C‐peptide index at 2 h post‐meal is a useful predictor of endogenous insulin secretory capacity and withdrawal from insulin therapy in subjects with type 2 diabetes

• Published in: Diabetes, obesity & metabolism Vol. 26; no. 7; pp. 2761 - 2773
• Main Authors: Iwamoto, Yuichiro, Kimura, Tomohiko, Shimoda, Masashi, Morimoto, Yuichi, Watanabe, Yuki, Itoh, Takashi, Sasaki, Taku, Mori, Shigehito, Kubo, Masato, Takenouchi, Haruka, Dan, Kazunori, Iwamoto, Hideyuki, Sanada, Junpei, Fushimi, Yoshiro, Katakura, Yukino, Nakanishi, Shuhei, Mune, Tomoatsu, Kaku, Kohei, Kaneto, Hideaki
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2024
• Subjects: Aged; C-Peptide - blood; C‐peptide index; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; endogenous insulin secretory capacity; Female; Glycated Hemoglobin - analysis; Glycated Hemoglobin - metabolism; Humans; Hypoglycemic Agents - therapeutic use; Insulin - administration & dosage; Insulin - therapeutic use; Insulin Secretion; insulin therapy; Machine Learning; Male; Meals; Middle Aged; Postprandial Period; Retrospective Studies; retrospective study; type 2 diabetes; Withholding Treatment - statistics & numerical data; C‐peptide index; endogenous insulin secretory capacity; type 2 diabetes; insulin therapy; retrospective study
• DOI: 10.1111/dom.15595
• ISSN: 1462-8902; 1463-1326

Aims To evaluate the correlation between C‐peptide index (CPI) at 2 h post‐meal and endogenous insulin secretory capacity and to develop clinical models to predict the possibility of withdrawal from insulin therapy in patients with type 2 diabetes. Method This was a single‐centre retrospective study of patients with type 2 diabetes admitted to our hospital. Patients were divided into a withdrawal group (n = 72) and a non‐withdrawal group (n = 75) based on whether they were able to withdraw from insulin therapy at discharge, and the correlation between CPI at 2 h after meal and diabetes‐related parameters was evaluated. In addition, we created two clinical models to predict the possibility of withdrawal from insulin therapy using machine learning. Results The glycated haemoglobin values of the study participants were 87.8 ± 22.6 mmol/mo. The CPI at 2 h post‐meal was 1.93 ± 1.28 in the non‐withdrawal group and 2.97 ± 2.07 in the withdrawal group (p < 0.001). CPI at 2 h post‐meal was an independent predictor of withdrawal from insulin therapy. In addition, CPI at 2 h post‐meal was a better predictor than fasting CPI. Six factors associated with insulin therapy withdrawal (age, duration of diabetes, creatinine, alanine aminotransferase, insulin therapy until hospitalization, and CPI at 2 h post‐meal) were used to generate two clinical models by machine learning. The accuracy of the generated clinical models ranged from 78.3% to 82.6%. Conclusion The CPI at 2 h post‐meal is a clinically useful measure of endogenous insulin secretory capacity under non‐fasting conditions.