4.5 Article

Urinary C-peptide/creatinine ratio: A useful biomarker of insulin resistance and refined classification of type 2 diabetes mellitus

Journal

JOURNAL OF DIABETES
Volume 13, Issue 11, Pages 893-904

Publisher

WILEY
DOI: 10.1111/1753-0407.13203

Keywords

insulin resistance; k-means analysis; type 2 diabetes; urinary C-peptide; creatinine ratio; vascular complications

Funding

  1. National Key Research and Development Program [2016YFC1304901]
  2. Beijing Municipal Commission of Science and Technology funds [Z141100007414002, D131100005313008]

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This study found that in patients with type 2 diabetes mellitus, UCPCR is positively correlated with insulin resistance, diabetic kidney disease, and coronary heart disease. Including UCPCR could help refine the classification of different subgroups within type 2 diabetes mellitus.
Background The urinary C-peptide/creatinine ratio (UCPCR) is low in patients with type 1 diabetes mellitus, but it has not been well characterized in patients with type 2 diabetes mellitus (T2DM). We aimed to measure the UCPCRs in patients with T2DM and explore the relationships among UCPCR, insulin resistance (IR), and chronic vascular complications of diabetes. Methods A cross-sectional study was performed of 1299 Chinese hospitalized patients with T2DM. Binary logistic regression was used to evaluate the relationships between the chronic vascular complications of diabetes and UCPCR. K-means analysis was used to allocate participants to subgroups with five to six variables (age at diagnosis, body mass index [BMI], glycosylated hemoglobin, homoeostasis model assessment 2-estimated beta-cell function (HOMA2-B), and HOMA2-insulin resistance (HOMA2-IR), with or without UCPCR). Results UCPCR positively correlated with HOMA2-IR (r = 0.448, P < .001). After adjustment for sex, age, duration of diabetes, and other cardiovascular risk factors, UCPCR was positively associated with diabetic kidney disease (DKD) (odds ratio [OR] = 1.198, 95% CI 1.019-1.408, P = .029) and coronary heart disease (CHD) (OR = 1.312, 95% CI 1.079-1.594, P = .006). When UCPCR was added, cluster analysis using the six variables identified five subgroups of T2DM, characterized by differing age at diagnosis, BMI, beta-cell function, IR, and prevalence of vascular complications. Conclusions UCPCR is positively associated with IR, DKD, and CHD and represents a promising biomarker that could refine the classification of T2DM.

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