Mixed-meal tolerance test to assess residual beta-cell secretion: Beyond the area-under-curve of plasma C-peptide concentration

Yue Ruan, Ruben H Willemsen, Malgorzata E Wilinska, Martin Tauschmann, David B Dunger, Roman Hovorka, Yue Ruan, Ruben H Willemsen, Malgorzata E Wilinska, Martin Tauschmann, David B Dunger, Roman Hovorka

Abstract

Aims: Residual beta-cell secretion in type 1 diabetes is commonly assessed by area-under-curve of plasma C-peptide concentration (AUCCpep ) following mixed-meal tolerance test (MMTT). We aimed to investigate alternative measures of beta-cell responsiveness.

Methods: We analyzed data from 32 youth (age 7 to 17 years) undergoing MMTT within 6 months of type 1 diabetes diagnosis. We related AUCCpep with (a) validated mechanistic index of postprandial beta-cell responsiveness MI accounting for glucose level during MMTT, and (b) pragmatic marker calculated as baseline plasma C-peptide concentration corrected for baseline plasma glucose concentration.

Results: Postprandial responsiveness MI was correlated with age and BMI SDS (Rs = 0.66 and 0.44, P < 0.01 and P < 0.05) and was more correlated with glycated hemoglobin than AUCCpep (Rs = 0.79, P = 0.04). The pragmatic marker was highly correlated with AUCCpep (Rs = 0.94, P < 0.01).

Conclusions: Postprandial responsiveness MI may be more relevant to glucose control than AUCCpep . Baseline C-peptide corrected for baseline glucose appears to be a suitable surrogate of AUCCpep if MMTT is not performed.

Keywords: C-peptide; beta-cell secretion; mixed-meal tolerance test; type 1 diabetes.

Conflict of interest statement

R.H. reports having received speaker honoraria from Eli Lilly and Novo Nordisk, serving on advisory panel for Eli Lilly and Novo Nordisk, receiving license fees from BBraun and Medtronic; and having served as a consultant to BBraun. M.E.W. has received license fees from Becton Dickinson and has served as a consultant to Beckton Dickinson. Y.R., M.T., R.H.W. and D.B.D. declare no competing financial interests exist.

© 2019 The Authors. Pediatric Diabetes published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
The scatter plot of AUCCpep vs baseline C‐peptide (A) and AUCCpep vs baseline C‐peptide corrected for baseline glucose level (B)

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