Diagnostic Test Accuracy of Urine C-peptide Creatinine Ratio for the Correct Identification of the Type of Diabetes: A Systematic Review.

TouchREVIEWS in endocrinology Pub Date : 2022-06-01 Epub Date: 2022-05-23 DOI:10.17925/EE.2022.18.1.2
Joseph M Pappachan, Bhuvana Sunil, Cornelius J Fernandez, Ian M Lahart, Ambika P Ashraf
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引用次数: 1

Abstract

Objective: To examine the accuracy of urine c-peptide creatinine ratio (UCPCR) for identifying the type of diabetes in appropriate clinical settings. Design: Systematic review of test accuracy studies on patients with different forms of diabetes. Data sources: Medline, Embase and Cochrane library databases from 1 January 2000 to 15 November 2020. Eligibility criteria: Studies reporting the use of UCPCR for diagnosing patients with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM) and monogenic forms of diabetes (categorized as maturity-onset diabetes of the young [MODY]). Study selection and data synthesis: Two reviewers independently assessed articles for inclusion and assessed the methodological quality of the studies using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, with input from a third reviewer to reach consensus when there was a dispute. Meta-analysis was performed with the studies reporting complete data to derive the pooled sensitivity, specificity and diagnostic odds ratio (DOR), and narrative synthesis only for those with incomplete data. Results: Nine studies with 4,488 patients were included in the qualitative synthesis, while only four of these (915 patients) had complete data and were included in the quantitative synthesis. All the studies had moderate risk of bias and applicability concerns. Meta-analysis of three studies (n=130) revealed sensitivity, specificity and DOR of 84.4% (95% confidence interval [CI] 68.1-93.2%), 91.6% (82.8-96.1%) and 59.9 (32.8-106.0), respectively, for diagnosing T1DM using a UCPCR cut-off of <0.2 nmol/mmol. For participants with T2DM (three studies; n=739), UCPCR >0.2 nmol/mmol was associated with sensitivity, specificity and DOR of 92.8% (84.2-96.9%), 81.6% (61.3-92.5%) and 56.9 (31.3-103.5), respectively. For patients with MODY in the appropriate clinical setting, a UCPCR cut-off of >0.2 nmol/mmol showed sensitivity, specificity and DOR of 85.2% (73.1-92.4%), 98.0% (92.4-99.5%) and 281.8 (57.5-1,379.7), respectively. Conclusions: Based on studies with moderate risk of bias and applicability concerns, UCPCR confers moderate to high sensitivity, specificity, and DOR for correctly identifying T1DM, T2DM and monogenic diabetes in appropriate clinical settings. Large multinational studies with multi-ethnic participation among different age groups are necessary before this test can be routinely used in clinical practice. Study registration: Protocol was registered as PROSPERO CRD42017060633.

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尿c肽肌酐比值对正确识别糖尿病类型的诊断试验准确性:一项系统评价。
目的:探讨尿c肽肌酐比值(UCPCR)在临床诊断糖尿病时的准确性。设计:对不同类型糖尿病患者的检测准确性研究进行系统回顾。数据来源:Medline, Embase和Cochrane图书馆数据库,2000年1月1日至2020年11月15日。入选标准:研究报告使用UCPCR诊断1型糖尿病(T1DM)、2型糖尿病(T2DM)和单基因型糖尿病(归类为年轻人的成熟型糖尿病[MODY])。研究选择和数据综合:两位审稿人使用诊断准确性研究质量评估-2工具独立评估文章的纳入和评估研究的方法学质量,当有争议时,第三位审稿人会提供意见以达成共识。对报告完整数据的研究进行荟萃分析,得出汇总敏感性、特异性和诊断优势比(DOR),并仅对数据不完整的研究进行叙事综合。结果:9项研究共4488例患者被纳入定性综合,其中只有4项研究(915例)数据完整,被纳入定量综合。所有研究均存在中等偏倚风险和适用性问题。3项研究(n=130)的荟萃分析显示,使用0.2 nmol/mmol的UCPCR截止值诊断T1DM的敏感性、特异性和DOR分别为84.4%(95%可信区间[CI] 68.1-93.2%)、91.6%(82.8-96.1%)和59.9(32.8-106.0),敏感性、特异性和DOR分别为92.8%(84.2-96.9%)、81.6%(61.3-92.5%)和56.9(31.3-103.5)。对于MODY患者,在合适的临床环境下,UCPCR截止值>0.2 nmol/mmol的敏感性、特异性和DOR分别为85.2%(73.1-92.4%)、98.0%(92.4-99.5%)和281.8(57.5- 1379.7)。结论:基于具有中等偏倚风险和适用性问题的研究,在适当的临床环境中,UCPCR在正确识别T1DM、T2DM和单基因糖尿病方面具有中等至高的敏感性、特异性和DOR。在该测试常规应用于临床实践之前,需要在不同年龄组中进行多民族参与的大型多国研究。研究注册:协议注册号为PROSPERO CRD42017060633。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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