Capturing the real-world benefit of residual β-cell function during clinically important time-periods in established Type 1 diabetes

Association of detectable C-peptide levels with glycemic control and chronic complications in individuals with type 1 diabetes mellitus: A systematic review and meta-analysis

AIMS

Multiple studies have addressed the association between detectable levels of C-peptide and glycemic control, as well as the development of chronic complications of type 1 diabetes mellitus (T1DM), including both macrovascular and microvascular diseases. We aimed to summarize the available evidence on the clinical significance of detectable levels of C-peptide in T1DM.

METHOD

A systematic search was performed on online databases using the following key terms: T1DM, C-peptide, diabetes mellitus complications, and glycemic parameters. We pooled standardized mean difference (SMD) and odds ratios (OR).

RESULTS

Of the 1519 articles retrieved from the initial search, 38 (12 cohort and 26 cross-sectional studies) met our eligibility criteria. Individuals with T1DM in the detectable C-peptide group, compared with the undetectable C-peptide group, had lower mean HbA1c [pooled SMD (95 % confidence interval (95 % CI)): -0.08 (-0.13 to -0.02), I2 = 0 %, p.

VALUE

0.005] and daily insulin dose [-0.41 (-0.65 to -0.18), I2 = 83 %, p.value < 0.001]. They also showed lower odds for retinopathy [pooled crude OR (95 % CI): 0.53 (0.41 to 0.69), I2 = 65 %, p.value < 0.001] and nephropathy complications [0.62 (0.55 to 0.70), I2 = 19 %, p.value < 0.001]; however, the two groups were similar regarding neuropathy [0.92 (0.65 to 1.31), I2 = 0 %, p.

VALUE

0.31].

CONCLUSIONS

The available evidence suggests that individuals with T1DM in the detectable C-peptide group may experience better clinical outcomes.

Association of Smartphone-Based Activity Tracking and Nocturnal Hypoglycemia in People With Type 1 Diabetes

BACKGROUND

Nocturnal hypoglycemia (NH) remains a major burden for people with type 1 diabetes (T1D). Daytime physical activity (PA) increases the risk of NH. This pilot study tested whether cumulative daytime PA measured using a smartphone-based step tracker was associated with NH.

METHODS

Adults with T1D for ≥ 5 years (y) on multiple daily insulin or continuous insulin infusion, not using continuous glucose monitoring and HbA1c 6 to 10% wore blinded Freestyle Libre Pro sensors and recorded total daily carbohydrate (TDC) and total daily dose (TDD) of insulin. During this time, daily step count (DSC) was tracked using the smartphone-based Fitbit MobileTrack application. Mixed effects logistic regression was used to estimate the effect of DSC on NH (sensor glucose <70, <54 mg/dl for ≥15 minutes), while adjusting for TDC and TDD of insulin, and treating participants as a random effect.

RESULTS

Twenty-six adults, with 65.4% females, median age 27 years (interquartile range: 26-32) mean body mass index 23.9 kg/m2, median HbA1c 7.6% (7.1-8.1) and mean Gold Score 2.1 (standard deviation 1.0) formed the study population. The median DSC for the whole group was 2867 (1820-4807). There was a significant effect of DSC on NH episodes <70 mg/dl. (odds ratio 1.11 [95% CI: 1.01-1.23, P = .04]. There was no significant effect on NH <54 mg/dl.

CONCLUSION

Daily PA measured by a smartphone-based step tracker was associated with the risk of NH in people with type 1 diabetes.

A perspective on treating type 1 diabetes mellitus before insulin is needed

Type 1 diabetes mellitus (T1DM) is a progressive autoimmune disease that starts long before a clinical diagnosis is made. The American Diabetes Association recognizes three stages: stage 1 (normoglycaemic and positive for autoantibodies to β-cell antigens); stage 2 (asymptomatic with dysglycaemia); and stage 3, which is defined by glucose levels consistent with the definition of diabetes mellitus. This Perspective focuses on the management of the proportion of individuals with early stage 3 T1DM who do not immediately require insulin; a stage we propose should be termed stage 3a. To date, this period of non-insulin-dependent T1DM has been largely unrecognized. Importantly, it represents a window of opportunity for intervention, as remaining at this stage might delay the need for insulin by months or years. Extending the insulin-free period and/or avoiding unnecessary insulin therapy are important goals, as there is no risk of hypoglycaemia during this period and the adherence burden on patients of glycaemic monitoring and daily adjustments for diet and exercise is substantially reduced. Recognizing the pressing need for guidance on adequate management of children and adults with stage 3a T1DM, we present our perspective on the subject, which needs to be tested in formal and adequately powered clinical trials.

Exercise in adults with type 1 diabetes mellitus

Regular physical activity improves cardiometabolic and musculoskeletal health, helps with weight management, improves cognitive and psychosocial functioning, and is associated with reduced mortality related to cancer and diabetes mellitus. However, turnover rates of glucose in the blood increase dramatically during exercise, which often results in either hypoglycaemia or hyperglycaemia as well as increased glycaemic variability in individuals with type 1 diabetes mellitus (T1DM). A complex neuroendocrine response to an acute exercise session helps to maintain circulating levels of glucose in a fairly tight range in healthy individuals, while several abnormal physiological processes and limitations of insulin therapy limit the capacity of people with T1DM to exercise in a normoglycaemic state. Knowledge of the acute and chronic effects of exercise and regular physical activity is critical for the formulation of clinical strategies for the management of insulin and nutrition for active patients with T1DM. Emerging diabetes-related technologies, such as continuous glucose monitors, automated insulin delivery systems and the administration of solubilized glucagon, are demonstrating efficacy for preserving glucose homeostasis during and after exercise in this population of patients. This Review highlights the beneficial effects of regular exercise and details the complex endocrine and metabolic responses to different types of exercise for adults with T1DM. An overview of basic clinical strategies for the preservation of glucose homeostasis using emerging technologies is also provided.

Application of urine C-peptide creatinine ratio in type 2 diabetic patients with different levels of renal function

OBJECTIVE

This study aims to investigate the effect of single urine C peptide/creatinine (UCPCR) in assessing the islet β Cell function of type 2 diabetes mellitus (T2DM) patients with different renal function.

METHODS

A total of 85 T2DM patients were recruited in this study, all the patients were assigned to one group with estimated glomerular filtration rate (eGFR)≤60 ml·min^-1·1.73 m^-2 and another group complicated with eGFR>60 ml·min^-1·1.73 m^-2. Serum creatinine, urine creatinine, serum fasting C-peptide (FCP), fasting blood glucose (FBG), glycosylated hemoglobin (HbA1C) and 24-hour urinary C-peptide (24hUCP) were measured. The modified homeostasis model assessment-islet β cell function [HOMA-islet (CP-DM)], the modified homeostasis model assessment-insulin resistance [HOMA-IR(CP)] and UCPCR were calculated.

RESULTS

When compared with group eGFR ≤60 ml·min^-1·1.73 m^-2, the levels of UCPCR, FCP, the modified HOMA-IR(CP) and HOMA-islet (CP-DM) were promoted and the concentrations of HbA1C, FPG, creatinine were decreased in the patients of eGFR>60 ml·min^-1·1.73 m^-2 (P<0.05); FCP was uncorrelated with 24hUCP while associated with UCPCR in the patients of eGFR ≤ 60 ml·min^-1·1.73 m^-2; UCPCR was positively correlated with FCP and HOMA-IR(CP) in the T2DM patients with different levels of renal function; the cut-off (UCPCR ≤ 1.13 nmol/g) had 88.37% sensitivity and 95.24% specificity [95% confidence interval (CI):0.919-0.997] for identifying severe insulin deficiency in T2DM patients[area under the curve (AUC) 0.978].

CONCLUSION

UCPCR can be used to evaluate islets β Cell function in T2DM patients with different renal function status.