Yonsei Med J.  2011 Nov;52(6):939-947. 10.3349/ymj.2011.52.6.939.

Parameters Measuring Beta-Cell Function Are Only Valuable in Diabetic Subjects with Low Body Mass Index, High Blood Glucose Level, or Long-Standing Diabetes

• Lee SW
• Lee S
• Kim SH
• Kim TH
• Kang BS
• Yoo SH
• Lee MK
• Koh WJ
• Kang WS
• Kim HJ

• KMID: 1058813
• DOI: http://doi.org/10.3349/ymj.2011.52.6.939

Abstract

PURPOSE
The aim of this study was to identify the most precise and clinically practicable parameters that predict future oral hypoglycemic agent (OHA) failure in patients with type 2 diabetes, and to determine whether these parameters are valuable in various subgroups.
MATERIALS AND METHODS
We took fasting blood samples from 231 patients for laboratory data and standard breakfast tests for evaluation of pancreatic beta-cell function. Hemoglobin A1c (HbA1c) levels were tested, and we collected data related to hypoglycemic medications one year from the start date of the study.
RESULTS
Fasting C-peptide, postprandial insulin and C-peptide, the difference between fasting and postprandial insulin, fasting beta-cell responsiveness (M0), postprandial beta-cell responsiveness (M1), and homeostasis model assessment-beta (HOMA-B) levels were significantly higher in those with OHA response than in those with OHA failure. The area under the curve (AUC) of the receiver operating characteristic (ROC) measured with postprandial C-peptide to predict future OHA failure was 0.720, and the predictive power for future OHA failure was the highest of the variable parameters. Fasting and postprandial C-peptide, M0, and M1 levels were the only differences between those with OHA response and those with OHA failure among diabetic subjects with low body mass index, high blood glucose level, or long-standing diabetes.
CONCLUSION
In conclusion, postprandial C-peptide was most useful in predicting future OHA failure in type 2 diabetic subjects. However, these parameters measuring beta-cell function are only valuable in diabetic subjects with low body mass index, high blood glucose level, or long-standing diabetes.

Keyword

Type 2 diabetes; beta-cell function; OHA failure; standard breakfast test; C-peptide

MeSH Terms

Administration, Oral
Adolescent
Aged
Blood Glucose/analysis
Body Mass Index
C-Peptide/blood
Child
Child, Preschool
Diabetes Mellitus, Type 2/*blood/drug therapy/*metabolism/physiopathology
Fasting/blood
Female
Humans
Hypoglycemic Agents/administration & dosage/therapeutic use
Insulin/blood
Insulin-Secreting Cells/*metabolism/*physiology
Male
Middle Aged
Postprandial Period

Figure

• 

  Fig. 1 Comparison of baseline insulin secretion parameters of OHA responders versus failures in subgroup analysis according to body mass index (BMI). Data are expressed as medians (interquartile range). OHA, oral hypoglycemic agent; FC-pept, fasting C-peptide; PP C-pept, postprandial C-peptide.

• 

  Fig. 2 Comparison of baseline insulin secretion parameters of OHA responders versus failures in subgroup analysis according to fasting blood glucose levels. Data are expressed as medians (interquartile range). OHA, oral hypoglycemic agent; FC-pept, fasting C-peptide; PP C-pept, postprandial C-peptide.

• 

  Fig. 3 Comparison of baseline insulin secretion parameters of OHA responders versus failures in subgroup analysis according to duration of diabetes. Data are expressed as medians (interquartile range). OHA, oral hypoglycemic agent; FC-pept, fasting C-peptide; PP C-pept, postprandial C-peptide.

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