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Fasting c-peptide and insulin-like growth factor-binding protein-1 levels help to distinguish childhood type 1 and
Lorraine E Levitt Katz1, Abbas F Jawad, Jaya Ganesh
1Division of Endocrinology and Diabetes, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA. katzl@email.chop.edu
Insights
Distinguishing type 1 diabetes mellitus (T1DM) from type 2 diabetes mellitus (T2DM) in children can be achieved using biochemical markers. Fasting C-peptide, IGFBP-1, CO2 levels, and urine ketones aid in differentiating these conditions.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Diabetes Mellitus Research
Background:
- New onset diabetes in children presents diagnostic challenges, with a subset presumptively diagnosed with type 2 diabetes mellitus (T2DM).
- Factors considered for T2DM diagnosis include obesity, family history, insulin independence, and absence of GAD-65 antibodies.
- Differentiating T1DM from T2DM in pediatric populations is crucial for appropriate management.
Purpose of the Study:
- To identify biochemical markers that can effectively distinguish between type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in children.
- To evaluate the utility of fasting C-peptide, IGFBP-1, initial CO2 levels, and urine ketones in this differentiation.
Main Methods:
- Retrospective analysis of 175 children with new onset diabetes over 12 months.
- Comparison of biochemical parameters including fasting C-peptide, IGFBP-1, initial CO2 levels, and urine ketones between T1DM and T2DM groups.
- Statistical analysis to determine sensitivity and specificity of individual markers and combinations.
Main Results:
- Children with T1DM were younger (mean age 8.7 yrs) and predominantly white, while T2DM patients were older (mean age 14.2 yrs) and more diverse racially.
- Fasting C-peptide levels were significantly lower in T1DM (0.38 ng/mL) vs. T2DM (2.66 ng/mL), with a threshold of 0.85 ng/mL showing 83% sensitivity.
- Fasting IGFBP-1 levels were higher in T1DM (38.1 ng/mL) vs. T2DM (3.6 ng/mL), with a threshold of 3.6 ng/dL showing 93% sensitivity. Urinary ketones and initial CO2 levels also differed significantly between groups.
Conclusions:
- Biochemical parameters including fasting C-peptide, IGFBP-1, CO2 levels, and urine ketones, in conjunction with clinical factors, can reliably distinguish T1DM from T2DM in children.
- These markers offer valuable tools for accurate diagnosis and appropriate treatment strategies in pediatric diabetes.
Background:
Children with new onset diabetes (n = 175) were evaluated over 12-months. Patients were presumptively diagnosed with type 2 diabetes mellitus (T2DM) (n = 26) based on obesity, a relative with T2DM, the ability to wean from insulin, and absence of glutamic acid decarboxylase-65 (GAD-65) antibodies. We hypothesized that markers of insulinization at diagnosis, including fasting C-peptide and insulin-like growth factor-binding protein (IGFBP)-1, in addition to initial CO(2) levels and urine ketones, would help in distinguishing type 1 diabetes mellitus (T1DM) from T2DM.
Results:
Children with T1DM (84 male, 65 female) had a mean age of 8.7 +/- 4.3 yr and a racial background of 78% white, 19% black, and 3% other. In contrast, children with T2DM (13 female, 13 male) had a mean age of 14.2 +/- 3.1 yr with a racial background of 58% black, 27% white, and 15% other. Fasting C-peptide level was 0.38 +/- 0.37 ng/mL in T1DM vs. 2.66 +/- 2.14 ng/mL in T2DM; a C-peptide of 0.85 ng/mL had 83% sensitivity in distinguishing T1DM from T2DM. Fasting IGFBP-1 level was 38.1 +/- 39.1 ng/mL (T1DM) vs. 3.6 +/- 4.5 ng/mL (T2DM); a value of 3.6 ng/dL could distinguish the two types of diabetes with 93% sensitivity. Urinary ketones were found in 79% of children with T1DM compared with 56% of those with T2DM, and the magnitude was associated with type of diabetes. Initial CO(2) level for T1DM was 17.9 +/- 6.9 mmol/L vs. 22.7 +/- 5.7 mmol/L for T2DM; a value of 21.5 mmol/L could distinguish the two types of diabetes with 83% sensitivity.
Conclusions:
In addition to obesity, family history of T2DM, and absence of GAD-65 antibodies, children with new-onset T2DM may be distinguished from those with T1DM by a combination of biochemical parameters (C-peptide, IGFBP-1, CO(2), and urine ketones).
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