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Review
. 2013 Jul;30(7):803-17.
doi: 10.1111/dme.12159.

The clinical utility of C-peptide measurement in the care of patients with diabetes

A G Jones  1 , A T Hattersley
Affiliations
Free PMC article
Review

The clinical utility of C-peptide measurement in the care of patients with diabetes

A G Jones et al. Diabet Med. 2013 Jul.
Free PMC article

Abstract

C-peptide is produced in equal amounts to insulin and is the best measure of endogenous insulin secretion in patients with diabetes. Measurement of insulin secretion using C-peptide can be helpful in clinical practice: differences in insulin secretion are fundamental to the different treatment requirements of Type 1 and Type 2 diabetes. This article reviews the use of C-peptide measurement in the clinical management of patients with diabetes, including the interpretation and choice of C-peptide test and its use to assist diabetes classification and choice of treatment. We provide recommendations for where C-peptide should be used, choice of test and interpretation of results. With the rising incidence of Type 2 diabetes in younger patients, the discovery of monogenic diabetes and development of new therapies aimed at preserving insulin secretion, the direct measurement of insulin secretion may be increasingly important. Advances in assays have made C-peptide measurement both more reliable and inexpensive. In addition, recent work has demonstrated that C-peptide is more stable in blood than previously suggested or can be reliably measured on a spot urine sample (urine C-peptide:creatinine ratio), facilitating measurement in routine clinical practice. The key current clinical role of C-peptide is to assist classification and management of insulin-treated patients. Utility is greatest after 3-5 years from diagnosis when persistence of substantial insulin secretion suggests Type 2 or monogenic diabetes. Absent C-peptide at any time confirms absolute insulin requirement and the appropriateness of Type 1 diabetes management strategies regardless of apparent aetiology.

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Figures

FIGURE 1
FIGURE 1
Boxplot of random non-fasting (with glucose > 8 mmol/l), fasting and glucagon-stimulated C-peptide in well-defined (on clinical features) Type 1 (n = 371) and Type 2 (n = 732) diabetes. Redrawn with permission from Berger et al. ([39]). Horizontal line represents median, box interquartile range, ‘whiskers’ represent 10–90% of values.
FIGURE 2
FIGURE 2
Boxplot using post-home meal urine C-peptide:creatinine ratio to discriminate Type 1 diabetes of over 5 years’ duration (n = 70) from Type 2 diabetes (n = 64) and HNF1A/4A MODY (n = 81). Adapted with permission from Besser et al. ([65]) (redrawn from original data). Cut-off of 0.2 nmol/mmol 96% sensitive and 98% specific in differentiating Type 1 diabetes from Type 2 diabetes or MODY (area under the receiver operating characteristic curve 0.99). Horizontal line represents median, box interquartile range, ‘whiskers’ represent the spread of remaining values. (o) outliers over 1.5 times the interquatile range, (*) outliers over 3 times the interquartile range.
FIGURE 3
FIGURE 3
Two-hour mixed-meal test C-peptide values in relation to diabetes duration at entry screening for the Diabetes Control and Complications Trial in (a) adults aged > 18 years and (b) adolescents aged < 18 years. Reproduced with permission from Palmer et al. ([23]).
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References

    1. Wahren J, Kallas A, Sima AA. The clinical potential of C-peptide replacement in type 1 diabetes. Diabetes. 2012;61:761–772. - PMC - PubMed
    1. Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER, et al. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2009;94:709–728. - PubMed
    1. Brandenburg D. History and diagnostic significance of C-peptide. Exp Diabetes Res. 2008;2008:576862. - PMC - PubMed
    1. Clark PM. Assays for insulin, proinsulin(s) and C-peptide. Ann Clin Biochem. 1999;36:541–564. - PubMed
    1. Polonsky KS, Licinio-Paixao J, Given BD, Pugh W, Rue P, Galloway J, et al. Use of biosynthetic human C-peptide in the measurement of insulin secretion rates in normal volunteers and type I diabetic patients. J Clin Invest. 1986;77:98–105. - PMC - PubMed

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