Predictive Value of C-Peptide Measures for Clinical Outcomes of β-Cell Replacement Therapy in Type 1 Diabetes: Report From the Collaborative Islet Transplant Registry (CITR)
Authors' conclusion
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 β-cell replacement.
Study context
- Population
- CITR islet-alone recipients with T1D, pretransplant C-peptide <0.1 nmol/L; mean follow-up 4.6 ± 1.1 years
- Participants
- 677 recipients
- Comparison
- Fasting and stimulated glucose and C-peptide measures for predicting ITx outcomes
- Outcome
- Seven primary outcomes: absence of severe hypoglycemic events (ASHEs); HbA1c <7.0%; HbA1c <7.0% and ASHEs; HbA1c ≤6.5%; HbA1c ≤6.5% and ASHEs; insulin independence; ASHEs, HbA1c ≤6.5% and insulin independence (optimal outcome)
Methodological detailsregistry (CITR)
- Registry (CITR)
Performance
As reported in the abstract
Prediction of ITx outcomes:
- Receiver operating characteristic area under the curve (ROC-AUC)
- Optimal cut points
| Test or model | AUC for ASHE | Optimal cut point for ASHE | AUC for optimal outcome | Optimal cut point for optimal outcome |
|---|---|---|---|---|
| Fasting C-peptide | 0.906 | 0.070 nmol/L | 0.845 | 0.33 nmol/L |
| Mixed-meal tolerance test (MMTT)-stimulated C-peptide-to-glucose ratio (CPGR) | 0.12 nmol/mmol | |||
| MMTT-stimulated C-peptide | 0.97 nmol/L |
AUC for ASHE
Fasting C-peptide0.906
Mixed-meal tolerance test (MMTT)-stimulated C-peptide-to-glucose ratio (CPGR)— not stated in the abstract
MMTT-stimulated C-peptide— not stated in the abstract
Optimal cut point for ASHE
Fasting C-peptide0.070 nmol/L
Mixed-meal tolerance test (MMTT)-stimulated C-peptide-to-glucose ratio (CPGR)— not stated in the abstract
MMTT-stimulated C-peptide— not stated in the abstract
AUC for optimal outcome
Fasting C-peptide0.845
Mixed-meal tolerance test (MMTT)-stimulated C-peptide-to-glucose ratio (CPGR)— not stated in the abstract
MMTT-stimulated C-peptide— not stated in the abstract
Optimal cut point for optimal outcome
Fasting C-peptide0.33 nmol/L
Mixed-meal tolerance test (MMTT)-stimulated C-peptide-to-glucose ratio (CPGR)0.12 nmol/mmol
MMTT-stimulated C-peptide0.97 nmol/L
Original publication
Predictive Value of C-Peptide Measures for Clinical Outcomes of β-Cell Replacement Therapy in Type 1 Diabetes: Report From the Collaborative Islet Transplant Registry (CITR). Diabetes Care. Published 17 January 2023. doi:10.
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