C 肽在阿布扎比门诊患者中区分 1 型糖尿病和 2 型糖尿病的预测潜力。

IF 3.2 4区 医学 Q2 PHARMACOLOGY & PHARMACY
Sajid Iqbal MPhil, MSc , Abdulrahim Abu Jayyab MSc, PhD , Ayah Mohammad Alrashdi BSc , Syed Shujauddin MSc, MBA , Josep Lluis Clua-Espuny MD, PhD , Silvia Reverté-Villarroya MSc, PhD
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引用次数: 0

摘要

目的:我们旨在研究血浆连接肽(C肽)在区分1型糖尿病(T1D)和2型糖尿病(T2D)方面的预测潜力,并为基于证据的糖尿病分类标准提供依据:方法:对2016年1月至2021年12月期间在糖尿病科、内分泌科、全科和家庭医学三级医疗保健中心门诊就诊的所有糖尿病患者进行回顾性研究:共纳入 222 名糖尿病患者,其中 85 人(44.8%)患有 T1D,127 人(55.2%)患有 T2D。确诊时的平均(标清)年龄为 35.9(15.1)岁,男性 112 人(52.8%)。糖尿病病程中位数(四分位数间距 [IQR])为 3.8(3.0-4.5)年(T1D,3.9 [3.5-4.6];T2D,3.4 [2.4-4.4];P = 0.001)。体重指数为 2 的有 5 人(2.5%)(T1D,5 人;T2D,无),18.5 至 2 的有 57 人(28.5%)(T1D,32 人;T2D,25 人),25 至 2 的有 58 人(29%)(T1D,28 人;T2D,30 人),大于 30 kg/m2 的有 80 人(40.0%)(T1D,20 人;T2D,60 人)。糖化血红蛋白中位数(IQR)为 7.4% (6.7%-8.5%)(T1D,8.3% [7.2%-9.9%];T2D,7% [6.3%-7.6%];P = 0.0001)。C肽浓度中位数(IQR)为0.59 nmol/L(0.01-1.14 nmol/L)(T1D,0.01 nmol/L [0.003-0.05 nmol/L];T2D,1.03 nmol/L [0.70-1.44 nmol/L];P = 0.0001)。在区分 T1D 和 T2D 方面,C 肽浓度≤0.16 nmol/L 的敏感性为 92.9%,特异性为 2.4%,AUC 为 97.2% (CI, 94.7%-99.6%; P = 0.0001):据我们所知,这是中东和北非地区第一项强调 C 肽在糖尿病分类中作用的研究。估计的 C 肽浓度临界点(≤0.16 nmol/L)肯定有助于准确划分 T1D,并将排除该地区常规的临床判断方法,尤其是在那些总是难以诊断糖尿病类型的情况和时期。量化 C 肽的临界值是这项研究的重要优势之一,它将为糖尿病护理管理提供更好的治疗方案。此外,我们还评估了同时出现的血糖水平,以排除在低血糖或严重葡萄糖中毒情况下出现的 C 肽假低值现象。根据我们的研究结果,C肽检测可被纳入以证据为基础的指南中,以区分 T1D 和 T2D。尽管如此,我们的研究仍有一些局限性,包括回顾性设计导致的选择偏差,以及低 C 肽水平可能表明因其他原因或长期 T2D 导致的胰腺储备不足,而量化这些原因需要额外的资源和时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Predictive Potential of C-Peptide in Differentiating Type 1 Diabetes From Type 2 Diabetes in an Outpatient Population in Abu Dhabi

Purpose

We aimed to investigate the predictive potential of plasma connecting peptide (C-peptide) in differentiating type 1 diabetes (T1D) from type 2 diabetes (T2D) and to inform evidence-based diabetes classification criteria.

Methods

A retrospective review was performed of all the patients with diabetes visiting an outpatient diabetology, endocrinology, general practice and family medicine tertiary health care center between January 2016 and December 2021.

Findings

Two hundred twelve individuals with diabetes were included, 85 (44.8%) with T1D and 127 (55.2%) with T2D. Mean (SD) age at diagnosis was 35.9 (15.1) years, and 112 (52.8%) men. Median (interquartile range [IQR]) duration of diabetes was 3.8 (3.0–4.5) years (T1D, 3.9 [3.5–4.6]; T2D, 3.4 [2.4–4.4]; P = 0.001). Body mass index was <18.5 kg/m2 in 5 (2.5%) individuals (T1D, 5; T2D, none), 18.5 to <25 kg/m2 in 57 (28.5%) (T1D, 32; T2D, 25), 25 to <30 kg/m2 in 58 (29%) (T1D, 28; T2D, 30), and >30 kg/m2 in 80 (40.0%) (T1D, 20; T2D, 60). Median (IQR) glycosylated hemoglobin was 7.4% (6.7%–8.5%) (T1D, 8.3% [7.2%–9.9%]; T2D, 7% [6.3%–7.6%]; P = 0.0001). Median (IQR) C-peptide concentration was 0.59 nmol/L (0.01–1.14 nmol/L) (T1D, 0.01 nmol/L [0.003–0.05 nmol/L]; T2D, 1.03 nmol/L [0.70–1.44 nmol/L]; P = 0.0001). C-peptide concentration of ≤0.16 nmol/L showed 92.9% sensitivity, 1-specificity of 2.4%, and AUC of 97.2% (CI, 94.7%–99.6%; P = 0.0001) in differentiating T1D from T2D.

Implications

To our knowledge, this is the first study in the Middle East and North Africa region highlighting the role of C-peptide in diabetes classification. The estimated cutoff point for C-peptide concentration (≤0.16 nmol/L) will certainly help in accurately classifying the T1D and will rule out the routine clinical judgmental approaches in the region, especially in those scenarios and periods where it is always difficult to diagnose the diabetes type. Quantifying the cutoff for C-peptide is among the vital strengths of this study that will provide a better treatment plan in diabetes care management. Also, we evaluated concomitant glucose levels to rule out the phenomenon of falsely low C-peptide values in the setting of hypoglycemia or severe glucose toxicity. Based on our findings, C-peptide testing could be included in postulating an evidence-based guideline that differentiates T1D from T2D. Despite this, our study has some limitations, including the selection bias due to the retrospective design and low C-peptide levels could be indicative of low pancreatic reserves due to other causes or long-standing T2D, and quantifying these reasons requires additional resources and time.

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来源期刊
Clinical therapeutics
Clinical therapeutics 医学-药学
CiteScore
6.00
自引率
3.10%
发文量
154
审稿时长
9 weeks
期刊介绍: Clinical Therapeutics provides peer-reviewed, rapid publication of recent developments in drug and other therapies as well as in diagnostics, pharmacoeconomics, health policy, treatment outcomes, and innovations in drug and biologics research. In addition Clinical Therapeutics features updates on specific topics collated by expert Topic Editors. Clinical Therapeutics is read by a large international audience of scientists and clinicians in a variety of research, academic, and clinical practice settings. Articles are indexed by all major biomedical abstracting databases.
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