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Aims/hypothesis <p>Residual endogenous insulin secretion, reflected by measurable C-peptide, has been linked to improved glycaemic management in type 1 diabetes. We aimed to assess the relationship between random plasma C-peptide levels and continuous glucose monitoring (CGM) metrics in a large, real-world cohort of adults with type 1 diabetes.</p> Methods <p>We conducted a cross-sectional analysis of adults with type 1 diabetes attending a single UK centre. Inclusion criteria were diabetes duration &gt;1 year, random plasma glucose &gt;4 mmol/l at C-peptide sampling and ≥70% data completeness on the Freestyle Libre 2 CGM device within the corresponding month. Associations between C-peptide categories (&lt;50 pmol/l to &gt;400 pmol/l) and CGM/HbA<sub>1c</sub> outcomes were assessed using non-parametric tests and multivariable logistic regression.</p> Results <p>In total, 945 adults with type 1 diabetes were included with a median age of 45 years (33–57) and median diabetes duration of 18 years (7–29). Of these, 54% were male and median HbA<sub>1c</sub> was 63 mmol/mol (54–73) (7.9% [7.1–8.8]). Higher C-peptide levels were associated with shorter diabetes duration (OR 0.87 per year, <i>p</i>&lt;0.001), older age at diagnosis (OR 1.04 per year, <i>p</i>&lt;0.001) and male sex (OR 1.44, <i>p</i>=0.042). Higher C-peptide was significantly associated with favourable CGM metrics, including lower time below range (2% [1–5] in those with C-peptide &lt;50 pmol/l vs 1% [0–3] in those with C-peptide 101–200 pmol/l), lower glucose variability (glucose CV 37.5% [34.2–42.0] in those with C-peptide &lt;50 pmol/l vs 32.5% [29.0–36.6] in those with C-peptide 101–200 pmol/l), higher time in range (45.0% [32.0–61.0] in those with C-peptide &lt;50 pmol/l vs 55.0% [37.0–66.5] in those with C-peptide 50–100 pmol/l) and favourable hyperglycaemia measures (time above 13.9 mmol/l 20.0% [9.0–36.0] in those with C-peptide &lt;50 pmol/l vs 10.0% [5.5–31.5] in those with C-peptide 50–100 pmol/l) (<i>p</i>&lt;0.05 for all pairwise comparisons). C-peptide ≥100 pmol/l was independently associated with meeting time below range &lt;4% (OR 5.4, <i>p</i>&lt;0.001), and C-peptide ≥100 pmol/l was also associated with achieving HbA<sub>1c</sub> &lt;53 mmol/mol (7%) (OR 1.8, <i>p</i>=0.043. No significant glycaemic differences were seen between individuals with C-peptide &lt;10 pmol/l and 10–49 pmol/l.</p> Conclusions/interpretation <p>Random C-peptide measurement in routine care identifies adults with type 1 diabetes who are more likely to achieve CGM and HbA<sub>1c</sub> targets. Differences in glycaemic metrics are clinically meaningful at thresholds ≥100 pmol/l. These findings support efforts to preserve residual beta cell function and highlight the potential value of C-peptide in individualising therapy.</p> Graphical Abstract <p></p>

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Persistent C-peptide secretion is associated with favourable CGM metrics in adults with type 1 diabetes

  • 期刊论文

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  • 发表日期：

    2025年10月30日

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  • Roland H. Stimson,
  • Anna R. Dover,
  • Catriona Clarke,
  • Carina Conceicao,
  • Lindsay McDonald,
  • Lucy Miller,
  • Helen Wise,
  • Shareen Forbes,
  • Rohana J. Wright,
  • Marcus J. Lyall,
  • Mark W. J. Strachan,
  • Fraser W. Gibb

摘要

Aims/hypothesis

Residual endogenous insulin secretion, reflected by measurable C-peptide, has been linked to improved glycaemic management in type 1 diabetes. We aimed to assess the relationship between random plasma C-peptide levels and continuous glucose monitoring (CGM) metrics in a large, real-world cohort of adults with type 1 diabetes.

Methods

We conducted a cross-sectional analysis of adults with type 1 diabetes attending a single UK centre. Inclusion criteria were diabetes duration >1 year, random plasma glucose >4 mmol/l at C-peptide sampling and ≥70% data completeness on the Freestyle Libre 2 CGM device within the corresponding month. Associations between C-peptide categories (<50 pmol/l to >400 pmol/l) and CGM/HbA1c outcomes were assessed using non-parametric tests and multivariable logistic regression.

Results

In total, 945 adults with type 1 diabetes were included with a median age of 45 years (33–57) and median diabetes duration of 18 years (7–29). Of these, 54% were male and median HbA1c was 63 mmol/mol (54–73) (7.9% [7.1–8.8]). Higher C-peptide levels were associated with shorter diabetes duration (OR 0.87 per year, p<0.001), older age at diagnosis (OR 1.04 per year, p<0.001) and male sex (OR 1.44, p=0.042). Higher C-peptide was significantly associated with favourable CGM metrics, including lower time below range (2% [1–5] in those with C-peptide <50 pmol/l vs 1% [0–3] in those with C-peptide 101–200 pmol/l), lower glucose variability (glucose CV 37.5% [34.2–42.0] in those with C-peptide <50 pmol/l vs 32.5% [29.0–36.6] in those with C-peptide 101–200 pmol/l), higher time in range (45.0% [32.0–61.0] in those with C-peptide <50 pmol/l vs 55.0% [37.0–66.5] in those with C-peptide 50–100 pmol/l) and favourable hyperglycaemia measures (time above 13.9 mmol/l 20.0% [9.0–36.0] in those with C-peptide <50 pmol/l vs 10.0% [5.5–31.5] in those with C-peptide 50–100 pmol/l) (p<0.05 for all pairwise comparisons). C-peptide ≥100 pmol/l was independently associated with meeting time below range <4% (OR 5.4, p<0.001), and C-peptide ≥100 pmol/l was also associated with achieving HbA1c <53 mmol/mol (7%) (OR 1.8, p=0.043. No significant glycaemic differences were seen between individuals with C-peptide <10 pmol/l and 10–49 pmol/l.

Conclusions/interpretation

Random C-peptide measurement in routine care identifies adults with type 1 diabetes who are more likely to achieve CGM and HbA1c targets. Differences in glycaemic metrics are clinically meaningful at thresholds ≥100 pmol/l. These findings support efforts to preserve residual beta cell function and highlight the potential value of C-peptide in individualising therapy.

Graphical Abstract