peptide measurements. However, the results from laboratories using different measurement systems were not comparable, and there is still much work needed to achieve the standardization or harmonization of serum insulin and C-peptide measurements.