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Glycaemic variability and hypoglycaemia are associated with C-peptide levels in insulin-treated type 2 diabetes

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@article{77635a84ad08492c9c9b9b54a58875ad,
title = "Glycaemic variability and hypoglycaemia are associated with C-peptide levels in insulin-treated type 2 diabetes",
abstract = "Aim: The aim of the study was to evaluate the association between C-peptide levels, glycaemic variability and hypoglycaemia in patients with insulin-treated type 2 diabetes (T2D). Methods: A total of 98 patients with T2D treated with basal-bolus insulin were enrolled in a cross-sectional study. Glycaemic variability and hypoglycaemia were assessed from continuous glucose monitoring (CGM) data recorded over 6 days: Glycemic variability was assessed by calculating the mean coefficient of variation (CV), while hypoglycemia was defined as sensor glucose levels ≤ 3.9 mmol/L or < 3.0 mmol/L. Fasting C-peptide and fasting glucose were measured on day 1. Results: Low levels of fasting C-peptide correlated with higher CV (r = −0.53, P < 0.0001). In a multivariate regression model with HbA 1c , body mass index, diabetes duration and total daily insulin dose, only C-peptide was significantly associated with CV. Patients with ≥ 1 episode of hypoglycaemia had significantly lower median C-peptide levels than patients without hypoglycaemia (274 (136–620) pmol/L vs. 675 (445–1013) pmol/L, respectively; P = 0.0004). Also, 17 patients clinically diagnosed with T2D had detectable glutamic acid decarboxylase (GAD) antibodies (≥ 5 U/mL). These GAD-positive patients had significantly lower fasting C-peptide, higher CV and greater frequency of hypoglycaemia than GAD-negative patients. Conclusion: In patients with insulin-treated T2D, low levels of C-peptide are associated with greater glycaemic variability and higher risk of hypoglycaemia, suggesting that C-peptide levels should be taken into consideration when optimizing insulin treatment and assessing hypoglycaemia risk.",
keywords = "Basal-bolus insulin, C-peptide, Continuous glucose monitoring, Glycaemic variability, Hypoglycaemia, Type 2 diabetes",
author = "Christensen, {M B} and P G{\ae}de and E Hommel and A Gotfredsen and K N{\o}rgaard",
note = "Copyright {\circledC} 2019 Elsevier Masson SAS. All rights reserved.",
year = "2020",
month = "2",
doi = "10.1016/j.diabet.2019.02.002",
language = "English",
volume = "46",
pages = "61--65",
journal = "Diabetes and Metabolism",
issn = "1262-3636",
publisher = "Elsevier Masson Editeur",
number = "1",

}

RIS

TY - JOUR

T1 - Glycaemic variability and hypoglycaemia are associated with C-peptide levels in insulin-treated type 2 diabetes

AU - Christensen, M B

AU - Gæde, P

AU - Hommel, E

AU - Gotfredsen, A

AU - Nørgaard, K

N1 - Copyright © 2019 Elsevier Masson SAS. All rights reserved.

PY - 2020/2

Y1 - 2020/2

N2 - Aim: The aim of the study was to evaluate the association between C-peptide levels, glycaemic variability and hypoglycaemia in patients with insulin-treated type 2 diabetes (T2D). Methods: A total of 98 patients with T2D treated with basal-bolus insulin were enrolled in a cross-sectional study. Glycaemic variability and hypoglycaemia were assessed from continuous glucose monitoring (CGM) data recorded over 6 days: Glycemic variability was assessed by calculating the mean coefficient of variation (CV), while hypoglycemia was defined as sensor glucose levels ≤ 3.9 mmol/L or < 3.0 mmol/L. Fasting C-peptide and fasting glucose were measured on day 1. Results: Low levels of fasting C-peptide correlated with higher CV (r = −0.53, P < 0.0001). In a multivariate regression model with HbA 1c , body mass index, diabetes duration and total daily insulin dose, only C-peptide was significantly associated with CV. Patients with ≥ 1 episode of hypoglycaemia had significantly lower median C-peptide levels than patients without hypoglycaemia (274 (136–620) pmol/L vs. 675 (445–1013) pmol/L, respectively; P = 0.0004). Also, 17 patients clinically diagnosed with T2D had detectable glutamic acid decarboxylase (GAD) antibodies (≥ 5 U/mL). These GAD-positive patients had significantly lower fasting C-peptide, higher CV and greater frequency of hypoglycaemia than GAD-negative patients. Conclusion: In patients with insulin-treated T2D, low levels of C-peptide are associated with greater glycaemic variability and higher risk of hypoglycaemia, suggesting that C-peptide levels should be taken into consideration when optimizing insulin treatment and assessing hypoglycaemia risk.

AB - Aim: The aim of the study was to evaluate the association between C-peptide levels, glycaemic variability and hypoglycaemia in patients with insulin-treated type 2 diabetes (T2D). Methods: A total of 98 patients with T2D treated with basal-bolus insulin were enrolled in a cross-sectional study. Glycaemic variability and hypoglycaemia were assessed from continuous glucose monitoring (CGM) data recorded over 6 days: Glycemic variability was assessed by calculating the mean coefficient of variation (CV), while hypoglycemia was defined as sensor glucose levels ≤ 3.9 mmol/L or < 3.0 mmol/L. Fasting C-peptide and fasting glucose were measured on day 1. Results: Low levels of fasting C-peptide correlated with higher CV (r = −0.53, P < 0.0001). In a multivariate regression model with HbA 1c , body mass index, diabetes duration and total daily insulin dose, only C-peptide was significantly associated with CV. Patients with ≥ 1 episode of hypoglycaemia had significantly lower median C-peptide levels than patients without hypoglycaemia (274 (136–620) pmol/L vs. 675 (445–1013) pmol/L, respectively; P = 0.0004). Also, 17 patients clinically diagnosed with T2D had detectable glutamic acid decarboxylase (GAD) antibodies (≥ 5 U/mL). These GAD-positive patients had significantly lower fasting C-peptide, higher CV and greater frequency of hypoglycaemia than GAD-negative patients. Conclusion: In patients with insulin-treated T2D, low levels of C-peptide are associated with greater glycaemic variability and higher risk of hypoglycaemia, suggesting that C-peptide levels should be taken into consideration when optimizing insulin treatment and assessing hypoglycaemia risk.

KW - Basal-bolus insulin

KW - C-peptide

KW - Continuous glucose monitoring

KW - Glycaemic variability

KW - Hypoglycaemia

KW - Type 2 diabetes

UR - http://www.scopus.com/inward/record.url?scp=85062271452&partnerID=8YFLogxK

U2 - 10.1016/j.diabet.2019.02.002

DO - 10.1016/j.diabet.2019.02.002

M3 - Journal article

VL - 46

SP - 61

EP - 65

JO - Diabetes and Metabolism

JF - Diabetes and Metabolism

SN - 1262-3636

IS - 1

ER -

ID: 56780632