Residual C-peptide secretion and hypoglycemia awareness in people with type 1 diabetes

Martine J Wellens; Charlotte E Vollenbrock; Pim Dekker; Lianne S M Boesten; Petronella H Geelhoed-Duijvestijn; Martine M C de Vries-Velraeds; Giesje Nefs; Bruce H R Wolffenbuttel; Henk-Jan Aanstoot; Peter R van Dijk

doi:10.1136/bmjdrc-2021-002288

Residual C-peptide secretion and hypoglycemia awareness in people with type 1 diabetes

Martine J Wellens, Charlotte E Vollenbrock, Pim Dekker, Lianne S M Boesten, Petronella H Geelhoed-Duijvestijn, Martine M C de Vries-Velraeds, Giesje Nefs, Bruce H R Wolffenbuttel^*, Henk-Jan Aanstoot, Peter R van Dijk

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

16 Citations (Scopus)

82 Downloads (Pure)

Abstract

INTRODUCTION: This study aimed to assess the association between fasting serum C-peptide levels and the presence of impaired awareness of hypoglycemia (IAH) in people with type 1 diabetes.

RESEARCH DESIGN AND METHODS: We performed a cross-sectional study among 509 individuals with type 1 diabetes (diabetes duration 5-65 years). Extensive clinical data and fasting serum C-peptide concentrations were collected and related to the presence or absence of IAH, which was evaluated using the validated Dutch version of the Clarke questionnaire. A multivariable logistic regression model was constructed to investigate the association of C-peptide and other clinical variables with IAH.

RESULTS: In 129 (25%) individuals, residual C-peptide secretion was detected, while 75 (15%) individuals reported IAH. The median (IQR) C-peptide concentration among all participants was 0.0 (0.0-3.9) pmol/L. The prevalence of severe hypoglycemia was lower in people with demonstrable C-peptide versus those with absent C-peptide (30% vs 41%, p=0.025). Individuals with IAH were older, had longer diabetes duration, more frequently had macrovascular and microvascular complications, and more often used antihypertensive drugs, antiplatelet agents and cholesterol-lowering medication. There was a strong association between IAH and having a severe hypoglycemia in the preceding year. In multivariable regression analysis, residual C-peptide, either continuously or dichotomous, was associated with lower prevalence of IAH (p=0.040-0.042), while age at diabetes onset (p=0.001), presence of microvascular complications (p=0.003) and body mass index (BMI) (p=0.003) were also independently associated with the presence of IAH.

CONCLUSIONS: Higher BMI, the presence of microvascular complications and higher age at diabetes onset were independent risk factors for IAH in people with type 1 diabetes, while residual C-peptide secretion was associated with lower risk of this complication.

Original language	English
Article number	e002288
Number of pages	8
Journal	BMJ Open Diabetes Research & Care
Volume	9
Issue number	1
DOIs	https://doi.org/10.1136/bmjdrc-2021-002288
Publication status	Published - 15-Sept-2021

Keywords

awareness
C-peptide
hypoglycemia
age of onset
IMPAIRED AWARENESS
ADULTS
UNAWARENESS
IMPACT
COMPLICATIONS
MECHANISMS
FREQUENCY
ONSET
CARE
AGE

Access to Document

10.1136/bmjdrc-2021-002288Licence: CC BY

Residual C-peptide secretion and hypoglycemia awareness in people with type 1 diabetesFinal publisher's version, 597 KBLicence: CC BY

Handle.net

Persistent link

Cite this

Wellens, M. J., Vollenbrock, C. E., Dekker, P., Boesten, L. S. M., Geelhoed-Duijvestijn, P. H., de Vries-Velraeds, M. M. C., Nefs, G., Wolffenbuttel, B. H. R., Aanstoot, H.-J., & van Dijk, P. R. (2021). Residual C-peptide secretion and hypoglycemia awareness in people with type 1 diabetes. BMJ Open Diabetes Research & Care, 9(1), Article e002288. https://doi.org/10.1136/bmjdrc-2021-002288

@article{cba070b5217844f98444f27fbaa5e12b,

title = "Residual C-peptide secretion and hypoglycemia awareness in people with type 1 diabetes",

abstract = "INTRODUCTION: This study aimed to assess the association between fasting serum C-peptide levels and the presence of impaired awareness of hypoglycemia (IAH) in people with type 1 diabetes.RESEARCH DESIGN AND METHODS: We performed a cross-sectional study among 509 individuals with type 1 diabetes (diabetes duration 5-65 years). Extensive clinical data and fasting serum C-peptide concentrations were collected and related to the presence or absence of IAH, which was evaluated using the validated Dutch version of the Clarke questionnaire. A multivariable logistic regression model was constructed to investigate the association of C-peptide and other clinical variables with IAH.RESULTS: In 129 (25%) individuals, residual C-peptide secretion was detected, while 75 (15%) individuals reported IAH. The median (IQR) C-peptide concentration among all participants was 0.0 (0.0-3.9) pmol/L. The prevalence of severe hypoglycemia was lower in people with demonstrable C-peptide versus those with absent C-peptide (30% vs 41%, p=0.025). Individuals with IAH were older, had longer diabetes duration, more frequently had macrovascular and microvascular complications, and more often used antihypertensive drugs, antiplatelet agents and cholesterol-lowering medication. There was a strong association between IAH and having a severe hypoglycemia in the preceding year. In multivariable regression analysis, residual C-peptide, either continuously or dichotomous, was associated with lower prevalence of IAH (p=0.040-0.042), while age at diabetes onset (p=0.001), presence of microvascular complications (p=0.003) and body mass index (BMI) (p=0.003) were also independently associated with the presence of IAH.CONCLUSIONS: Higher BMI, the presence of microvascular complications and higher age at diabetes onset were independent risk factors for IAH in people with type 1 diabetes, while residual C-peptide secretion was associated with lower risk of this complication.",

keywords = "awareness, C-peptide, hypoglycemia, age of onset, IMPAIRED AWARENESS, ADULTS, UNAWARENESS, IMPACT, COMPLICATIONS, MECHANISMS, FREQUENCY, ONSET, CARE, AGE",

author = "Wellens, {Martine J} and Vollenbrock, {Charlotte E} and Pim Dekker and Boesten, {Lianne S M} and Geelhoed-Duijvestijn, {Petronella H} and {de Vries-Velraeds}, {Martine M C} and Giesje Nefs and Wolffenbuttel, {Bruce H R} and Henk-Jan Aanstoot and {van Dijk}, {Peter R}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.",

year = "2021",

month = sep,

day = "15",

doi = "10.1136/bmjdrc-2021-002288",

language = "English",

volume = "9",

journal = "BMJ Open Diabetes Research & Care",

issn = "2052-4897",

publisher = "BMJ Publishing Group",

number = "1",

}

TY - JOUR

T1 - Residual C-peptide secretion and hypoglycemia awareness in people with type 1 diabetes

AU - Wellens, Martine J

AU - Vollenbrock, Charlotte E

AU - Dekker, Pim

AU - Boesten, Lianne S M

AU - Geelhoed-Duijvestijn, Petronella H

AU - de Vries-Velraeds, Martine M C

AU - Nefs, Giesje

AU - Wolffenbuttel, Bruce H R

AU - Aanstoot, Henk-Jan

AU - van Dijk, Peter R

N1 - © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

PY - 2021/9/15

Y1 - 2021/9/15

N2 - INTRODUCTION: This study aimed to assess the association between fasting serum C-peptide levels and the presence of impaired awareness of hypoglycemia (IAH) in people with type 1 diabetes.RESEARCH DESIGN AND METHODS: We performed a cross-sectional study among 509 individuals with type 1 diabetes (diabetes duration 5-65 years). Extensive clinical data and fasting serum C-peptide concentrations were collected and related to the presence or absence of IAH, which was evaluated using the validated Dutch version of the Clarke questionnaire. A multivariable logistic regression model was constructed to investigate the association of C-peptide and other clinical variables with IAH.RESULTS: In 129 (25%) individuals, residual C-peptide secretion was detected, while 75 (15%) individuals reported IAH. The median (IQR) C-peptide concentration among all participants was 0.0 (0.0-3.9) pmol/L. The prevalence of severe hypoglycemia was lower in people with demonstrable C-peptide versus those with absent C-peptide (30% vs 41%, p=0.025). Individuals with IAH were older, had longer diabetes duration, more frequently had macrovascular and microvascular complications, and more often used antihypertensive drugs, antiplatelet agents and cholesterol-lowering medication. There was a strong association between IAH and having a severe hypoglycemia in the preceding year. In multivariable regression analysis, residual C-peptide, either continuously or dichotomous, was associated with lower prevalence of IAH (p=0.040-0.042), while age at diabetes onset (p=0.001), presence of microvascular complications (p=0.003) and body mass index (BMI) (p=0.003) were also independently associated with the presence of IAH.CONCLUSIONS: Higher BMI, the presence of microvascular complications and higher age at diabetes onset were independent risk factors for IAH in people with type 1 diabetes, while residual C-peptide secretion was associated with lower risk of this complication.

AB - INTRODUCTION: This study aimed to assess the association between fasting serum C-peptide levels and the presence of impaired awareness of hypoglycemia (IAH) in people with type 1 diabetes.RESEARCH DESIGN AND METHODS: We performed a cross-sectional study among 509 individuals with type 1 diabetes (diabetes duration 5-65 years). Extensive clinical data and fasting serum C-peptide concentrations were collected and related to the presence or absence of IAH, which was evaluated using the validated Dutch version of the Clarke questionnaire. A multivariable logistic regression model was constructed to investigate the association of C-peptide and other clinical variables with IAH.RESULTS: In 129 (25%) individuals, residual C-peptide secretion was detected, while 75 (15%) individuals reported IAH. The median (IQR) C-peptide concentration among all participants was 0.0 (0.0-3.9) pmol/L. The prevalence of severe hypoglycemia was lower in people with demonstrable C-peptide versus those with absent C-peptide (30% vs 41%, p=0.025). Individuals with IAH were older, had longer diabetes duration, more frequently had macrovascular and microvascular complications, and more often used antihypertensive drugs, antiplatelet agents and cholesterol-lowering medication. There was a strong association between IAH and having a severe hypoglycemia in the preceding year. In multivariable regression analysis, residual C-peptide, either continuously or dichotomous, was associated with lower prevalence of IAH (p=0.040-0.042), while age at diabetes onset (p=0.001), presence of microvascular complications (p=0.003) and body mass index (BMI) (p=0.003) were also independently associated with the presence of IAH.CONCLUSIONS: Higher BMI, the presence of microvascular complications and higher age at diabetes onset were independent risk factors for IAH in people with type 1 diabetes, while residual C-peptide secretion was associated with lower risk of this complication.

KW - awareness

KW - C-peptide

KW - hypoglycemia

KW - age of onset

KW - IMPAIRED AWARENESS

KW - ADULTS

KW - UNAWARENESS

KW - IMPACT

KW - COMPLICATIONS

KW - MECHANISMS

KW - FREQUENCY

KW - ONSET

KW - CARE

KW - AGE

U2 - 10.1136/bmjdrc-2021-002288

DO - 10.1136/bmjdrc-2021-002288

M3 - Article

C2 - 34526306

SN - 2052-4897

VL - 9

JO - BMJ Open Diabetes Research & Care

JF - BMJ Open Diabetes Research & Care

IS - 1

M1 - e002288

ER -

Residual C-peptide secretion and hypoglycemia awareness in people with type 1 diabetes

Abstract

Keywords

Access to Document

Handle.net

Fingerprint

Cite this