Most people with long-duration type 1 diabetes in a large population-based study are insulin microsecretors

2.50
Hdl Handle:
http://hdl.handle.net/11287/593930
Title:
Most people with long-duration type 1 diabetes in a large population-based study are insulin microsecretors
Authors:
Oram, Richard A.; McDonald, Timothy J. ( 0000-0003-3559-6660 ) ; Shields, Beverley M; Hudson, M. M.; Shepherd, Maggie ( 0000-0003-2660-0955 ) ; Hammersley, S.; Pearson, E. R.; Hattersley, Andrew T.; United Team
Abstract:
OBJECTIVE: Small studies using ultrasensitive C-peptide assays suggest endogenous insulin secretion is frequently detectable in patients with long-standing type 1 diabetes (T1D), but these studies do not use representative samples. We aimed to use the stimulated urine C-peptide-to-creatinine ratio (UCPCR) to assess C-peptide levels in a large cross-sectional, population-based study of patients with T1D. RESEARCH DESIGN AND METHODS: We recruited 924 patients from primary and secondary care in two U.K. centers who had a clinical diagnosis of T1D, were under 30 years of age when they received a diagnosis, and had a diabetes duration of >5 years. The median age at diagnosis was 11 years (interquartile range 6-17 years), and the duration of diabetes was 19 years (11-27 years). All provided a home postmeal UCPCR, which was measured using a Roche electrochemiluminescence assay. RESULTS: Eighty percent of patients (740 of 924 patients) had detectable endogenous C-peptide levels (UCPCR >0.001 nmol/mmol). Most patients (52%, 483 of 924 patients) had historically very low undetectable levels (UCPCR 0.0013-0.03 nmol/mmol); 8% of patients (70 of 924 patients) had a UCPCR >/=0.2 nmol/mmol, equivalent to serum levels associated with reduced complications and hypoglycemia. Absolute UCPCR levels fell with duration of disease. Age at diagnosis and duration of disease were independent predictors of C-peptide level in multivariate modeling. CONCLUSIONS: This population-based study shows that the majority of long-duration T1D patients have detectable urine C-peptide levels. While the majority of patients are insulin microsecretors, some maintain clinically relevant endogenous insulin secretion for many years after the diagnosis of diabetes. Understanding this may lead to a better understanding of pathogenesis in T1D and open new possibilities for treatment.
Citation:
Diabetes Care. 2015 Feb;38(2):323-8.
Publisher:
Diabetes Care
Journal:
Diabetes care
Issue Date:
1-Feb-2015
URI:
http://hdl.handle.net/11287/593930
DOI:
10.2337/dc14-0871
PubMed ID:
25519449
Additional Links:
http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=25519449
Type:
Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't
Language:
eng
ISSN:
1935-5548
Appears in Collections:
2015 RD&E publications; Diabetes/Endocrine Services; Honorary contracts publications

Full metadata record

DC FieldValue Language
dc.contributor.authorOram, Richard A.en
dc.contributor.authorMcDonald, Timothy J.en
dc.contributor.authorShields, Beverley Men
dc.contributor.authorHudson, M. M.en
dc.contributor.authorShepherd, Maggieen
dc.contributor.authorHammersley, S.en
dc.contributor.authorPearson, E. R.en
dc.contributor.authorHattersley, Andrew T.en
dc.contributor.authorUnited Teamen
dc.date.accessioned2016-01-19T12:37:29Zen
dc.date.available2016-01-19T12:37:29Zen
dc.date.issued2015-02-01en
dc.identifier.citationDiabetes Care. 2015 Feb;38(2):323-8.en
dc.identifier.issn1935-5548en
dc.identifier.pmid25519449en
dc.identifier.doi10.2337/dc14-0871en
dc.identifier.urihttp://hdl.handle.net/11287/593930en
dc.description.abstractOBJECTIVE: Small studies using ultrasensitive C-peptide assays suggest endogenous insulin secretion is frequently detectable in patients with long-standing type 1 diabetes (T1D), but these studies do not use representative samples. We aimed to use the stimulated urine C-peptide-to-creatinine ratio (UCPCR) to assess C-peptide levels in a large cross-sectional, population-based study of patients with T1D. RESEARCH DESIGN AND METHODS: We recruited 924 patients from primary and secondary care in two U.K. centers who had a clinical diagnosis of T1D, were under 30 years of age when they received a diagnosis, and had a diabetes duration of >5 years. The median age at diagnosis was 11 years (interquartile range 6-17 years), and the duration of diabetes was 19 years (11-27 years). All provided a home postmeal UCPCR, which was measured using a Roche electrochemiluminescence assay. RESULTS: Eighty percent of patients (740 of 924 patients) had detectable endogenous C-peptide levels (UCPCR >0.001 nmol/mmol). Most patients (52%, 483 of 924 patients) had historically very low undetectable levels (UCPCR 0.0013-0.03 nmol/mmol); 8% of patients (70 of 924 patients) had a UCPCR >/=0.2 nmol/mmol, equivalent to serum levels associated with reduced complications and hypoglycemia. Absolute UCPCR levels fell with duration of disease. Age at diagnosis and duration of disease were independent predictors of C-peptide level in multivariate modeling. CONCLUSIONS: This population-based study shows that the majority of long-duration T1D patients have detectable urine C-peptide levels. While the majority of patients are insulin microsecretors, some maintain clinically relevant endogenous insulin secretion for many years after the diagnosis of diabetes. Understanding this may lead to a better understanding of pathogenesis in T1D and open new possibilities for treatment.en
dc.language.isoengen
dc.publisherDiabetes Careen
dc.relation.urlhttp://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=25519449en
dc.titleMost people with long-duration type 1 diabetes in a large population-based study are insulin microsecretorsen
dc.typeJournal Articleen
dc.typeMulticenter Studyen
dc.typeResearch Support, Non-U.S. Gov'ten
dc.identifier.journalDiabetes careen

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