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CZECH MEDICAL ASSOCIATION J. Ev. PURKYNĚ |
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Česky / Czech version | Vnitř. Lék., 48, 2002, No. 6, p. 490-499 |
C-peptide as the Decisive Factor for Classifi-cation
of Diabetes Mellitus ype 1 and Diabetes Mellitus ype 2 Perušičová J.1 , Bárová H.2 , Hill M.2 ,†MašekZ.2 1 Diabetologické centr m VFN a 1. lékařské fakulty UK, Praha, III. interní klinika, přednosta doc. MUDr. Š. Svacina, DrSc. 2 Endokrinologický ústav, Praha, reditel MUDr. K. Pacák, DrSc. |
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Summary: Objective: he main objective was to seek, based on defined groups of diabetics, C-peptide levels
on fasting and after stimulation which would help to differentiate diabetes mellitus type 1 from
diabetes mellitus type 2 in patients with manifestation of diabetes in adult age. Groups: Group
A comprised 65 non-obese diabetics type 2 with failure of PAD treatment. Group B included 304
newly manifested diabetics type 1 and 2 aged 31-65 years. Group C was formed by 424 patients
with diabetes mellitus type 1 and type 2 with different duration of diabetes. Results: Group A:
mean C-peptide levels on fasting 0.32 and after stimulation with a standard breakfast 0.59 pmol/ml
suggest absolute insulin deficiency in type 2 diabetics with failure of PAD treatment. Group B:
29.2% diabetics type 1 had already during manifestation of diabetes C-peptide levels on fasting <
0.43 pmol/ml and 47.9 % C-peptide of < 0.6 after a meal. here were 1.9 and 4.9 % subjects among
type 2 diabetics with such low C-peptide levels. After a six-year follow up the mean C-peptide
levels on fasting declined in type 1 diabetics from 0.49 to 0.16 pmol/ml and in patients originally
with type 2 diabetes reclassified to type 1 the levels dropped from 0.56 to 0.26 pmol/ml. Group C
served as the basic group for statistically (linear regression method) detected discrimination
values of C-peptide differentiating diabetes mellitus type 1 and diabetes mellitus type 2 - the
liminal value being 0.59 pmol/ml on fasting and 1.0 pmol/ml after a meal. Conclusion: In clinical
practice it is not possible to assess reliably slowly manifesting diabetes type 1 (LADA by age, BMI
and compensation of diabetes. Positivity of antiGAD antibodies does not rule out diabetes melli-tus
type 1. In unequivocal cases the decisive factor is therefore the C-peptide level on fasting and
after a meal.
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