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Xiao-Yun Zha, Chang-Shun Wei, Jia-Jia Dong, Jin-Zhi Wu, Liang-Xiao Xie, Ze-Hong Xu, Hua-Qiang Zheng, Duo-Bin Huang, Peng-Bin Lai The First Department of Endocrinology and Metabolism, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, 363000, People’s Republic of ChinaCorrespondence: Peng-Bin Lai, The First Department of Endocrinology and Metabolism, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, 363000, People’s Republic of China, Tel +8613709398727, Email 13709398727@163.comPurpose: This study aims to analyze the impact of serum C-peptide levels in patients with newly diagnosed type 2 diabetes (T2DM) on the 10-year risk of atherosclerotic cardiovascular disease (ASCVD).Patients and Methods: A total of 1923 patients with newly diagnosed T2DM were selected and categorized into four groups based on the interquartile range of fasting C-peptide (FCP) levels: Q1 group (FCP≤ 0.568 ng/mL), Q2 group (0.568 < FCP≤ 0.751 ng/mL), Q3 group (0.751 < FCP≤ 0.980 ng/mL), and Q4 group (FCP > 0.980 ng/mL). Clinical data were collected, and the China-PAR model was employed to evaluate the risk score of ASCVD within 10 years. Additionally, the correlation between FCP levels and the risk of ASCVD was analyzed.Results: As the quartiles of FCP increased, the 10-year ASCVD risk exhibited a gradual increase. The risk score in the FCP > 0.980 ng/mL group was significantly higher than that in the other groups, with noted differences related to gender and weight. Multiple linear regression analysis indicated that, even after adjusting for confounding factors such as gender, age, body mass index (BMI), and glycosylated hemoglobin, FCP levels remained a positive predictor of the 10-year ASCVD risk.Conclusion: High FCP levels are identified as a risk factor for ASCVD within 10 years in patients with newly diagnosed T2DM.Keywords: type 2 diabetes, fasting C-peptide, ASCVD risk

Li Gao,1,&ast; Jiexing Qin,1,&ast; Ying Chen,1 Wenqun Jiang,2 Desheng Zhu,1 Xiajun Zhou,1 Jie Ding,1 Huiying Qiu,1 Yan Zhou,1 Qing Dong,1 Yangtai Guan1 1Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Department of Laboratory Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qing Dong; Yangtai Guan, Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People’s Republic of China, Email dnqn1969@qq.com; yangtaiguan@sina.comPurpose: To investigate the risk factors associated with subclinical diabetic peripheral neuropathy (sDPN) in patients with type 2 diabetes mellitus (T2DM).Patients and Methods: This cross-sectional, retrospective study involved 311 patients with T2DM who were successively admitted from January 2018 to December 2021 without any neurological symptoms. All participants underwent a nerve conduction study (NCS), and those asymptomatic patients with abnormal nerve conduction were diagnosed with sDPN. Differences between groups were evaluated by the chi-squared, Wilcoxon, or Fisher’s exact test. Binary logistic regression analysis was performed to determine the independent risk factors for sDPN. Receiver operating characteristic (ROC) curves were constructed, and the areas under curves (AUCs) were detected.Results: Among 311 asymptomatic patients with T2DM, 142 (45.7%) with abnormal nerve conduction were diagnosed with sDPN. Patients with sDPN significantly differed from those without diabetic peripheral neuropathy (DPN) in age, history of hypertension, duration of diabetes, anemia, neutrophil-to-lymphocyte ratio, fasting C-peptide level, serum creatinine level, and albuminuria (all p< 0.05). Furthermore, the duration of diabetes (odds ratio [OR]: 1.062, 95% confidence interval [CI]: 1.016– 1.110), fasting C-peptide level (OR: 2.427, 95% CI: 1.126– 5.231), and presence of albuminuria (OR: 2.481, 95% CI: 1.406– 4.380) were independently associated with the development of sDPN (all p< 0.05). The AUCs for fasting C-peptide level, duration of diabetes, and the two factors combined were 0.6229 (95% CI: 0.5603– 0.6855, p=0.0002), 0.6738 (95% CI: 0.6142– 0.7333, p< 0.0001), and 0.6808 (95% CI: 0.6212– 0.7404, p< 0.0001), respectively.Conclusion: For patients with T2DM and longer duration of diabetes, lower fasting C-peptide levels, and presence with albuminuria, the risk for developing DPN is higher even if they have no clinical signs or symptoms. Identifying potential risk factors for the development of sDPN and effectively controlling them early are critical for the successful management of DPN.Keywords: type 2 diabetes mellitus, subclinical diabetic peripheral neuropathy, nerve conduction study, fasting C-peptide, albuminuria, risk factor

Background: To compare glycemic control in Chinese patients with type 2 diabetes mellitus (T2DM) whose blood glucose levels were inadequately controlled with oral antidiabetic drugs after beinaglutide alone or combined with insulin glargine (IGlar). Methods: In this 16‐week multicenter, randomized clinical trial, 68 participants randomly received beinaglutide or IGlar for 8 weeks, then the two drugs in combination for 8 weeks. The primary outcomes were the proportion of individuals achieving their glycemic target and the change in glucose variability as measured with a continuous glucose monitoring system from baseline to 8 and 16 weeks. Results: Both the beinaglutide and IGlar groups showed increased proportions achieving their glycemic target at 8 weeks, and the combination augmented the proportion reaching the glycated hemoglobin target from 25.42% at 8 weeks to 40.68% at 16 weeks. The beinaglutide group showed a significant reduction in body weight, body mass index, waist circumference, and systolic blood pressure. Beinaglutide elevated high‐density lipoprotein cholesterol by 0.08 mmol/L (95% confidence interval [CI], 0.00–0.16), and diminished low‐density lipoprotein cholesterol by 0.21 mmol/L (95% CI, 0.05–0.48), whereas IGlar showed no effect. Though IGlar was more efficient in lowering fasting plasma glucose than beinaglutide at comparable efficacies (to −1.57 mmol/L [95% CI, −2.60 to −0.54]), this difference was abolished in patients whose fasting C‐peptide was ≥0.9 ng/mL. Conclusion: Beinaglutide exhibited a favorable hypoglycemic effect on patients with T2DM, and in combination with IGlar, glucose level was further decreased. Low fasting C‐peptide in patients may reduce the glycemic response to beinaglutide therapy. We recommend that C‐peptide levels be evaluated when using or switching to the novel glucagon‐like peptide‐1 receptor agonists beinaglutide. Trial Registration: ClinicalTrials.gov: NCT03829891. [ABSTRACT FROM AUTHOR]

Maisa A Wahab,1 Alshaymaa M Alhabibi,2 Ahmed Khairy Sakr,1 Mohamed Yahia Zakaria,3 Ola I Saleh,4 Inass Hassan Ahmad,5 Eman Kamel Abdelrahman,6 Randa Sabour Elshahat Taha,4 Fayka Karem Abdel Azeem Ahmed,4 Bothayna Ismail,2 Lamiaa Hosney Azel,5 Asmaa S Hassan,2 Hanaa Mohammed Eid El Sayed,7 Sammar Ahmed Kasim,7 Safaa Abdelfattah Elsharkawy8 1Department of Vascular Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 2Department of Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 3Department of Vascular and Endovascular Surgery, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt; 4Department of Radio-Diagnosis, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 5Department of Endocrinology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 6Department of Internal Medicine, Faculty of Medicine, Port Said University, Port Said, Egypt; 7Department of Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 8Department of Community Medicine and Occupational Health, Faculty of Medicine for Girls, Al-Azhar University, Cairo, EgyptCorrespondence: Alshaymaa M Alhabibi, Tel +201002894075, Email alshaymaa.alhabibi@yahoo.comBackground: One of the major issues affecting global health is Diabetes mellitus (DM), not only in terms of the disease itself but also its complications. Macrovascular complications are both common and serious, affecting many patients. This study aimed to assess fasting C-peptide levels and correlate them with the severity of the peripheral arterial disease complicating type 2 DM (T2DM).Patients and Methods: This study included 200 participants who were categorized into two groups: Group I (n=100, patients with T2DM complicated by femoropopliteal arterial atherosclerosis) and Group II (n=100, healthy age- and sex-matched individuals serving as controls). Fasting C-peptide levels were estimated using an immunochemiluminometric assay.Results: Fasting C-peptide levels were significantly higher in Group I than in the control group. Fasting C-peptide levels were positively correlated with the severity of atherosclerosis. In addition, the receiver operating characteristic (ROC) curve analysis revealed that fasting C-peptide levels served as a specific and sensitive marker for detecting the severity of this disease.Conclusion: Fasting C-peptide levels can be used as a sensitive and specific indicator of the severity of femoropopliteal arteriosclerosis that complicates T2DM.Keywords: diabetes mellitus, femoropopliteal arteriosclerosis, fasting C-peptide

Objective To analyze the interdependent relationships between insulin resistance (IR) related indicators and Chinese medicine syndromes in patients with diabetic kidney disease (DKD) of stages G2 and A2/3,and to explore rules of Chinese medicine syndromes differentiation in patients with DKD (stages G2 and A2/3). Methods A total of 98 patients with DKD (stages G2 and A2/3) admitted to Nanjing Drum Tower Hospital from January 2015 to December 2016 were retrospective analyzed. The general clinical indexes, the frequency of Chinese medicine syndromes and the distribution of Chinese medicine syndromes type were investigated. Furthermore, IR related indicators including fast blood glucose (FBG), fast insulin (FIN), fast C-Peptide (FCP) and homeostatic model assessment of insulin resistance (HOMA-IR) were examined, respectively. And then, the multivariate regression analysis of IR related indicators and Chinese medicine syndromes was performed. Results Among 98 patients with DKD (stage G2, A2/3), root cause syndrome included 64 cases of spleen-kidney Qi deficiency syndrome, 20 cases of deficiency of both Qi and Yin syndrome, 8 cases of Yin deficiency dryness-heat syndrome, and 6 cases of deficiency of both Yin and Yang syndrome. The clinical manifestation syndrome included 42 cases of blood stasis syndrome, 10 cases of phlegm stasis syndrome, 5 cases of damp-heat syndrome, and 1 case of cold-dampness syndrome. There were 58 cases of complex syndrome types, including 28 cases of spleen-kidney Qi deficiency and blood-stasis syndrome. Compared with non spleen-kidney Qi deficiency syndrome patients, the TG, FIN, FCP and HOMA-IR in patients with spleen-kidney Qi deficiency syndrome were significantly increased (P＜0.05). Logistic regression analysis showed that there was no correlation between Chinese medicine symptoms (frequent or clear urination, fatigue, numbness, and soreness in the waist and knees) and elevated FBG and FIN(P＞0.05). For those with fatigue symptom, the probability of FCP elevation was 7.661 times higher than those without this symptom (P＜0.05). For those with fatigue symptom and frequent or clear urination symptom, the probability of HOMA-IR elevation was 10.787 and 5.911 times higher than those without the symptom, respectively (P

Objective To analyse the risk factors for type 2 diabetes mellitus (T2DM) combined with non-alcoholic fatty liver disease (NAFLD) and progressive liver fibrosis and their predictive efficacy. Methods Based on the results of abdominal ultrasound, 431 patients with T2DM were divided into 316 patients with T2DM combined with NAFLD (combined group) and 115 patients with T2DM (simple group); 316 patients with T2DM combined with NAFLD were further divided into 39 patients with progressive liver fibrosis (progressive group), 122 patients with suspected liver fibrosis (suspicious group), and 155 patients without liver fibrosis (excluded group) according to the NAFLD fibrosis score (NFS). Univariate and multifactorial Logistic regression was used to analyze of influencing factors and risk factors for T2DM combined with NAFLD and progressive liver fibrosis. The ROC curve was used to assess the predictive efficiency of the risk factors on NAFLD and progressive liver fibrosis in T2DM combined with NAFLD. Results There were significant differences in age, body mass index (BMI), white blood cell (WBC), lymphocyte (LY), aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (GGT), albumin (Alb), serum urid acid (SUA), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), UHR, fasting insulin (FIns), fasting C-peptide (FC-P), and homeostatic model assessment of insulin resistance (HOMA-IR) between the combined group and simple group (all P<0. 05); multifactorial Logistic regression analysis showed that BMI, AST, Alb, TG, UHR, and FC-P were risk factors for T2DM in combination with NAFLD. When the predicted critical value of BMI was 24. 87 kg/m2, the sensitivity of T2DM combined with NAFLD was 77. 5% and the specificity was 72. 2%; when the predicted critical value of AST was 19. 5 U/L, the sensitivity of T2DM combined with NAFLD was 56. 7% and the specificity was 78. 3%; when the predicted critical value of Alb was 4. 42 g/dL, its sensitivity was 57. 0% and specificity was 58. 3%; when the predicted critical value of TG was 1. 45 mmol/L, its sensitivity was 73. 7% and specificity was 65. 2%; when the predicted critical value of UHR was 308. 5, its sensitivity was 66. 5% and specificity was 81. 7%; when the FC-P predicted critical value was 1. 44 ng/mL, its sensitivity was 67. 1% and specificity was 63. 5% for the diagnosis of T2DM combined with NAFLD. There were significant differences in gender, age, history of hypertension, BMI, platelet (PLT), AST/ALT, GGT, Alb, total bilirubin (TBil), serum creatinine (Scr), cystatin C (Cys-C), SUA, TC, TG, HDL, low-density lipoprotein cholesterol (LDL), UHR, fasting plasma glucose (FPG), FIns, FC-P, and HOMA-IR between the progressive group, suspicious group and the excluded group (all P<0. 05); multifactorial Logistic regression analysis showed that UHR, FC-P and HOMA-IR were risk factors for progressive liver fibrosis; when the predicted critical value of UHR was 313. 98, the sensitivity of the diagnosis of progressive liver fibrosis in T2DM combined with NAFLD was 84. 6% and the specificity was 54. 9%; when the predicted critical value of HOMA-IR was 5. 56, the sensitivity of the diagnosis of progressive liver fibrosis in T2DM combined with NAFLD was 69. 2% and the specificity was 72. 6%; when the the predicted critical value of FC-P was 2. 64 ng/mL, the sensitivity of the diagnosis of progressive liver fibrosis in T2DM combined with NAFLD was 53. 8%, and the specificity was 82. 3%. Conclusions BMI, AST, Alb, TG, UHR, and FC-P are risk factors for NAFLD in combination with T2DM; UHR, FC-P, and HOMA-IR are risk factors for progressive liver fibrosis in T2DM combined with NAFLD. Each index has good predictive efficacy for T2DM combined with NAFLD and for progressive liver fibrosis in T2DM combined with NAFLD. [ABSTRACT FROM AUTHOR]

Abstract Background Fasting C-peptide (FCP) has been shown to play an important role in the pathophysiology of mood disorders including depression and schizophrenia, but it is unknown whether it also predicts post-stroke depression (PSD). This study examined the association between FCP and PSD at 6 months after acute ischemic-stroke onset among Chinese subjects. Methods A total of 656 stroke patients were consecutively recruited from three hospitals of Wuhan city, Hubei province. Clinical and laboratory data were collected on admission. PSD status was evaluated by DSM-V criteria and 17-item Hamilton Rating Scale for Depression (HAMD-17) at 6 months after acute ischemic stroke. The χ2-test, Mann-Whitney U-test, and t-test were used to check for statistical significance. Multivariate logistic regression model was used to explore independent predictor of PSD. Results In the univariate analysis, significant differences were found between the PSD and non-PSD groups in terms of FCP level (p = 0.009). After multivariate adjustments, FCP remained a significant independent predictor of PSD, with an adjusted odds ratio of 1.179 (95%CI: 1.040–1.337, p = 0.010). Conclusions Higher FCP levels on admission were found to be associated with PSD at 6 months after acute ischemic-stroke onset. For stroke patients, doctors should pay attention to the baseline FCP for screening high-risk PSD in clinical practice.

ObjectiveThe aim of this study was to analyze the clinical characteristics and the pattern of long-term changes of fasting plasma C-peptide in patients with mitochondrial diabetes (MD), and to provide guidance for the diagnosis and treatment of MD.MethodsWe retrieved MD patients with long-term follow-up at Peking Union Medical College Hospital from January 2005 to July 2021 through the medical record retrieval system and retrospectively analyzed their clinical data, biochemical parameters, fasting plasma C-peptide, glycosylated hemoglobin and treatment regimens. Non-parametric receiver operating characteristic (ROC) curves were used to assess the relationship between exercise test-related plasma lactate levels and suffering from MD.ResultsA total of 12 MD patients were included, with clinical characteristics of early-onset, normal or low body weight, hearing loss, maternal inheritance, and negative islet-related autoantibodies. In addition, patients with MD exhibited significantly higher mean plasma lactate levels immediately after exercise compared to patients with type 1 diabetes mellitus (T1DM) (8.39 ± 2.75 vs. 3.53 ± 1.47 mmol/L, p=0.003) and delayed recovery time after exercise (6.02 ± 2.65 vs. 2.17 ± 1.27 mmol/L, p=0.011). The optimal cut-off points identified were 5.5 and 3.4 mmol/L for plasma lactate levels immediately after and 30 minutes after exercise, respectively. The fasting plasma C-peptide levels decreased as a negative exponential function with disease progression (Y= 1.343*e-0.07776X, R2 = 0.4154). Treatment regimens in MD patients were varied, with no metformin users and a weak correlation between insulin dosage and body weight.ConclusionsThe increased level of plasma lactate during exercise or its delayed recovery after exercise would contribute to the diagnosis of MD. Changes of fasting plasma C-peptide in MD patients over the course of the disease indicated a rapid decline in the early stages, followed by a gradual slowing rate of decline.

Objective: The aim of this study was to analyze the clinical characteristics and the pattern of long-term changes of fasting plasma C-peptide in patients with mitochondrial diabetes (MD), and to provide guidance for the diagnosis and treatment of MD. Methods: We retrieved MD patients with long-term follow-up at Peking Union Medical College Hospital from January 2005 to July 2021 through the medical record retrieval system and retrospectively analyzed their clinical data, biochemical parameters, fasting plasma C-peptide, glycosylated hemoglobin and treatment regimens. Non-parametric receiver operating characteristic (ROC) curves were used to assess the relationship between exercise test-related plasma lactate levels and suffering from MD. Results: A total of 12 MD patients were included, with clinical characteristics of early-onset, normal or low body weight, hearing loss, maternal inheritance, and negative islet-related autoantibodies. In addition, patients with MD exhibited significantly higher mean plasma lactate levels immediately after exercise compared to patients with type 1 diabetes mellitus (T1DM) (8.39 ± 2.75 vs. 3.53 ± 1.47 mmol/L, p=0.003) and delayed recovery time after exercise (6.02 ± 2.65 vs. 2.17 ± 1.27 mmol/L, p=0.011). The optimal cut-off points identified were 5.5 and 3.4 mmol/L for plasma lactate levels immediately after and 30 minutes after exercise, respectively. The fasting plasma C-peptide levels decreased as a negative exponential function with disease progression (Y= 1.343*e-0.07776X, R2 = 0.4154). Treatment regimens in MD patients were varied, with no metformin users and a weak correlation between insulin dosage and body weight. Conclusions: The increased level of plasma lactate during exercise or its delayed recovery after exercise would contribute to the diagnosis of MD. Changes of fasting plasma C-peptide in MD patients over the course of the disease indicated a rapid decline in the early stages, followed by a gradual slowing rate of decline. [ABSTRACT FROM AUTHOR]

• It is the first study about the prevalence of pancreatic exocrine insufficiency (PEI) in Chinese patients with T2DM. Our research showed the frequent occurrence of PEI in Chinese patients with T2DM. • We provided the direct evidence of close connection between the exocrine and endocrine pancreases. Fasting C-peptide is positively correlated with FE-1 and has independent predictive value for PEI with good sensitivity and specificity. • The pancreatic islet function and exocrine impairment of patients with T2DM in clinical practice should be paid attention.. Recently, numerous studies validated frequent pancreatic exocrine dysfunction in patients with diabetes. However, the prevalence of pancreatic exocrine insufficiency (PEI) in diabetes mellitus (DM) varies widely among studies. This study aims to determine the prevalence of PEI in Chinese people with type 2 DM (T2DM) by measuring the fecal elastase-1 (FE-1) levels and further identify potential factors that influence pancreatic exocrine function in patients with T2DM. A total of 85 patients with T2DM without known exocrine pancreatic disorders or digestive system diseases were recruited. Fecal samples were submitted to measure FE-1 levels, and blood samples were collected to investigate pancreatic endocrine function and metabolic biomarkers in all participants. The multiple logistic regression analysis was established to evaluate the influencing factors of PEI in patients with T2DM. The potential predictors of PEI were examined using receiver operating characteristic (ROC) curves. The prevalence of PEI measured by low FE-1 in T2DM was 18.8%. The Spearman correlation demonstrated that the FE-1 level was inversely correlated with DM duration (r = − 0.360, P = 0.001) and glycated hemoglobin (HbA1c) level (r = − 0.228, P = 0.036). A highly significant positive association was observed between FE-1 and fasting C-peptide (FCP) levels (r = 0.451, P < 0.001). Furthermore, the multiple logistic regression analysis showed that FCP was an independent influencing factor of PEI (OR = 0.204, P = 0.024, 95% CI: 0.051–0.813). The ROC analysis indicated that the FCP level had a predictive value for low FE-1 (AUC = 0.793, P < 0.001) with an optimal cutoff value of 1.20 ng/ml. Chinese patients with T2DM show high PEI prevalence. FCP may be a potential predictor of pathological exocrine function in T2DM. The exocrine and endocrine functions of patients with T2DM in clinical practice should be evaluated. Further studies are needed to clarify the internal association between exocrine and endocrine pancreases. [ABSTRACT FROM AUTHOR]

Background: Fasting C-peptide (FCP) has been shown to play an important role in the pathophysiology of mood disorders including depression and schizophrenia, but it is unknown whether it also predicts post-stroke depression (PSD). This study examined the association between FCP and PSD at 6 months after acute ischemic-stroke onset among Chinese subjects.Methods: A total of 656 stroke patients were consecutively recruited from three hospitals of Wuhan city, Hubei province. Clinical and laboratory data were collected on admission. PSD status was evaluated by DSM-V criteria and 17-item Hamilton Rating Scale for Depression (HAMD-17) at 6 months after acute ischemic stroke. The χ2-test, Mann-Whitney U-test, and t-test were used to check for statistical significance. Multivariate logistic regression model was used to explore independent predictor of PSD.Results: In the univariate analysis, significant differences were found between the PSD and non-PSD groups in terms of FCP level (p = 0.009). After multivariate adjustments, FCP remained a significant independent predictor of PSD, with an adjusted odds ratio of 1.179 (95%CI: 1.040-1.337, p = 0.010).Conclusions: Higher FCP levels on admission were found to be associated with PSD at 6 months after acute ischemic-stroke onset. For stroke patients, doctors should pay attention to the baseline FCP for screening high-risk PSD in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction. The aim of this study was to investigate the effectiveness of low level laser therapy (extravascular laser blood irradiation) on glycaemic levels in type 2 diabetes mellitus patients. Methods. Sixty patients with type 2 diabetes mellitus lasting more than 1 year, aged 45–60 years, receiving 2 types of medication (metformin and sulphonylurea) were randomly divided into 2 equal groups. The laser group received laser therapy (low level laser therapy, 3 sessions/week for 12 weeks) combined with their prescribed hypoglycaemic medications, while the comparative group received the prescribed hypoglycaemic medications only. Glycated haemoglobin (HbA1c), fasting plasma glucose, 75-g oral glucose tolerance, and fasting C-peptide were evaluated before and after the therapy in both groups, while the glycaemic level was checked before and after each laser session to determine the acute effect of laser. Results. All variables were tested with mixed MANOVA, with a statistical significance level at p < 0.05. There was a significant post-treatment decrease in HbA1c, fasting plasma glucose, and oral glucose tolerance in the laser group compared with the control group (p < 0.05), but no significant difference for post-treatment fasting C-peptide between the groups (p > 0.05). Regarding the acute effect of laser, a significant decrease was observed in the blood glucose level after the laser sessions (p = 0.0001), with a mean difference of 22.73 mg/dl. Conclusions. The study showed a considerable positive effect of extravascular low level laser therapy on the glycaemic levels in type 2 diabetes mellitus patients. [ABSTRACT FROM AUTHOR]

Aim: To examine the relationship between baseline fasting C‐peptide (FCP) and outcomes in insulin‐naïve people with type 2 diabetes initiating basal insulin glargine 100 U/mL (Gla‐100). Materials and methods: Post hoc pooled analysis of nine randomized, treat‐to‐target trials in patients with type 2 diabetes inadequately controlled on oral antihyperglycaemic drugs initiating once‐daily Gla‐100. Participants (n = 2165) were stratified at baseline according to FCP (≤0.40, >0.40–1.20, >1.20–2.00, >2.00 nmol/L). Glycaemic control, body weight, insulin dose and hypoglycaemia were determined at 24 weeks. Results: At baseline low FCP levels were associated with longer known diabetes duration, lower body mass index and higher fasting plasma glucose (FPG). Following Gla‐100 introduction, the mean HbA1c reduction at week 24 was similar in all four FCP groups, albeit fewer people in the lowest FCP group achieved HbA1c <7.0% versus FCP groups >0.40 nmol/L. By contrast, FPG reduction and proportion reaching FPG ≤5.6 mmol/L were greatest in the lowest FCP group, diminishing at higher FCP levels. Gla‐100 dose at week 24 was lowest in the ≤0.40 nmol/L FCP group and highest in the >1.20 nmol/L FCP group. Incidence and event rate of overall, nocturnal and severe hypoglycaemia were higher at week 24 in groups with lower FCP levels. In multivariable regression analysis baseline FCP, concomitant sulphonylurea use and endpoint HbA1c were strong predictors of hypoglycaemia. Conclusions: FCP levels identified patients with type 2 diabetes experiencing different responses to basal insulin Gla‐100. A low FCP identifies a markedly insulin‐deficient, insulin‐sensitive subgroup/phenotype with an enhanced risk of hypoglycaemia, which requires a low initial basal insulin dose, cautious titration and earlier addition of prandial glucose‐lowering therapy. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the role of preoperative fasting C-peptide (FCP) levels in predicting diabetic outcomes in low-BMI Chinese patients following Roux-en-Y gastric bypass (RYGB) by comparing the metabolic outcomes of patients with FCP > 1 ng/ml versus FCP ≤ 1 ng/ml.Methods: The study sample included 78 type 2 diabetes mellitus patients with an average BMI < 30 kg/m2 at baseline. Patients' parameters were analyzed before and after surgery, with a 2-year follow-up. A univariate logistic regression analysis and multivariate analysis of variance between the remission and improvement group were performed to determine factors that were associated with type 2 diabetes remission after RYGB. Linear correlation analyses between FCP and metabolic parameters were performed. Patients were divided into two groups: FCP > 1 ng/ml and FCP ≤ 1 ng/ml, with measured parameters compared between the groups.Results: Patients' fasting plasma glucose, 2-h postprandial plasma glucose, FCP, and HbA1c improved significantly after surgery (p < 0.05). Factors associated with type 2 diabetes remission were BMI, 2hINS, and FCP at the univariate logistic regression analysis (p < 0.05). Multivariate logistic regression analysis was performed then showed the results were more related to FCP (OR = 2.39). FCP showed a significant linear correlation with fasting insulin and BMI (p < 0.05). There was a significant difference in remission rate between the FCP > 1 ng/ml and FCP ≤ 1 ng/ml groups (p = 0.01). The parameters of patients with FCP > 1 ng/ml, including BMI, plasma glucose, HbA1c, and plasma insulin, decreased markedly after surgery (p < 0.05).Conclusion: FCP level is a significant predictor of diabetes outcomes after RYGB in low-BMI Chinese patients. An FCP level of 1 ng/ml may be a useful threshold for predicting surgical prognosis, with FCP > 1 ng/ml predicting better clinical outcomes following RYGB. [ABSTRACT FROM AUTHOR]

Objective: Islet autoimmunity, age at onset and time to insulin treatment are often used to define subgroups of diabetes. However, the latter criterion is not clinical useful. Here, we examined whether an unbiased stratification of diabetes according to age at onset, fasting C-peptide and GAD autoantibodies (GADab) defines groups with differences in glycaemic control and markers of cardiometabolic risk.Design and Methods: A cohort of 4374 adults with relatively newly diagnosed diabetes referred to a Danish hospital during 1997-2012 was stratified according to age at onset above or below 30 years, fasting C-peptide above or below 300 pmol/l (CPEPhigh or CPEPlow), and presence or absence of GADab (GADpos or GADneg). HbA1c, BMI, blood pressure (BP), lipid profile, alanine aminotransferase (ALT) and creatinine were evaluated.Results: GADab were present in 13% of the cohort. Age at onset was not associated with major differences between groups. Patients with insulin deficient diabetes (CPEPlow; n = 503) had higher HbA1c but otherwise lower cardiometabolic risk (lower BMI, BP, LDL, triacylglycerol, and ALT, and higher HDL) than both patients with latent autoimmune diabetes of adults (LADA defined as GADposCPEPhigh; n = 327) and patients with type 2 diabetes (GADnegCPEPhigh; n = 3544). Patients with LADA defined an intermediate group with higher HbA1c but otherwise lower cardiometabolic risk than patients with type 2 diabetes.Conclusions: Our results demonstrate that fasting C-peptide and GADab status, but not age at onset, define groups of patients with diabetes with clinically relevant differences in glycaemic control and cardiometabolic risk. [ABSTRACT FROM AUTHOR]

Obesity is a major factor in development of insulin resistance (IR) and metabolic features in polycystic ovary syndrome (PCOS) patients. Nearly two-thirds patients with PCOS (30 of 37 confirmed cases of PCOS) in our previous community based study were lean, in contrast to Caucasians. Metabolic parameters including IR and β cell function have not been characterized well in this group of lean PCOS. To study the metabolic features including IR and β cell function in lean PCOS patients, 53 patients with BMI, <23 kg/m2were compared with 71 obese PCOS and 45 age and body mass index matched controls. Lean patients had similar β cell function and IR as compared to controls and obese patients, though the latter group had more metabolic abnormality. Fasting c-peptide and its ratio to glucose were significantly higher in lean patients compared to controls. In subset of subjects with five point OGTT, disposition index and Matsuda index (MI) showed significant negative correlation with BMI and blood pressure. MI also negatively correlated with waist, WHR, and HOMAB. High fasting C-peptide is probably a class effect as is seen in both lean and obese PCOS. [ABSTRACT FROM AUTHOR]

Aims: To explore the factors mediating the relationship between body mass index (BMI) and diabetic retinopathy (DR) in Chinese type 2 diabetes patients. Methods: This is a cross-sectional study. Data of 2,533 patients with type 2 diabetes were studied from the Shanghai Diabetes Registry Database. DR was assessed using non-mydriatic fundus photography and graded as non-DR, mild-moderate (DR I-II), and sight-threatening (DR III-IV). BMI (kg/m) was classified as normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30), and obese (BMI ≥ 30). β cell function was evaluated by fasting C-peptide (FCP). Results: DR was present in 701 (27.7 %) patients. Patients with DR had lower BMI (24.3 vs. 24.9 kg/m, P = 0.001) and fasting C-peptide (1.46 vs. 1.86 ng/ml, P < 0.001) than those without DR. The association between BMI (2 kg/m interval) and DR was U-shaped; patients with BMI 28-29.9 kg/m had the lowest DR rate. Compared with normal weight, overweight was associated with reduced risk of any DR [odds ratio (OR) 0.73], DR I-II (OR 0.76), and DR III-IV (OR 0.64) after adjustment for sex, age at diabetes diagnosis, and duration of diabetes. This negative association attenuated after adjustment for other confounders and became nonsignificant after further adjustment for FCP. Patients with different BMI categories had similar DR risk when stratified by FCP tertiles. Conclusion: Overweight patients have lower DR prevalence than normal weight individuals, which may be attributable to better β cell function in overweight patients. [ABSTRACT FROM AUTHOR]

Objective: To clarify whether random C-peptide is a valuable test in the classification of diabetes.Research Design and Methods: All C-peptide measurements conducted in the diabetic population of Skaraborg (280,539 inhabitants and 3.2% diabetes) between 1995 and 1998 (3,115 samples) were considered, but only patients with well-defined diabetes type (1,449 samples from 1,093 patients) were analyzed for the correlation between diabetes type and C-peptide concentration. Serum C-peptide was measured after fasting over night (fCP), after glucagon stimulation (gCP), and randomly (rCP) without considering previous meals at an ordinary visit to the diabetic clinic (rCP). Receiver Operating Characteristic (ROC) curves were constructed to illustrate the power of the different C-peptide protocols and to determine the optimal cut-off values.Results: Although all three tests had high discriminative power, the ROC curves demonstrated that rCP was superior to fCP and gCP in discriminating type 1 from type 2 diabetes. The optimal cut-off value for rCP was 0.50 nmol/L, for fCP 0.42 nmol/L, and for gCP 0.60 nmol/L.Conclusions: rCP is more powerful than fCP and gCP in distinguishing type 1 from type 2 diabetes and can therefore be recommended as a classification tool, particularly in outpatients. [ABSTRACT FROM AUTHOR]

A cohort of 82 patients with Type 1 (insulin-dependent) diabetes was followed prospectively for 24 months, and 54 of them for 30 months, to study the relationship between fasting levels of immunoreactive C-peptide and titres of islet cell antibodies. After diagnosis, fasting C-peptide rose temporarily for 1-6 months of insulin therapy and declined continuously thereafter. While islet cell antibodies were present among 55% of the newly diagnosed patients, only 31% remained positive at 30 months. Their antibody titres decreased from 1∶81 at diagnosis to 1∶3. Only 3 patients (4%) who were islet cell antibody negative at diagnosis became positive later. The median C-peptide values among the persistently islet cell antibody positive patients decreased from 0.11 pmol/ml at 18 months, to 0.09 pmol/ml at 24 months, to 0.06 pmol/ml at 30 months compared to 0.18 ( p=0.04), 0.15 ( p=0.05) and 0.16 ( p< 0.003) pmol/ml, respectively, for the islet cell antibody negative patients. The median slope for the latter was −0.09 compared to −0.19 for the islet cell antibody positive patients ( p=0.01). These differences were reflected in increasing dosages of insulin, since patients remaining antibody-positive for 30 months were given 1.3-1.4 times more insulin ( p=0.01-0.004) than the antibody negative patients. This study demonstrates that islet cell antibodies may be a useful marker for predicting an increased rate by which endogenous B cell function is lost in Type 1 diabetes. [ABSTRACT FROM AUTHOR]

To clarify the utility of islet cell antibodies (ICA) to correctly classify and predict insulin treatment in newly diagnosed diabetic subjects, ICA, body mass index (BMI), glycated hemoglobin (HbA), and fasting plasma C-peptide values were evaluated at and 3 years after diagnosis in 233 new, consecutively diagnosed, adult diabetic patients classified as obese or nonobese (National Diabetes Data Group, NDDG criteria). Among the 233 patients, 31 were nonobese ICA-positive (mean age at diagnosis 43±3 years), 55 nonobese ICA-negative (mean age at diagnosis 58±2 years), 7 obese ICA-positive (mean age at diagnosis 57±5 years), and 139 obese ICA-negative (mean age at diagnosis 58±1 years). Fasting C-peptide decreased ( P<0.05) in nonobese ICA-positive patients who after 3 years showed lower BMI (22.6±0.6 versus 24.5±0.4; P<0.05), lower fasting C-peptide (0.14±0.06 nmol/l versus 0.71±0.07 nmol/l; P<0.001), and higher frequency of insulin treatment [28/31 (90%) versus 6/45 (13%); P<0.001] than nonobese ICA-negative patients. In obese ICA-positive patients, fasting C-peptide also decreased (Δ C-peptide 0.17±0.04 nmol/l; P<0.05) after diagnosis, and 3 years after diagnosis, obese ICA-positive patients showed lower BMI (25.7±1.2 versus 29.8±0.4; P<0.01) and fasting C-peptide (0.08±0.04 nmol/l versus 1.06±0.05 nmol/l; P<0.001) and higher HbA values (9.92%±0.68% versus 7.39%±0.21%; P<0.01) and a higher frequency of insulin treatment [7/7 (100%) versus 5/121 (4%); P<0.001] than obese ICA-negative patients. Therefore, ICA detected at diagnosis of diabetes in both obese and nonobese adult patients indicate β-cell dysfunction, high HbA levels, and progression to insulin dependency. [ABSTRACT FROM AUTHOR]

Aims: Whether fasting C-peptide can be a potential indicator for nonalcoholic fatty liver disease (NAFLD) in obese children is unknown. This study aimed to assess whether fasting C-peptide represented a risk factor for NAFLD.Methods: A total of 520 obese children (376 male, 144 female) aged 3.4-17.1 years were divided into two groups, obese with NAFLD and non-NAFLD, according to hepatic ultrasound results. Fasting plasma glucose, fasting C-peptide, hemoglobin A1c, renal function, liver function, blood lipid, fasting insulin and blood routine indices were measured. Insulin resistance by homoeostasis model (HOMA-IR) was calculated.Results: Compared with the non-NAFLD group, the obese children with NAFLD had higher fasting C-peptide, fasting insulin and HOMA-IR (P < 0.001). Stepwise multiple logistic regression models showed that fasting C-peptide (odds ratio: OR = 2.367) was independent indicator of the presence of NAFLD in obese children as well as white blood cell (OR = 1.113), albumin (OR = 1.124), alanine aminotransferase (OR = 1.030), triglycerides (OR = 1.335), and waist circumference (OR = 1.047). Furthermore, after adjustment for confounding variables, the prevalence of NAFLD in obese children was significantly higher according to increased serum fasting C-peptide levels. The adjusted OR for NAFLD according to fasting C-peptide tertiles were 1.00 (as references), 1.896(1.045-3.436), and 4.169(1.822-9.537).Conclusion: Our data suggested that obese children with high level of fasting C-peptide had an increased risk for developing NAFLD. [ABSTRACT FROM AUTHOR]

Background & Aims: This participant-blinded parallel-group randomized placebo-controlled study demonstrated that alfacalcidol (vitamin D analogue) preserves beta cell function in newly diagnosed type 1 diabetes (T1DM) in children., Methods: Subjects from outpatient clinic were randomized to intervention and control groups. Inclusion: (1) age 8-15, (2) T1DM, (3) duration <8 weeks, (4) no chronic diseases, (5) stable diet. Exclusion: (1) vitamin D, calcium supplements or fortified foods, (2) hypercalcemia. Intervention group received alfacalcidol 0.25 μg twice daily, while control group received placebo. Insulin given physician-titrated to blood glucose. Safety monitored by serum calcium and phosphate. Beta cell function assessed at 0, 3, 6 months using fasting C-peptide (FCP) and daily insulin dosage per body weight (DID). Primary outcome measured using multivariate repeated measures GLM-ANOVA, with FCP and DID as primary measures and age, gender, sunlight exposure, 25-hydroxy vitamin D, and HbA1c as covariates., Results: Of 61 subjects, 7 dropped out. GLM-ANOVA showed that groups were different (p=0.019, Eta-squared=0.087), with no significant covariates. FCP was higher and DID lower in the intervention group, with males having stronger responses to alfacalcidol (p=0.001). No adverse effects were observed., Conclusions: The study confirmed that alfacalcidol can safely preserve beta cell function in newly diagnosed T1DM in children, with a stronger effect in males., Clinical Trial Reg No: IRCT201205159753N1., (Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)