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Hormone replacement therapy in diabetes
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
J. C. Stevenson, I. F. Godsland
Studies of the effects of estrogens on glucose and insulin metabolism in postmenopausal women may complement findings from studies of the menopause. Estrogen replacement would be expected to have the opposite effect to the changes seen in postmenopausal women due to estrogen deficiency. Cagnacci and associates studied the effects of transdermally administered 17β-estradiol (50 µg/day) on OGTT glucose, insulin and C-peptide responses in 15 postmenopausal women followed for 3 months9. There was no change in glucose response, insulin response fell significantly and C-peptide response increased significantly. The increase in C-peptide response with no change in glucose response suggests an improved sensitivity of pancreatic insulin secretion to glucose; the increase in C-peptide response with a reduction in insulin response suggests an improvement in insulin elimination; and the reduction in insulin response with no change in glucose response suggests a reduction in insulin resistance. Thus, these effects of estradiol were indeed the opposite of the effect seen with the menopause.
Medicinal poisons
Published in Jason Payne-James, Richard Jones, Simpson's Forensic Medicine, 2019
Jason Payne-James, Richard Jones
No discussion of forensic toxicology would be complete without some mention of insulin poisoning via the exogenous administration of insulin. Insulin poisoning was once a popular means of homicide; now it is rare. Insulin overdose can cause fatal brain damage, but if overdose is suspected it can be confirmed by several different methods. Analysis of homicidal insulin overdose is always a challenging task in forensic practice because of the difficulties in toxicological analysis as well as the elusive pathologic changes. C-peptide is a peptide that is made when proinsulin is split into insulin and its C-peptide fragment. This event occurs just before release of insulin from the pancreas. If concentrations of the peptide are very low and insulin very high, the disparity would suggest that exogenous insulin had been administered. However, unless the blood specimen is frozen, levels of C-peptide may degrade rapidly. DNA analysis offers another possible approach. Biosynthetic insulin is now produced by genetic engineering. Some of the bioengineered insulin has a slightly different structure than human insulin and these differences can be detected. A friend, relative or care-giver may be the one who carries out homicide by insulin injection. Suicide by insulin overdose is well recognised.
Diabetes Mellitus
Published in Victor A. Bernstam, Pocket Guide to GENE LEVEL DIAGNOSTICS in Clinical Practice, 2019
Insulin and C peptide are secreted together in response to physiological stimuli. Guanine nucleotide-binding proteins (G proteins) play a significant role in both regulation of the insulin gene and modulation of insulin action in target tissues.
Admission eGFR predicts in-hospital mortality independently of admission glycemia and C-peptide in patients with type 2 diabetes mellitus and COVID-19
Published in Current Medical Research and Opinion, 2023
Marco Infante, Massimo Pieri, Santina Lupisella, Ali Mohamad, Sergio Bernardini, David Della-Morte, Andrea Fabbri, Alberto De Stefano, Marco Iannetta, Lorenzo Ansaldo, Angela Crea, Massimo Andreoni, Maria Morello
In keeping with our findings, a post hoc analysis aimed to assess long-term beta-cell secretory capacity in 54 survivors of COVID-19 (including only 15 patients with pre-existing T2DM) showed that all participants had detectable random non-fasting serum C-peptide levels measured at least 3 months after SARS-CoV-2 infection. In particular, median C-peptide level was 1319 pmol/L (3.98 ng/mL), while none of the patients had undetectable C-peptide levels (<3.3 pmol/L; <0.01 ng/mL)59. A retrospective Bulgarian study conducted on 66 hospitalized patients with COVID-19 (of whom only 43.93% had T2DM) also found that admission plasma C-peptide levels did not predict the need for oxygen therapy, although they were significant predictors of leukocytosis60. Ilias et al.61 found no significant difference in admission fasting plasma C-peptide values between critically ill and non-critically ill patients in a cohort of 157 hospitalized COVID-19 patients (of whom 135 did not have prior history of diabetes). In a similar Italian study conducted on 24 hospitalized COVID-19 patients (of whom only one had T2DM), Bergantini et al.62 found no significant difference in admission serum C-peptide values between patients with severe disease and patients with mild-to-moderate disease.
Predictors of HbA1c reduction and hypoglycemia in type 2 diabetes mellitus individuals switching from premixed to basal insulin: an exploratory analysis of optimization study
Published in Current Medical Research and Opinion, 2022
Wenying Yang, Juan Du, Minlu Zhang, Jing Hou, Xia Zhang, Nan Cui
C-peptide is an emerging valuable and widely used method to assess pancreatic β-cell function25,26. After its formation following the cleavage of proinsulin, the 31-amino-acid C-peptide34,35 is degraded slower than that of insulin (half-life: 20–30 min, vs. 3–5 min, respectively), allowing a more stable test window of fluctuating β-cell response. Hitherto, very limited evidence exists in the literature highlighting whether C-peptide can effectively predict need of insulin in individuals with diabetes36,37. Since C-peptide is inversely associated with glycemic variability and post meal glucose in T2DM individuals, very low C-peptide levels (<0.2 nmol/L) is predictive of insulin requirement in these individuals25. A pooled analysis of individuals with T2DM and on treatment with BI showed that low FCP levels (≤4 nmol/L) is useful in identifying individuals with insulin deficiency, enhanced insulin sensitivity and higher risk of hypoglycemia in contrast to those with higher FCP levels (>0.40 nmol/L)31. A recent review suggested that the current clinical role of C-peptide is to assist classification and management of insulin-treated individuals. The utility is greatest after 3–5 years from diagnosis in differentiating the type of diabetes25,27. However, further substantial studies are needed to prove the effectiveness of this biomarker.
Beta-cell failure in type 2 diabetes: mechanisms, markers, and clinical implications
Published in Postgraduate Medicine, 2020
Currently, the most commonly used method for assessing glycemic control is measurement of A1C, which provides an indication of average blood sugar level for the previous 2–3 months. Although targets for A1C control should be individualized, it is generally agreed that most people with diabetes should target an A1C level of <7% [76]. However, maintenance of adequate beta-cell function is important in facilitating glycemic control, and as such is an important indicator of disease status and the need for additional or alternative treatment. This was demonstrated over a 6-year period in the UKPDS study, which showed that 62% of participants with baseline beta-cell function below 27% required additional therapy to maintain glycemic targets, whereas only 28% of those with beta-cell function above 55% required additional therapy [51]. An analysis of the Veterans Affairs Diabetes Trial cohort revealed that C-peptide levels decreased with the duration of diabetes. In individuals with T2D duration of 0–3 years, mean baseline C-peptide was ~1.1 pmol/mL (0.0033 ng/mL), which decreased to ~0.6 pmol/mL (0.0018 ng/mL) in those with disease duration of 16–18 years. There was no further decline in those with T2D duration of ≥21 years, which suggests that there is a point at which beta-cell loss becomes stable [77].