PMID- 36657975
OWN - NLM
STAT- MEDLINE
DCOM- 20230327
LR  - 20240402
IS  - 1935-5548 (Electronic)
IS  - 0149-5992 (Print)
IS  - 0149-5992 (Linking)
VI  - 46
IP  - 4
DP  - 2023 Apr 1
TI  - Predictive Value of C-Peptide Measures for Clinical Outcomes of beta-Cell 
      Replacement Therapy in Type 1 Diabetes: Report From the Collaborative Islet 
      Transplant Registry (CITR).
PG  - 697-703
LID - 10.2337/dc22-1155 [doi]
AB  - OBJECTIVE: To determine C-peptide measures and levels associated with positive 
      glycemic control outcomes following islet transplant (ITx) in type 1 diabetes. 
      RESEARCH DESIGN AND METHODS: We evaluated Collaborative Islet Transplant Registry 
      (CITR) islet-alone recipients with pretransplant C-peptide <0.1 nmol/L and mean 
      follow-up of 4.6 +/- 1.1 years (n = 677). Receiver operating characteristic area 
      under the curve (ROC-AUC) was used to evaluate the predictive value of fasting 
      and stimulated glucose and C-peptide measures for seven primary outcomes: 1) 
      absence of severe hypoglycemic events (ASHEs); 2) HbA1c <7.0%; 3) HbA1c <7.0% and 
      ASHEs; 4) HbA1c </=6.5%; 5) HbA1c </=6.5% and ASHEs; 6) insulin independence; and 7) 
      ASHEs, HbA1c </=6.5%, and insulin independence (the optimal outcome). Measures with 
      the highest ROC-AUC were selected for determination of optimal cut points. 
      RESULTS: Fasting C-peptide was highly predictive for ASHE (ROC-AUC 0.906; optimal 
      cut point 0.070 nmol/L) and the optimal outcome (ROC-AUC 0.845; optimal cut point 
      0.33 nmol/L). Mixed-meal tolerance test (MMTT)-stimulated C-peptide-to-glucose 
      ratio (CPGR) outperformed both fasting and stimulated C-peptide for all outcomes 
      except ASHE. The optimal cut point for the optimal outcome was 0.12 nmol/mmol for 
      MMTT-stimulated CPGR and 0.97 nmol/L for MMTT-stimulated C-peptide. CONCLUSIONS: 
      Fasting C-peptide reliably predicts ITx primary outcomes. MMTT-stimulated CPGR 
      provides marginally better prediction for composite ITx outcomes, including 
      insulin independence. In the absence of an MMTT, a fasting C-peptide >/=0.33 nmol/L 
      is a reassuring measure of optimal islet graft function. C-peptide targets 
      represent excellent and easily determinable means to predict glycemic control 
      outcomes after ITx and should be considered as potential goals of beta-cell 
      replacement.
CI  - (c) 2023 by the American Diabetes Association.
FAU - Baidal, David A
AU  - Baidal DA
AUID- ORCID: 0000-0001-7694-3265
AD  - Diabetes Research Institute, Miller School of Medicine, University of Miami, 
      Miami, FL.
FAU - Ballou, Cassandra M
AU  - Ballou CM
AD  - Collaborative Islet Transplant Registry Coordinating Center, The EMMES Company, 
      LLC, Rockville, MD.
FAU - Rickels, Michael R
AU  - Rickels MR
AUID- ORCID: 0000-0002-9253-838X
AD  - Institute for Diabetes, Obesity and Metabolism, University of Pennsylvania 
      Perelman School of Medicine, Philadelphia, PA.
FAU - Berney, Thierry
AU  - Berney T
AD  - Division of Transplantation, Department of Surgery, Geneva University Hospitals, 
      Geneva, Switzerland.
FAU - Pattou, Francois
AU  - Pattou F
AD  - Department of General and Endocrine Surgery, Centre Hospitalier Universitaire de 
      Lille, Translational Research for Diabetes, INSERM, Universite de Lille, Lille, 
      France.
FAU - Payne, Elizabeth H
AU  - Payne EH
AD  - Collaborative Islet Transplant Registry Coordinating Center, The EMMES Company, 
      LLC, Rockville, MD.
FAU - Barton, Franca B
AU  - Barton FB
AD  - Collaborative Islet Transplant Registry Coordinating Center, The EMMES Company, 
      LLC, Rockville, MD.
FAU - Alejandro, Rodolfo
AU  - Alejandro R
AUID- ORCID: 0000-0003-4387-5360
AD  - Diabetes Research Institute, Miller School of Medicine, University of Miami, 
      Miami, FL.
CN  - CITR Investigators
LA  - eng
GR  - R01 DK091331/DK/NIDDK NIH HHS/United States
GR  - U01 DK133709/DK/NIDDK NIH HHS/United States
GR  - UC4 DK114839/DK/NIDDK NIH HHS/United States
GR  - UC4 DK098086/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - Diabetes Care
JT  - Diabetes care
JID - 7805975
RN  - 0 (C-Peptide)
RN  - 0 (Blood Glucose)
RN  - 0 (Glycated Hemoglobin)
RN  - 0 (Insulin)
RN  - IY9XDZ35W2 (Glucose)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin, Regular, Human)
SB  - IM
MH  - Humans
MH  - *Diabetes Mellitus, Type 1/surgery/drug therapy
MH  - C-Peptide
MH  - Blood Glucose
MH  - Glycated Hemoglobin
MH  - *Islets of Langerhans Transplantation
MH  - Insulin/therapeutic use
MH  - Glucose/therapeutic use
MH  - Hypoglycemic Agents/therapeutic use
MH  - Insulin, Regular, Human/therapeutic use
PMC - PMC10148684
EDAT- 2023/01/20 06:00
MHDA- 2023/03/28 06:00
PMCR- 2024/04/01
CRDT- 2023/01/19 21:41
PHST- 2022/06/12 00:00 [received]
PHST- 2022/12/23 00:00 [accepted]
PHST- 2023/01/20 06:00 [pubmed]
PHST- 2023/03/28 06:00 [medline]
PHST- 2023/01/19 21:41 [entrez]
PHST- 2024/04/01 00:00 [pmc-release]
AID - 148301 [pii]
AID - 221155 [pii]
AID - 10.2337/dc22-1155 [doi]
PST - ppublish
SO  - Diabetes Care. 2023 Apr 1;46(4):697-703. doi: 10.2337/dc22-1155.