Impact of routine clinic measurement of serum C-peptide in people with a clinician-diagnosis of type 1 diabetes.

Published on Jul 1, 2021in Diabetic Medicine3.083
· DOI :10.1111/DME.14449
Evgenia Foteinopoulou1
Estimated H-index: 1
(Western General Hospital),
Catriona Clarke6
Estimated H-index: 6
(Western General Hospital)
+ 7 AuthorsMark W. J. Strachan46
Estimated H-index: 46
(Western General Hospital)
Aims/hypothesis The aim of this study was to determine the impact of the routine use of serum C-peptide in an out-patient clinic setting on individuals with a clinician-diagnosis of type 1 diabetes. Methods In this single centre study, individuals with type 1 diabetes of at least 3 years duration were offered random serum C-peptide testing at routine clinic review. A C-peptide ≥200 pmol/L prompted further evaluation of the individual using a diagnostic algorithm that included measurement of islet cell antibodies and genetic testing. Where appropriate, a trial of anti-diabetic co-therapies was considered. Results Serum C-peptide testing was performed in 859 individuals (90% of the eligible cohort), of whom 114 (13.2%) had C-peptide ≥200 pmol/L. The cause of diabetes was reclassified in 58 individuals (6.8% of the tested cohort). The majority of reclassifications were to type 2 diabetes (44 individuals; 5.1%), with a smaller proportion of monogenic diabetes (14 individuals; 1.6%). Overall, 13 individuals (1.5%) successfully discontinued insulin, while a further 16 individuals (1.9%) had improved glycaemic control following the addition of co-therapies. The estimated total cost of the testing programme was £23,262 (~€26,053), i.e. £27 (~€30) per individual tested. In current terms, the cost of prior insulin therapy in the individuals with monogenic diabetes who successfully stopped insulin was approximately £57,000 (~€64,000). Conclusions/interpretation Serum C-peptide testing can easily be incorporated into an out-patient clinic setting and could be a cost-effective intervention. C-peptide testing should be strongly considered in individuals with a clinician-diagnosis of type 1 diabetes of at least 3 years duration.
#1Humaira Hussein (University of Leicester)H-Index: 2
#2Francesco Zaccardi (University of Leicester)H-Index: 33
Last. Laura J. Gray (University of Leicester)H-Index: 60
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#1Fraser W. Gibb (Edin.: University of Edinburgh)H-Index: 13
#2John A. McKnight (Western General Hospital)H-Index: 30
Last. Mark W. J. Strachan (Western General Hospital)H-Index: 46
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We aimed to assess whether persistence of C-peptide secretion is associated with less glucose variability and fewer low-glucose events in adults with type 1 diabetes who use flash monitoring. We performed a cross-sectional study of 290 adults attending a university teaching hospital diabetes clinic, with type 1 diabetes, who use flash monitoring and in whom a random plasma C-peptide was available in the past 2 years. Variables relating to flash monitoring were compared between individuals with l...
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Last. Helen M. Colhoun (Western General Hospital)H-Index: 79
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The objective of this cross-sectional study was to explore the relationship of detectable C-peptide secretion in type 1 diabetes to clinical features and to the genetic architecture of diabetes. C-peptide was measured in an untimed serum sample in the SDRNT1BIO cohort of 6076 Scottish people with clinically diagnosed type 1 diabetes or latent autoimmune diabetes of adulthood. Risk scores at loci previously associated with type 1 and type 2 diabetes were calculated from publicly available summary...
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#2Timothy J. McDonaldH-Index: 32
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This work was principally supported by the Juvenile Diabetes Research Foundation (JDRF) (ref 3-SRA-2014-314-M-R), with additional funding from the Department of Health and Wellcome Trust Health Innovation Challenge Award (HICF-1009-041; WT-091985). ATH is an NIHR Senior investigator and Wellcome Trust senior investigator. BS is a core member of the NIHR Exeter Clinical Research facility. ERP holds a Wellcome Trust New Investigator award (102820/Z/13/Z). TJM is funded by an NIHR clinical senior l...
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#1Beverley M. Shields (University of Exeter)H-Index: 67
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Last. Andrew T. Hattersley (University of Exeter)H-Index: 157
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OBJECTIVE Monogenic diabetes, a young-onset form of diabetes, is often misdiagnosed as type 1 diabetes, resulting in unnecessary treatment with insulin. A screening approach for monogenic diabetes is needed to accurately select suitable patients for expensive diagnostic genetic testing. We used C-peptide and islet autoantibodies, highly sensitive and specific biomarkers for discriminating type 1 from non–type 1 diabetes, in a biomarker screening pathway for monogenic diabetes. RESEARCH DESIGN AN...
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#1Andrew T. Hattersley (University of Exeter)H-Index: 157
#2Kashyap A. Patel (RD&E: Royal Devon and Exeter Hospital)H-Index: 16
The precision medicine approach of tailoring treatment to the individual characteristics of each patient or subgroup has been a great success in monogenic diabetes subtypes, MODY and neonatal diabetes. This review examines what has led to the success of a precision medicine approach in monogenic diabetes (precision diabetes) and outlines possible implications for type 2 diabetes. For monogenic diabetes, the molecular genetics can define discrete aetiological subtypes that have profound implicati...
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#1Danijela Tatovic (Cardiff University)H-Index: 6
#2Colin M. Dayan (Cardiff University)H-Index: 59
For almost a hundred years, the management of Type 1 diabetes has not advanced beyond insulin replacement. However, insulin does not provide satisfactory glycaemic control in the majority of individuals and there remains a major unmet need for novel treatments for Type 1 diabetes. Immunomodulation to preserve beta-cell function offers the prospect of making treatment with insulin easier and/or preventing the need for insulin, particularly when it comes to novel low-risk immunotherapies. Led by t...
#1Nicholas J Thomas (University of Exeter)
#2Helen C. Walkey (Imperial College London)H-Index: 10
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