Demonstration of an Intrinsic Relationship Between Endogenous C-Peptide Concentration and Determinants of Glycemic Control in Type 1 Diabetes Following Islet Transplantation  

Oleh:

Brooks, Augustin M. ; Oram, Richard ; Home, Philip ; Steen, Nick ; Shaw, James A.M.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Diabetes Care vol. 38 no. 01 (Jan. 2015), page 105-112 .

Ketersediaan

Perpustakaan FK Nomor Panggil: D05.K Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

OBJECTIVE Maintenance of endogenous pancreatic ß-cell function could be an important goal in the management of type 1 diabetes. However, the impact of stimulated C-peptide level on overall glycemic control is unknown. The relationship between C-peptide and parameters of glucose control was therefore characterized in a cohort with rapidly changing ß-cell function following islet transplantation. RESEARCH DESIGN AND METHODS Standardized mixed-meal tolerance test was undertaken in 12 consecutive islet recipients at 1–6-month intervals, with graft function determined by 90-min stimulated C-peptide. Continuous glucose monitoring was undertaken in the week preceding each assessment and the relationship between C-peptide and glucose control evaluated by mixed Poisson regression. RESULTS Recipients completed 5 (1–14) [median (range)] clinical assessments over 18 (1–51) months posttransplant encompassing a wide range of stimulated C-peptide levels (7–2,622 pmol/L). Increasing ß-cell function across predefined C-peptide groups was associated with reduced insulin dose, HbA1c, mean glucose (low [<200 pmol/L] 10.7 vs. excellent [>1,000 pmol/L] 7.5 mmol/L), and glucose SD (low, 4.4 vs. excellent, 1.4 mmol/L). Highly statistically significant continuous associations between stimulated C-peptide and mean interstitial glucose (lower by 2.5% [95% CI 1.5–3.5%] per 100 pmol/L higher C-peptide), glucose SD, time outside glucose target range, and measures of hyper-/hypoglycemia risk were confirmed. CONCLUSIONS Repeated assessment of islet transplant recipients has enabled modeling of the relationship between endogenous ß-cell function and measures of glycemic control providing quantitative estimates of likely impact of an acute change in ß-cell function in individuals with type 1 diabetes.

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