Control of juvenile diabetes mellitus and its relationship to endogenous insulin secretion as measured by C-peptide immunoreactivity

  • Luiz A. Grajwer
    Affiliations
    Department of Pediatrics, Cook County Hospital, Chicago, Ill. USA

    Department of Pediatrics University of Illinois, Chicago, Ill. USA

    Department of Medicine, University of Chicago, Pritzker School of Medicine, Chicago, Ill. USA
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  • Rosita S. Pildes
    Correspondence
    Reprint address: Cook County Hospital, 700 S. Wood St. Chicago, IL 60612.
    Affiliations
    Department of Pediatrics, Cook County Hospital, Chicago, Ill. USA

    Department of Pediatrics University of Illinois, Chicago, Ill. USA

    Department of Medicine, University of Chicago, Pritzker School of Medicine, Chicago, Ill. USA
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  • David L. Horwitz
    Affiliations
    Department of Pediatrics, Cook County Hospital, Chicago, Ill. USA

    Department of Pediatrics University of Illinois, Chicago, Ill. USA

    Department of Medicine, University of Chicago, Pritzker School of Medicine, Chicago, Ill. USA
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  • Arthur H. Rubenstein
    Affiliations
    Department of Pediatrics, Cook County Hospital, Chicago, Ill. USA

    Department of Pediatrics University of Illinois, Chicago, Ill. USA

    Department of Medicine, University of Chicago, Pritzker School of Medicine, Chicago, Ill. USA
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      Proinsulin is converted to insulin and C-peptide in the pancreatic β-cells; the latter two peptides are secreted in equimolar concentrations. Thus measurements of C-peptide immunoreactivity may provide a means of assessing residual pancreatic function in insulin-treated diabetic patients. Thirty-five patients with a mean (±SE) age of 13.4±.6 years who had diabetes mellitus for 4.8±.3 years were included in this study. Glucose and CPR were measured in the fasting state and one hour after 1 gm/kg (maximum 50 gm) of oral glucose. Patients were assigned to one two groups on the basis of adequate or poor control of diabetes. Twenty-five of the 35 (71%) patients had evidence of endogenous β-cell function, i.e., CPR>0.5 ng/ml. CPR levels over 0.5 ng/ml were present in a significantly (p<0.05) greater number of patients with diabetes of <5 years duration (19/21) than in those with diabetes >5 years duration (6/14). Only one patient showed a rise in CPR after the glucose load. All patients with CPR>2.0 ng/ml were in the adequately controlled group, but there were patients with CPR<2.0 ng/ml in both adequately and poorly controlled groups. Because the CPR value includes both C-peptide and antibody-bound proinsulin, separate determination of free C-peptide was done in 30 patients. These results confirmed the conclusions based on CPR estimation. Although growth hormone values were higher in patients in the poorly controlled group, there was no correlation between hGH and CPR. We conclude that residual insulin secretion in diabetic patients may facilitate good control, but that low CPR values and hence absent β-cell reserve is not always associated with poor control.
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