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Iwamoto Y, Kimura T, Shimoda M, Morimoto Y, Watanabe Y, Itoh T, Sasaki T, Mori S, Kubo M, Takenouchi H, Dan K, Iwamoto H, Sanada J, Fushimi Y, Katakura Y, Nakanishi S, Mune T, Kaku K, Kaneto H. C-peptide index at 2 h post-meal is a useful predictor of endogenous insulin secretory capacity and withdrawal from insulin therapy in subjects with type 2 diabetes. Diabetes Obes Metab 2024; 26:2761-2773. [PMID: 38646845 DOI: 10.1111/dom.15595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/23/2024]
Abstract
AIMS To evaluate the correlation between C-peptide index (CPI) at 2 h post-meal and endogenous insulin secretory capacity and to develop clinical models to predict the possibility of withdrawal from insulin therapy in patients with type 2 diabetes. METHOD This was a single-centre retrospective study of patients with type 2 diabetes admitted to our hospital. Patients were divided into a withdrawal group (n = 72) and a non-withdrawal group (n = 75) based on whether they were able to withdraw from insulin therapy at discharge, and the correlation between CPI at 2 h after meal and diabetes-related parameters was evaluated. In addition, we created two clinical models to predict the possibility of withdrawal from insulin therapy using machine learning. RESULTS The glycated haemoglobin values of the study participants were 87.8 ± 22.6 mmol/mo. The CPI at 2 h post-meal was 1.93 ± 1.28 in the non-withdrawal group and 2.97 ± 2.07 in the withdrawal group (p < 0.001). CPI at 2 h post-meal was an independent predictor of withdrawal from insulin therapy. In addition, CPI at 2 h post-meal was a better predictor than fasting CPI. Six factors associated with insulin therapy withdrawal (age, duration of diabetes, creatinine, alanine aminotransferase, insulin therapy until hospitalization, and CPI at 2 h post-meal) were used to generate two clinical models by machine learning. The accuracy of the generated clinical models ranged from 78.3% to 82.6%. CONCLUSION The CPI at 2 h post-meal is a clinically useful measure of endogenous insulin secretory capacity under non-fasting conditions.
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Affiliation(s)
- Yuichiro Iwamoto
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Tomohiko Kimura
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Masashi Shimoda
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Yuichi Morimoto
- Department of Pediatrics, Kinki University, Osakasayama, Japan
| | - Yuki Watanabe
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Takashi Itoh
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Taku Sasaki
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Shigehito Mori
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Masato Kubo
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Haruka Takenouchi
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Kazunori Dan
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Hideyuki Iwamoto
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Junpei Sanada
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Yoshiro Fushimi
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Yukino Katakura
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Shuhei Nakanishi
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Tomoatsu Mune
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Kohei Kaku
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
| | - Hideaki Kaneto
- Department of Diabetes, Endocrinology and Metabolism, Kawasaki Medical School, Kurashiki, Japan
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Effects of dapagliflozin combined with short-term intensive insulin therapy on β-cell function in patients with newly diagnosed type 2 diabetes mellitus—a randomized controlled study. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01089-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Yoshiji S, Hasebe M, Iwasaki Y, Shibue K, Keidai Y, Seno Y, Iwasaki K, Honjo S, Fujikawa J, Hamasaki A. Exploring a Suitable Marker of Glycemic Response to Dulaglutide in Patients with Type 2 Diabetes: A Retrospective Study. Diabetes Ther 2022; 13:733-746. [PMID: 35285007 PMCID: PMC8991285 DOI: 10.1007/s13300-022-01231-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/10/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Previous studies suggested that β-cell function markers such as fasting and postprandial serum C-peptide and C-peptide increment (FCPR, PCPR, and ΔCPR, respectively) may be useful in estimating glycemic response to glucagon-like peptide-1 receptor agonists. However, it remains elusive whether baseline glycemic control confounds these markers. Here we aimed to identify the least confounded β-cell function markers and investigate whether these markers could predict glycemic response to dulaglutide. METHODS We evaluated FCPR, PCPR, and ΔCPR levels in patients with type 2 diabetes who initiated dulaglutide treatment after a standardized meal tolerance test (MTT). We first investigated the confounding effects of baseline HbA1c on β-cell function markers using Pearson's correlation test. Then, we evaluated the association between each β-cell function marker and glycemic response (HbA1c change 0-6 months) to dulaglutide using generalized linear model and logistic regression analysis with adjustment for baseline HbA1c. RESULTS In 141 patients, baseline HbA1c was significantly inversely correlated with PCPR and ΔCPR (P < 0.01 for both) but not with FCPR (r = 0.02; P = 0.853), suggesting that FCPR was the marker least confounded by baseline glycemic control. Of all patients, 59 continued dulaglutide for at least 6 months without initiating any additional glucose-lowering medications. Mean ± SE HbA1c change 0-6 months was - 1.16 ± 0.17% (P < 0.001 vs. baseline). The β-cell function markers were significantly associated with HbA1c change 0-6 months in the generalized linear model. FCPR was also a significant predictor for achieving a reduction in HbA1c of at least 1% (P = 0.044) with an area under the receiver operating characteristic curve of 0.83 (sensitivity = 0.81 and specificity = 0.79). CONCLUSION Fasting and meal-induced C-peptide levels are associated with glycemic response to dulaglutide, among which FCPR is least confounded by baseline glycemic control, suggesting its utility as a marker for glycemic response to dulaglutide.
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Affiliation(s)
- Satoshi Yoshiji
- Department of Diabetes and Endocrinology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Human Genetics, McGill University, Montreal, QC, Canada
- Kyoto-McGill International Collaborative Program in Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masashi Hasebe
- Department of Diabetes and Endocrinology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Yorihiro Iwasaki
- Department of Diabetes and Endocrinology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
- Endocrine Unit, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Kimitaka Shibue
- Department of Diabetes and Endocrinology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Yamato Keidai
- Department of Diabetes and Endocrinology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
- Department of Diabetes, Endocrinology and Nutrition, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yohei Seno
- Department of Diabetes and Endocrinology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Kanako Iwasaki
- Department of Diabetes and Endocrinology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Sachiko Honjo
- Department of Diabetes and Endocrinology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan
| | - Jun Fujikawa
- Department of Laboratory Medicine, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Akihiro Hamasaki
- Department of Diabetes and Endocrinology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka, 530-8480, Japan.
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Gupta AP, Chakraborty PP, Halder R, Sahoo A, Roy K. Post-usual meal C-peptide as a reliable and practical alternative to C-peptide following glucagon or standardized mixed-meal for β-cell reserve: a comparative study between three stimulatory methods in different types of diabetes. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00987-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Chung JO, Park SY, Cho DH, Chung DJ, Chung MY. Association Between Serum C-Peptide Level and Cardiovascular Autonomic Neuropathy According to Estimated Glomerular Filtration Rate in Individuals with Type 2 Diabetes. Exp Clin Endocrinol Diabetes 2019; 128:607-614. [PMID: 31610588 DOI: 10.1055/a-1017-3048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To investigate the association between serum C-peptide level and cardiovascular autonomic neuropathy (CAN) in individuals with type 2 diabetes mellitus (DM) according to estimated glomerular filtration rate (eGFR) METHODS: In a cross-sectional study, we examined 939 individuals with type 2 DM. We measured fasting C-peptide, 2-hour postprandial C-peptide, and ΔC-peptide (postprandial C-peptide minus fasting C-peptide) levels. The individuals were classified into 2 groups based on eGFR: individuals without impaired renal function (eGFR ≥60 ml∙min-1 1.73m-2) and those with impaired renal function (eGFR <60 ml∙min-1 1.73m-2). RESULTS Individuals with CAN had lower fasting C-peptide, postprandial C-peptide, and ΔC-peptide levels in patients both with and without impaired renal function. Multivariate logistic regression analyses adjusted for gender, age, and other confounders, including eGFR, showed that serum C-peptide level was significantly associated with CAN (odds ratio [OR] per standard deviation increase in the log-transformed value, 0.67; 95% confidence interval [CI], 0.52-0.87 for fasting C-peptide, P < 0.01; OR, 0.62; 95% CI, 0.47-0.83 for postprandial C-peptide, P < 0.01; OR, 0.71; 95% CI, 0.54-0.93 for ΔC-peptide, P < 0.05). CONCLUSIONS Serum C-peptide level was negatively associated with CAN in individuals with type 2 DM independent of eGFR.
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Affiliation(s)
- Jin Ook Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Republic of Korea
| | - Seon-Young Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Medical School, Republic of Korea
| | - Dong Hyeok Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Republic of Korea
| | - Dong Jin Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Republic of Korea
| | - Min Young Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonnam National University Medical School, Republic of Korea
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Ohbatake A, Yagi K, Karashima S, Shima Y, Miyamoto Y, Asaka H, Okazaki S, Kometani M, Kawashiri MA, Takeda Y, Yoneda T, Chujo D. C-Peptide Area Under the Curve at Glucagon Stimulation Test Predicts Glucose Improvements by GLP-1 Receptor Analogue: A Retrospective Observational Study. Diabetes Ther 2019; 10:673-681. [PMID: 30788807 PMCID: PMC6437227 DOI: 10.1007/s13300-019-0586-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Despite the widespread use of glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1ras) to improve glycemic regulation, with a low risk of hypoglycemia and weight reduction, their effectiveness varies among individuals. This study aimed to identify predictors of the efficacy of GLP-1ra on Hemoglobin A1c (HbA1c) in patients with insulin-independent diabetes. METHODS In total, 58 patients with insulin-independent diabetes were included. Patients were included if their β-cell function was evaluated via a glucagon stimulation test (GST) before the introduction of GLP-1ra therapy. β-Cell function-related indices, such as the C-peptide index (CPI), increments in C-peptide immunoreactivity (CPR) after glucagon stimulation (ΔCPR), and the area under the CPR curve (CPR-AUC) during the GST, were evaluated. HbA1c and body weight (BW) were measured at 6 and 12 months after the initiation of GLP-1ra. RESULTS A univariate regression analysis revealed a significant correlation between CPR-AUC and changes in HbA1c at 6 months and with changes in BW at 6 and 12 months. A multivariate regression analysis revealed that CPR-AUC was significantly correlated with changes in HbA1c at 6 months. A receiver-operating characteristic analysis revealed that 21.9 ng/ml·min CPR-AUC was the optimal cut-off value to predict an HbA1c level < 7%, i.e., 53 mmol/mol. CONCLUSION Residual β-cell function, as assessed via CPR-AUC in the GST, is an effective predictor of the efficacy of GLP-1ras.
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Affiliation(s)
- Azusa Ohbatake
- Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kunimasa Yagi
- First Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Shigehiro Karashima
- Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yuki Shima
- Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yukiko Miyamoto
- Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hiroyuki Asaka
- Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Satoko Okazaki
- Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Mitsuhiro Kometani
- Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Masa-Aki Kawashiri
- Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yoshiyu Takeda
- Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Takashi Yoneda
- Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
- Department of Health Promotion and Medicine of the Future, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
- Institute of Liberal Arts and Science, Kanazawa University, Kanazawa, Japan
| | - Daisuke Chujo
- Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
- Department of Diabetes, Endocrinology, and Metabolism, National Center for Global Health and Medicine, Tokyo, Japan.
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Lv R, Chen Y, Xia N, Liang Y, He Q, Li M, Qi Z, Lu Y, Zhao S. Development of a double-antibody sandwich ELISA for rapid detection to C-peptide in human urine. J Pharm Biomed Anal 2018; 162:179-184. [PMID: 30261444 DOI: 10.1016/j.jpba.2018.07.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/18/2018] [Accepted: 07/29/2018] [Indexed: 01/18/2023]
Abstract
C-peptide level is recognized as an important indicator of diabetes diagnosis. A sensitive and specific double-antibody sandwich enzyme-linked immunosorbent assay for the detection of C-peptide based on double antibody sandwich method was studied in this paper. The rabbit and hen were innunized with PLL-C-peptide and BSA-C-peptide respectively to obtain specific Yolk antibody (IgY) and polyclonal antibody used to construct the sandwich ELISA for the measurement of C-peptide. The limit of detection was 0.51 μg/mL and the half maximal inhibitory concentration (IC50) was 3.26 μg/mL. The method developed in the study showed no evident cross-reactivity with other similar analogs. The detection standard curve of C-peptide exhibited a good linearity (R2 = 0.9896, n = 15). 17 types of the urine of diabetes patients on c-peptide levels compared with the hospital type of diabetes information, with a conclusion of a high consistent rate. Therefore, the methods could be selectively used for rapid screening of C-peptide in human urine, and the type of diabetes has some referential significance.
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Affiliation(s)
- Rui Lv
- Department of Pharmaceutical Engineering, Faculty of Chemical Engineering and Light Industry, Guangdong University of Technology, Guangzhou 510006, People's Republic of China.
| | - Yingshan Chen
- Department of Pharmaceutical Engineering, Faculty of Chemical Engineering and Light Industry, Guangdong University of Technology, Guangzhou 510006, People's Republic of China.
| | - Nana Xia
- Department of Pharmaceutical Engineering, Faculty of Chemical Engineering and Light Industry, Guangdong University of Technology, Guangzhou 510006, People's Republic of China.
| | - Yuxin Liang
- Department of Pharmaceutical Engineering, Faculty of Chemical Engineering and Light Industry, Guangdong University of Technology, Guangzhou 510006, People's Republic of China.
| | - Qiyi He
- Department of Pharmaceutical Engineering, Faculty of Chemical Engineering and Light Industry, Guangdong University of Technology, Guangzhou 510006, People's Republic of China.
| | - Minyou Li
- Guangzhou Jinde Biotechnology Co., LTD, Guangzhou 510663, People's Republic of China.
| | - Zongxian Qi
- Guangzhou Jinde Biotechnology Co., LTD, Guangzhou 510663, People's Republic of China.
| | - Yeyu Lu
- Department of Pharmaceutical Engineering, Faculty of Chemical Engineering and Light Industry, Guangdong University of Technology, Guangzhou 510006, People's Republic of China.
| | - Suqing Zhao
- Department of Pharmaceutical Engineering, Faculty of Chemical Engineering and Light Industry, Guangdong University of Technology, Guangzhou 510006, People's Republic of China.
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Fujioka Y, Okura T, Sumi K, Matsumoto K, Shoji K, Nakamura R, Matsuzawa K, Izawa S, Kato M, Taniguchi S, Yamamoto K. Normal meal tolerance test is preferable to the glucagon stimulation test in patients with type 2 diabetes that are not in a hyperglycemic state: Comparison with the change of C-peptide immunoreactivity. J Diabetes Investig 2018; 9:274-278. [PMID: 28494143 PMCID: PMC5835464 DOI: 10.1111/jdi.12692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 04/22/2017] [Accepted: 05/01/2017] [Indexed: 12/01/2022] Open
Abstract
AIMS/INTRODUCTION The aim of the present study was to evaluate the properties of the glucagon stimulation test (GST) and the normal meal tolerance test (NMTT) in patients with type 2 diabetes. MATERIALS AND METHODS We enrolled 142 patients with type 2 diabetes, and carried out a GST and a NMTT. We carried out the NMTT using a calorie-controlled meal based on an intake of 30 kcal/kg ideal bodyweight/day. We calculated the change in C-peptide immunoreactivity (ΔCPR) by subtracting fasting CPR from the CPR 6 min after the 1-mg glucagon injection (GST) or 120 min after the meal (NMTT). RESULTS Mean ΔCPR for the GST was 2.0 ng/mL, and for the NMTT was 3.1 ng/mL. A total of 104 patients had greater ΔCPR in the NMTT than the GST, and the mean ΔCPR was significantly greater in the NMTT than the GST (P < 0.05). To exclude any influence of antidiabetic drugs, we examined 42 individuals not taking antidiabetic agents, and found the mean ΔCPR was significantly greater in the NMTT than the GST (GST 2.4 ng/mL, NMTT 4.3 ng/mL; P < 0.05). To consider the influence of glucose toxicity, we carried out receiver operating characteristic analyses with fasting plasma glucose and glycated hemoglobin. The optimal cut-off levels predicting GST ΔCPR to be larger than NMTT ΔCPR were fasting plasma glucose 147 mg/dL and glycated hemoglobin 9.0% (fasting plasma glucose: sensitivity 0.64, specificity 0.76, area under the curve 0.73; glycated hemoglobin: sensitivity 0.56, specificity 0.71, area under the curve 0.66). CONCLUSIONS The NMTT is a reliable insulin secretion test in patients with type 2 diabetes, except for those in a hyperglycemic state.
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Affiliation(s)
- Youhei Fujioka
- Division of Molecular Medicine and TherapeuticsDepartment of Multidisciplinary Internal MedicineTottori UniversityYonago, TottoriJapan
| | - Tsuyoshi Okura
- Division of Molecular Medicine and TherapeuticsDepartment of Multidisciplinary Internal MedicineTottori UniversityYonago, TottoriJapan
| | - Keisuke Sumi
- Division of Molecular Medicine and TherapeuticsDepartment of Multidisciplinary Internal MedicineTottori UniversityYonago, TottoriJapan
| | - Kazuhisa Matsumoto
- Division of Molecular Medicine and TherapeuticsDepartment of Multidisciplinary Internal MedicineTottori UniversityYonago, TottoriJapan
| | - Kyoko Shoji
- Division of Molecular Medicine and TherapeuticsDepartment of Multidisciplinary Internal MedicineTottori UniversityYonago, TottoriJapan
| | - Risa Nakamura
- Division of Molecular Medicine and TherapeuticsDepartment of Multidisciplinary Internal MedicineTottori UniversityYonago, TottoriJapan
| | - Kazuhiko Matsuzawa
- Department of Regional MedicineFaculty of MedicineTottori UniversityYonago, TottoriJapan
| | - Shoichiro Izawa
- Division of Molecular Medicine and TherapeuticsDepartment of Multidisciplinary Internal MedicineTottori UniversityYonago, TottoriJapan
| | - Masahiko Kato
- Division of Molecular Medicine and TherapeuticsDepartment of Multidisciplinary Internal MedicineTottori UniversityYonago, TottoriJapan
| | - Shinichi Taniguchi
- Department of Regional MedicineFaculty of MedicineTottori UniversityYonago, TottoriJapan
| | - Kazuhiro Yamamoto
- Division of Molecular Medicine and TherapeuticsDepartment of Multidisciplinary Internal MedicineTottori UniversityYonago, TottoriJapan
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Sonoda R, Tanaka K, Kikuchi T, Onishi Y, Takao T, Tahara T, Yoshida Y, Suzawa N, Kawazu S, Iwamoto Y, Kushiyama A. C-Peptide Level in Fasting Plasma and Pooled Urine Predicts HbA1c after Hospitalization in Patients with Type 2 Diabetes Mellitus. PLoS One 2016; 11:e0147303. [PMID: 26849676 PMCID: PMC4743946 DOI: 10.1371/journal.pone.0147303] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 01/01/2016] [Indexed: 12/16/2022] Open
Abstract
In this study, we investigate how measures of insulin secretion and other clinical information affect long-term glycemic control in patients with type 2 diabetes mellitus. Between October 2012 and June 2014, we monitored 202 diabetes patients who were admitted to the hospital of Asahi Life Foundation for glycemic control, as well as for training and education in diabetes management. We measured glycated hemoglobin (HbA1c) six months after discharge to assess disease management. In univariate analysis, fasting plasma C-peptide immunoreactivity (F-CPR) and pooled urine CPR (U-CPR) were significantly associated with HbA1c, in contrast to ΔCPR and C-peptide index (CPI). This association was strongly independent of most other patient variables. In exploratory factor analysis, five underlying factors, namely insulin resistance, aging, sex differences, insulin secretion, and glycemic control, represented patient characteristics. In particular, insulin secretion and resistance strongly influenced F-CPR, while insulin secretion affected U-CPR. In conclusion, the data indicate that among patients with type 2 diabetes mellitus, F-CPR and U-CPR may predict improved glycemic control six months after hospitalization.
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Affiliation(s)
- Remi Sonoda
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Chuo-ku, Tokyo, Japan
| | - Kentaro Tanaka
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Chuo-ku, Tokyo, Japan
| | - Takako Kikuchi
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Chuo-ku, Tokyo, Japan
| | - Yukiko Onishi
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Chuo-ku, Tokyo, Japan
| | - Toshiko Takao
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Chuo-ku, Tokyo, Japan
| | - Tazu Tahara
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Chuo-ku, Tokyo, Japan
| | - Yoko Yoshida
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Chuo-ku, Tokyo, Japan
| | - Naoki Suzawa
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Chuo-ku, Tokyo, Japan
| | - Shoji Kawazu
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Chuo-ku, Tokyo, Japan
| | - Yasuhiko Iwamoto
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Chuo-ku, Tokyo, Japan
| | - Akifumi Kushiyama
- Division of Diabetes and Metabolism, The Institute for Adult Diseases, Asahi Life Foundation, Chuo-ku, Tokyo, Japan
- * E-mail:
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Onishi Y, Niemoeller E, Ikeda Y, Takagi H, Yabe D, Seino Y. Efficacy and safety of lixisenatide in Japanese patients with type 2 diabetes mellitus inadequately controlled by sulfonylurea with or without metformin: Subanalysis of GetGoal-S. J Diabetes Investig 2014; 6:201-9. [PMID: 25802728 PMCID: PMC4364855 DOI: 10.1111/jdi.12275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/10/2014] [Accepted: 08/07/2014] [Indexed: 11/30/2022] Open
Abstract
Aims/Introduction This was a subanalysis of Japanese patients included in the glucagon-like peptide-1 receptor agonist AVE0010 in patients with type 2 diabetes mellitus for glycemic control and safety evaluation (GetGoal-S) study – a 24-week, randomized, placebo-controlled study of lixisenatide in patients with type 2 diabetes mellitus inadequately controlled by sulfonylurea with or without metformin. Materials and Methods In GetGoal-S, 127 Japanese patients received the once-daily prandial glucagon-like peptide-1 receptor agonist lixisenatide 20 μg/day or a matching placebo. The primary outcome was change in glycated hemoglobin. Results At week 24, lixisenatide significantly reduced mean glycated hemoglobin (least squares mean difference vs the placebo −1.1% [12 mmol/mol, P < 0.0001]), and significantly more lixisenatide patients reached glycated hemoglobin targets of <7% (53 mmol/mol) and ≤6.5% (48 mmol/mol) vs the placebo. Lixisenatide produced statistically significant reductions in 2-h postprandial plasma glucose (least squares mean difference vs the placebo −8.51 mmol/L, P < 0.0001) and glucose excursion vs the placebo, and significantly reduced fasting plasma glucose (least squares mean difference vs the placebo −0.65 mmol/L, P = 0.0454). Bodyweight decreased with both lixisenatide and the placebo (least squares mean change −1.12 kg for lixisenatide, −1.02 kg for placebo). The overall incidence of adverse events was similar for lixisenatide and the placebo (84.2 and 82.4%, respectively), the most frequent being gastrointestinal disorders (52.6% for lixisenatide vs 29.4% for placebo). The incidence of symptomatic hypoglycemia was higher with lixisenatide vs the placebo (17.1 and 9.8%, respectively), with no cases of severe symptomatic hypoglycemia in either group. Conclusions In the Japanese subpopulation of the GetGoal-S study, lixisenatide produced a significant and clinically relevant improvement in glycated hemoglobin, with a pronounced improvement in postprandial plasma glucose, and a good safety and tolerability profile.
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Affiliation(s)
- Yukiko Onishi
- The Institute for Adult Disease, Asahi Life Foundation Tokyo, Japan
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Usui R, Yabe D, Kuwata H, Fujiwara S, Watanabe K, Hyo T, Yasuhara A, Iwasaki M, Kitatani N, Kuwabara K, Yokota K, Kurose T, Seino Y. Retrospective analysis of safety and efficacy of insulin-to-liraglutide switch in Japanese type 2 diabetes: A caution against inappropriate use in patients with reduced β-cell function. J Diabetes Investig 2013; 4:585-94. [PMID: 24843713 PMCID: PMC4020254 DOI: 10.1111/jdi.12111] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 04/08/2013] [Accepted: 05/06/2013] [Indexed: 02/05/2023] Open
Abstract
Aims/Introduction The safety and efficacy of insulin‐to‐liraglutide switch in type 2 diabetes has not been studied adequately. Here, we retrospectively characterize clinical parameters that might predict insulin‐to‐liraglutide treatment switch without termination due to hyperglycemia, and examine the effects of switching the therapies on glycated hemoglobin (HbA1c) and bodyweight in Japanese type 2 diabetes. Materials and Methods Japanese type 2 diabetes patients who underwent the switch of therapy were evaluated for their clinical data including β‐cell function‐related indices, such as increment of serum C‐peptide during glucagon stimulation test (GST‐ΔCPR). HbA1c and bodyweight were analyzed in patients continuing with liraglutide after switching from insulin for 12 weeks. Results Of 147 patients, 28 failed in the switch due to hyperglycemia, nine failed because of other reasons and 110 continued with liraglutide for the 12‐week period. Patients failing in the switch due to hyperglycemia showed longer duration and higher daily insulin dose, as well as lower GST‐ΔCPR. Receiver–operating characteristic analysis showed that GST‐ΔCPR of 1.34 ng/mL is a cut‐off point for insulin‐to‐liraglutide switch without termination due to hyperglycemia. In patients continuing liraglutide for 12 weeks, the switch significantly reduced HbA1c and bodyweight with no severe hypoglycemia, irrespective of sulfonylurea co‐administration, body mass index, duration and total daily insulin dose. The switch also significantly reduced the percentage of body fat and visceral fat areas. Conclusions Insulin‐to‐liraglutide switch can improve glycemic control and reduce bodyweight in Japanese type 2 diabetes patients. However, caution must be taken with the switch in patients with reduced insulin secretory capacity as predicted by GST‐ΔCPR.
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Affiliation(s)
- Ryota Usui
- Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan
| | - Daisuke Yabe
- Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan ; Division of Metabolism and Clinical Nutrition Kansai Electric Power Hospital Osaka Japan
| | - Hitoshi Kuwata
- Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan
| | - Shuichi Fujiwara
- Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan
| | - Koin Watanabe
- Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan
| | - Takanori Hyo
- Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan
| | - Akihiro Yasuhara
- Division of Nephrology Kansai Electric Power Hospital Osaka Japan
| | - Masahiro Iwasaki
- Division of Metabolism and Clinical Nutrition Kansai Electric Power Hospital Osaka Japan
| | - Naomi Kitatani
- Division of Metabolism and Clinical Nutrition Kansai Electric Power Hospital Osaka Japan
| | - Kyoko Kuwabara
- Division of Nursing Kansai Electric Power Hospital Osaka Japan
| | - Kayo Yokota
- Division of Nursing Kansai Electric Power Hospital Osaka Japan
| | - Takeshi Kurose
- Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan
| | - Yutaka Seino
- Division of Diabetes, Clinical Nutrition and Endocrinology Kansai Electric Power Hospital Osaka Japan
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Matsumoto K, Kanazawa A, Ikeda F, Ohmura C, Shimizu T, Tamura Y, Fujitani Y, Kawamori R, Watada H. The area of abdominal subcutaneous adipose tissue is independently correlated with C-peptide increment during glucagon load in Japanese patients with type 2 diabetes. Diabetol Int 2013. [DOI: 10.1007/s13340-013-0123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Fujiwara D, Takahashi K, Suzuki T, Shii M, Nakashima Y, Takekawa S, Yoshida A, Matsuoka T. Postprandial serum C-peptide value is the optimal index to identify patients with non-obese type 2 diabetes who require multiple daily insulin injection: Analysis of C-peptide values before and after short-term intensive insulin therapy. J Diabetes Investig 2013; 4:618-25. [PMID: 24843717 PMCID: PMC4020258 DOI: 10.1111/jdi.12103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Revised: 04/03/2013] [Accepted: 04/09/2013] [Indexed: 12/20/2022] Open
Abstract
Aims/Introduction Type 2 diabetes is a progressive disease characterized by a yearly decline in insulin secretion; however, no definitive evidence exists showing the relationship between decreased insulin secretion and the need for insulin treatment. To determine the optimal insulin secretory index for identifying patients with non‐obese type 2 diabetes who require multiple daily insulin injection (MDI), we evaluated various serum C‐peptide immunoreactivity (CPR) values. Materials and Methods We near‐normalized blood glucose with intensive insulin therapy (IIT) over a 2‐week period in 291 patients with non‐obese type 2 diabetes, based on our treatment protocol. After improving hyperglycemia, we challenged with oral hypoglycemic agent (OHA), and according to the responsiveness to OHA, patients were classified into three therapy groups: OHA alone (n = 103), basal insulin plus OHA (basal insulin‐supported oral therapy [BOT]; n = 56) and MDI (n = 132). Glucagon‐loading CPR increment (ΔCPR), fasting CPR (FCPR), CPR 2 h after breakfast (CPR2h), the ratio of FCPR to FPG (CPI), CPI 2 h after breakfast (CPI2h) and secretory unit of islets in transplantation (SUIT) were submitted for the analyses. Receiver operating characteristic (ROC) and multiple logistic analyses for these CPR indices were carried out. Results Many CPR values were significantly lower in the MDI group compared with the OHA alone or BOT groups. ROC and multiple logistic analyses disclosed that post‐prandial CPR indices (CPR2h and CPI2h) were the most reliable CPR markers to identify patients requiring MDI. Conclusions Postprandial CPR level after breakfast is the most useful index for identifying patients with non‐obese type 2 diabetes who require MDI therapy.
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Affiliation(s)
- Daisuke Fujiwara
- Diabetes Division Department of Internal Medicine Kurashiki Central Hospital Kurashiki Okayama Japan
| | - Kenji Takahashi
- Diabetes Division Department of Internal Medicine Kurashiki Central Hospital Kurashiki Okayama Japan
| | - Takahiro Suzuki
- Diabetes Division Department of Internal Medicine Kurashiki Central Hospital Kurashiki Okayama Japan
| | - Masakazu Shii
- Diabetes Division Department of Internal Medicine Kurashiki Central Hospital Kurashiki Okayama Japan
| | - Yukako Nakashima
- Diabetes Division Department of Internal Medicine Kurashiki Central Hospital Kurashiki Okayama Japan
| | - Sato Takekawa
- Diabetes Division Department of Internal Medicine Kurashiki Central Hospital Kurashiki Okayama Japan
| | - Atsushi Yoshida
- Diabetes Division Department of Internal Medicine Kurashiki Central Hospital Kurashiki Okayama Japan
| | - Takashi Matsuoka
- Diabetes Division Department of Internal Medicine Kurashiki Central Hospital Kurashiki Okayama Japan
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