PMID- 23111058
OWN - NLM
STAT- MEDLINE
DCOM- 20130819
LR  - 20211021
IS  - 1935-5548 (Electronic)
IS  - 0149-5992 (Print)
IS  - 0149-5992 (Linking)
VI  - 36
IP  - 2
DP  - 2013 Feb
TI  - Lessons from the mixed-meal tolerance test: use of 90-minute and fasting 
      C-peptide in pediatric diabetes.
PG  - 195-201
LID - 10.2337/dc12-0836 [doi]
AB  - OBJECTIVE: Mixed-meal tolerance test (MMTT) area under the curve C-peptide (AUC 
      CP) is the gold-standard measure of endogenous insulin secretion in type 1 
      diabetes but is intensive and invasive to perform. The 90-min MMTT-stimulated CP 
      >/=0.2 nmol/L (90CP) is related to improved clinical outcomes, and CP >/=0.1 nmol/L 
      is the equivalent fasting measure (FCP). We assessed whether 90CP or FCP are 
      alternatives to a full MMTT. RESEARCH DESIGN AND METHODS: CP was measured during 
      1,334 MMTTs in 421 type 1 diabetes patients aged <18 years at 3, 9, 18, 48, and 
      72 months duration. We assessed: 1) correlation between mean AUC CP and 90CP or 
      FCP; 2) sensitivity and specificity of 90CP >/=0.2 nmol/L and FCP >/= 0.1 nmol/L to 
      detect peak CP >/=0.2 nmol/L and the equivalent AUC CP; and 3) how the time taken 
      to reach the CP peak varied with age of diagnosis and diabetes duration. RESULTS: 
      AUC CP was highly correlated to 90CP (r(s) = 0.96; P < 0.0001) and strongly 
      correlated to FCP (r(s) = 0.84; P < 0.0001). AUC CP >/=23 nmol/L/150 min was the 
      equivalent cutoff for peak CP >/=0.2 nmol/L (98% sensitivity/97% specificity). A 
      90CP >/=0.2 nmol/L correctly classified 96% patients using AUC or peak CP, whereas 
      FCP >/=0.1 nmol/L classified 83 and 85% patients, respectively. There was only a 
      small difference seen between peak and 90CP (median 0.02 nmol/L). The CP peak 
      occurred earlier in patients with longer diabetes duration (6.1 min each 1-year 
      increase in duration) and younger age (2.5 min each 1-year increase). 
      CONCLUSIONS: 90CP is a highly sensitive and specific measure of AUC and peak CP 
      in children and adolescents with type 1 diabetes and offers a practical 
      alternative to a full MMTT.
FAU - Besser, Rachel E J
AU  - Besser RE
AD  - Peninsula National Institute of Health Research Clinical Research Facility, 
      Peninsula Medical School, University of Exeter, Exeter, United Kingdom. 
      rachel.besser@nhs.net
FAU - Shields, Beverley M
AU  - Shields BM
FAU - Casas, Rosaura
AU  - Casas R
FAU - Hattersley, Andrew T
AU  - Hattersley AT
FAU - Ludvigsson, Johnny
AU  - Ludvigsson J
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20121030
PL  - United States
TA  - Diabetes Care
JT  - Diabetes care
JID - 7805975
RN  - 0 (C-Peptide)
SB  - IM
CIN - Diabetes Care. 2013 Dec;36(12):e221. PMID: 24265390
CIN - Diabetes Care. 2013 Dec;36(12):e222. PMID: 24265391
MH  - Adolescent
MH  - C-Peptide/*blood
MH  - Child
MH  - Diabetes Mellitus, Type 1/*blood
MH  - Fasting/*blood
MH  - Female
MH  - Humans
MH  - Male
MH  - Postprandial Period
PMC - PMC3554273
EDAT- 2012/11/01 06:00
MHDA- 2013/08/21 06:00
PMCR- 2014/02/01
CRDT- 2012/11/01 06:00
PHST- 2012/11/01 06:00 [entrez]
PHST- 2012/11/01 06:00 [pubmed]
PHST- 2013/08/21 06:00 [medline]
PHST- 2014/02/01 00:00 [pmc-release]
AID - dc12-0836 [pii]
AID - 0836 [pii]
AID - 10.2337/dc12-0836 [doi]
PST - ppublish
SO  - Diabetes Care. 2013 Feb;36(2):195-201. doi: 10.2337/dc12-0836. Epub 2012 Oct 30.