{"title":"1例2型糖尿病患者停用苏比里尔/缬沙坦后尿c肽水平的纵向监测:1例报告和文献综述","authors":"Keiichiro Kondo, Hiroto Minamino, Takaaki Murakami, Emi Okamura, Takuro Hakata, Yohei Ueda, Daisuke Taura, Daisuke Yabe","doi":"10.1007/s13340-025-00816-y","DOIUrl":null,"url":null,"abstract":"<p><p>We report two cases of diabetes mellitus treated with sacubitril/valsartan, whose urinary C-peptide dynamics exhibited significant difference. The first case is an 84-year-old Japanese man with type 2 diabetes and hypertension who exhibited significantly elevated urinary C-peptide levels during treatment with sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNi). Despite normal serum C-peptide levels, his urinary C-peptide excretion was disproportionately high, suggesting that sacubitril/valsartan may have altered C-peptide clearance through neprilysin inhibition. The discontinuation of sacubitril/valsartan demonstrated gradual decline of urinary C-peptide levels, although they remained elevated compared to serum ones. Daily longitudinal monitoring of urinary C-peptide revealed marked fluctuations of its levels, indicating a prolonged and potentially complex effect of neprilysin inhibition on C-peptide excretion. Additionally, we observed a corresponding decrease in atrial natriuretic peptide (ANP) levels after discontinuation of sacubitril/valsartan, further supporting the role of neprilysin inhibition in altering peptide metabolism. In contrast, the second case involves a 78-year-old Japanese woman with insulin-dependent type 1 diabetes and undetectable serum C-peptide levels. In her case, urinary C-peptide levels remained undetectable despite ARNi therapy. These cases highlight the need for careful clinical interpretation of urinary C-peptide levels in patients receiving neprilysin inhibitors. When evaluating pancreatic β-cell function using urinary C-peptide levels under ARNi therapy, it is crucial to consider extended monitoring of urinary C-peptide levels, the duration of drug withdrawal, and serum C-peptide levels to ensure accurate assessment.</p>","PeriodicalId":11340,"journal":{"name":"Diabetology International","volume":"16 3","pages":"580-585"},"PeriodicalIF":1.2000,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209063/pdf/","citationCount":"0","resultStr":"{\"title\":\"Longitudinal monitoring of urinary C-peptide levels following discontinuation of sacubitril/valsartan in a type 2 diabetes patient: a case report and literature review.\",\"authors\":\"Keiichiro Kondo, Hiroto Minamino, Takaaki Murakami, Emi Okamura, Takuro Hakata, Yohei Ueda, Daisuke Taura, Daisuke Yabe\",\"doi\":\"10.1007/s13340-025-00816-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>We report two cases of diabetes mellitus treated with sacubitril/valsartan, whose urinary C-peptide dynamics exhibited significant difference. The first case is an 84-year-old Japanese man with type 2 diabetes and hypertension who exhibited significantly elevated urinary C-peptide levels during treatment with sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNi). Despite normal serum C-peptide levels, his urinary C-peptide excretion was disproportionately high, suggesting that sacubitril/valsartan may have altered C-peptide clearance through neprilysin inhibition. The discontinuation of sacubitril/valsartan demonstrated gradual decline of urinary C-peptide levels, although they remained elevated compared to serum ones. Daily longitudinal monitoring of urinary C-peptide revealed marked fluctuations of its levels, indicating a prolonged and potentially complex effect of neprilysin inhibition on C-peptide excretion. Additionally, we observed a corresponding decrease in atrial natriuretic peptide (ANP) levels after discontinuation of sacubitril/valsartan, further supporting the role of neprilysin inhibition in altering peptide metabolism. In contrast, the second case involves a 78-year-old Japanese woman with insulin-dependent type 1 diabetes and undetectable serum C-peptide levels. In her case, urinary C-peptide levels remained undetectable despite ARNi therapy. These cases highlight the need for careful clinical interpretation of urinary C-peptide levels in patients receiving neprilysin inhibitors. When evaluating pancreatic β-cell function using urinary C-peptide levels under ARNi therapy, it is crucial to consider extended monitoring of urinary C-peptide levels, the duration of drug withdrawal, and serum C-peptide levels to ensure accurate assessment.</p>\",\"PeriodicalId\":11340,\"journal\":{\"name\":\"Diabetology International\",\"volume\":\"16 3\",\"pages\":\"580-585\"},\"PeriodicalIF\":1.2000,\"publicationDate\":\"2025-03-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209063/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Diabetology International\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s13340-025-00816-y\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/7/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diabetology International","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s13340-025-00816-y","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
Longitudinal monitoring of urinary C-peptide levels following discontinuation of sacubitril/valsartan in a type 2 diabetes patient: a case report and literature review.
We report two cases of diabetes mellitus treated with sacubitril/valsartan, whose urinary C-peptide dynamics exhibited significant difference. The first case is an 84-year-old Japanese man with type 2 diabetes and hypertension who exhibited significantly elevated urinary C-peptide levels during treatment with sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNi). Despite normal serum C-peptide levels, his urinary C-peptide excretion was disproportionately high, suggesting that sacubitril/valsartan may have altered C-peptide clearance through neprilysin inhibition. The discontinuation of sacubitril/valsartan demonstrated gradual decline of urinary C-peptide levels, although they remained elevated compared to serum ones. Daily longitudinal monitoring of urinary C-peptide revealed marked fluctuations of its levels, indicating a prolonged and potentially complex effect of neprilysin inhibition on C-peptide excretion. Additionally, we observed a corresponding decrease in atrial natriuretic peptide (ANP) levels after discontinuation of sacubitril/valsartan, further supporting the role of neprilysin inhibition in altering peptide metabolism. In contrast, the second case involves a 78-year-old Japanese woman with insulin-dependent type 1 diabetes and undetectable serum C-peptide levels. In her case, urinary C-peptide levels remained undetectable despite ARNi therapy. These cases highlight the need for careful clinical interpretation of urinary C-peptide levels in patients receiving neprilysin inhibitors. When evaluating pancreatic β-cell function using urinary C-peptide levels under ARNi therapy, it is crucial to consider extended monitoring of urinary C-peptide levels, the duration of drug withdrawal, and serum C-peptide levels to ensure accurate assessment.
期刊介绍:
Diabetology International, the official journal of the Japan Diabetes Society, publishes original research articles about experimental research and clinical studies in diabetes and related areas. The journal also presents editorials, reviews, commentaries, reports of expert committees, and case reports on any aspect of diabetes. Diabetology International welcomes submissions from researchers, clinicians, and health professionals throughout the world who are interested in research, treatment, and care of patients with diabetes. All manuscripts are peer-reviewed to assure that high-quality information in the field of diabetes is made available to readers. Manuscripts are reviewed with due respect for the author''s confidentiality. At the same time, reviewers also have rights to confidentiality, which are respected by the editors. The journal follows a single-blind review procedure, where the reviewers are aware of the names and affiliations of the authors, but the reviewer reports provided to authors are anonymous. Single-blind peer review is the traditional model of peer review that many reviewers are comfortable with, and it facilitates a dispassionate critique of a manuscript.