The Relationship Among C-peptide,blood Glucose Target And Diabetic Complications In T2DM

Objective:To explore the relationship between C-peptide and long-term management of type 2diabetes mellitus(T2DM),providing the evidence for C-peptide as a basis for the long-term management of T2DM.Method:This is a cross-sectional study based on the real world.According to the inclusion and exclusion criteria,we included 1377 patients with T2DM,grouped by fasting C-peptide and HOMA-IR.Blood samples were collected after fasting overnight.Fasting plasma glucose(FPG),fasting insulin,fasting C-peptide,Bread meal test:2h postprandial C-peptide,2h postprandial insulin;Hb A1c,triglyceride(TG),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C),urine microalbumin/creatinine(UACR).All samples were cold-chained,stored and transported to a central laboratory for testing within 2-4 h.Patients were examined for Diabetic retinopathy(DR)by using slit lamp microscope and non-invasive optical coherence tomography(OCT),diabetic kidney disease(DKD)was diagnosed by UACR and e GFR,and fatty liver was evaluated based on ultrasound.We use SPSS to analyze the data.One-way ANOVA was used to compare the differences between continuous variables,using group Q1/G1 as a reference.The chi-square(χ~2)test is used to compare categorical variables.Binary logistic regression was used to analyze the relationship among fasting C-peptide,HOMA-IR,C2/C0 ratio,blood glucose target rate,and the occurrence of diabetic complications.Results:1)Group Q4(C-peptide≥2.51ng/m L)had the shortest duration of diabetes,lower Hb A1C and C2/C0 ratio,but higher BMI,FPG and HOMA-IR index.Besides,the occurrence of DKD in Q4 was higher,while the occurrence of DR was not so high,compared with Q1.It is worth noticing that,group Q3(1.71≤C-peptide<2.51 ng/m L)has the lowest incidence of DKD,DR and the using rate of insulin,and higher blood glucose target rate.Group Q1(C-peptide<1.12 ng/m L)has the highest using rate of insulin and higher incidence of DKD and DR.2)In the binary logistic regression,when C-peptide≥1.71 ng/m L,with the increase of C-peptide,the possibility of not reaching blood glucose target decreased,compared with the group Q1,after adjusting for age,gender,duration of diabetes and BMI.Only when 1.71≤C-peptide<2.51 ng/m L,the incidence of DKD and DR decreased with the increase of C-peptide,after adjusting for age,gender,duration of diabetes and BMI.With the C2/C0 ratio increase,the possibility of not reaching plasma glucose target decreased.In group Q3 and Q2,with the C2/C0 ratio increase,the incidence of DKD decreased,but there’s no significant relationship between C2/C0 ratio and DKD in the group Q1 and Q4.3)When grouped by HOMA-IR,group G4 has a higher BMI,FPG,Hb A1c,and the using rate of thiazolidinedione,while the duration of diabetes,blood glucose target rate,the using rate of insulin are lower,compared with G1.The incidence of DKD is higher than that in G1,while the incidence of DR is lower.4)After adjusting for age,gender,duration of diabetes,and BMI,HOMA-IR was significantly associated with blood glucose target and fatty liver.In group G4,as the HOMA-IR increased,the possibility of not reaching blood glucose target increased(OR=2.79,95%CI(1.830,4.225)),and the incidence of fatty liver increased(OR=2.32,95%CI(1.549,3.474)),compared with the lowest quartile group(G1).What’s more,there is no significant relationship among HOMA-IR,DKD and DR.Conclusion:(1)When 1.71≤fasting C-peptide<2.51 ng/m L,patients with T2DM had a higher blood glucose target rate and a lower incidence of diabetic complications.(2)It not only reflects the function of pancreaticβ-cell,but also was associated with blood glucose management and diabetic complications.(3)Based on our research,for patients with more than 5 years duration of diabetes,C-peptide and C2/C0 are the basis for the treatment strategy.