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Besser REJ, Long AE, Owen KR, Law R, Birks JS, Pearce O, Williams CL, Scudder CL, McDonald TJ, Todd JA. Transdermal Blood Sampling for C-Peptide Is a Minimally Invasive, Reliable Alternative to Venous Sampling in Children and Adults With Type 1 Diabetes. Diabetes Care 2024; 47:239-245. [PMID: 38087932 DOI: 10.2337/dc23-1379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/02/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE C-peptide and islet autoantibodies are key type 1 diabetes biomarkers, typically requiring venous sampling, which limits their utility. We assessed transdermal capillary blood (TCB) collection as a practical alternative. RESEARCH DESIGN AND METHODS Ninety-one individuals (71 with type 1 diabetes, 20 control; individuals with type 1 diabetes: aged median 14.8 years [interquartile range (IQR) 9.1-17.1], diabetes duration 4.0 years [1.5-7.7]; control individuals: 42.2 years [38.0-52.1]) underwent contemporaneous venous and TCB sampling for measurement of plasma C-peptide. Participants with type 1 diabetes also provided venous serum and plasma, and TCB plasma for measurement of autoantibodies to glutamate decarboxylase, islet antigen-2, and zinc transporter 8. The ability of TCB plasma to detect significant endogenous insulin secretion (venous C-peptide ≥200 pmol/L) was compared along with agreement in levels, using Bland-Altman. Venous serum was compared with venous and TCB plasma for detection of autoantibodies, using established thresholds. Acceptability was assessed by age-appropriate questionnaire. RESULTS Transdermal sampling took a mean of 2.35 min (SD 1.49). Median sample volume was 50 µL (IQR 40-50) with 3 of 91 (3.3%) failures, and 13 of 88 (14.7%) <35 µL. TCB C-peptide showed good agreement with venous plasma (mean venous ln[C-peptide] - TCB ln[C-peptide] = 0.008, 95% CI [-0.23, 0.29], with 100% [36 of 36] sensitivity/100% [50 of 50] specificity to detect venous C-peptide ≥200 pmol/L). Where venous serum in multiple autoantibody positive TCB plasma agreed in 22 of 32 (sensitivity 69%), comparative specificity was 35 of 36 (97%). TCB was preferred to venous sampling (type 1 diabetes: 63% vs. 7%; 30% undecided). CONCLUSIONS Transdermal capillary testing for C-peptide is a sensitive, specific, and acceptable alternative to venous sampling; TCB sampling for islet autoantibodies needs further assessment.
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Affiliation(s)
- Rachel E J Besser
- Juvenile Diabetes Research Foundation/Wellcome Diabetes and Inflammation Laboratory, Wellcome Centre for Human Genetics, Nuffield Department of Medicine, Oxford National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, U.K
- Department of Paediatric Diabetes, Oxford Children's Hospital, John Radcliffe Hospital, Oxford, U.K
| | - Anna E Long
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, U.K
| | - Katharine R Owen
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, U.K
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, U.K
| | - Rebecca Law
- Department of Paediatric Diabetes, Oxford Children's Hospital, John Radcliffe Hospital, Oxford, U.K
| | - Jacqueline S Birks
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, U.K
| | - Olivia Pearce
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, U.K
| | - Claire L Williams
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, U.K
| | - Claire L Scudder
- Juvenile Diabetes Research Foundation/Wellcome Diabetes and Inflammation Laboratory, Wellcome Centre for Human Genetics, Nuffield Department of Medicine, Oxford National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, U.K
| | - Timothy J McDonald
- Academic Department of Blood Sciences, Royal Devon University Hospital, Exeter, U.K
- Exeter NIHR Biomedical Research Centre, University of Exeter, Exeter, U.K
| | - John A Todd
- Juvenile Diabetes Research Foundation/Wellcome Diabetes and Inflammation Laboratory, Wellcome Centre for Human Genetics, Nuffield Department of Medicine, Oxford National Institute for Health Research (NIHR) Biomedical Research Centre, University of Oxford, Oxford, U.K
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