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Home urine C-peptide creatinine ratio (UCPCR) testing can identify type 2 and MODY in pediatric diabetes

Rachel E J Besser1, Beverley M Shields, Suzanne E Hammersley

  • 1Peninsula NIHR Clinical Research Facility, Peninsula Medical School, University of Exeter, Exeter, UK. rachel.besser@nhs.net

Pediatric Diabetes
|January 8, 2013
PubMed

Insights

Postprandial urinary C-peptide creatinine ratio (UCPCR) effectively distinguishes type 1 diabetes from type 2 and MODY in children over two years duration. This non-invasive test aids in accurate pediatric diabetes diagnosis.

Area of Science:

  • Pediatric Endocrinology
  • Diabetes Diagnostics
  • Metabolic Disorders

Background:

  • Accurate diabetes diagnosis in children is vital for lifelong management.
  • Differentiating type 1 diabetes from type 2 and MODY in pediatric patients presents diagnostic challenges.
  • Postprandial urinary C-peptide creatinine ratio (UCPCR) is an underutilized non-invasive measure of insulin secretion.

Purpose of the Study:

  • To evaluate the utility of UCPCR in differentiating pediatric diabetes subtypes.
  • To assess UCPCR as a diagnostic tool in children with diabetes duration less than 5 years.
  • To determine if UCPCR can distinguish type 1 diabetes from MODY and type 2 diabetes in pediatric populations.

Main Methods:

  • Measured 2-hour postprandial UCPCR in 264 pediatric patients (<21 years) with type 1 diabetes (n=160), type 2 diabetes (n=41), and MODY (n=63).
  • Employed receiver operating characteristic (ROC) curve analysis to establish optimal UCPCR cutoffs for subtype discrimination.
  • Analyzed UCPCR values in relation to diabetes type and duration of disease.

Main Results:

  • UCPCR was significantly lower in type 1 diabetes compared to type 2 diabetes and MODY (p<0.0001).
  • UCPCR values were similar between type 2 diabetes and MODY (p=0.25).
  • For diabetes duration >2 years, UCPCR ≥ 0.7 nmol/mmol demonstrated 100% sensitivity and 97% specificity in identifying non-type 1 diabetes (MODY + type 2) from type 1 diabetes (AUC 0.997).

Conclusions:

  • UCPCR testing is a practical, non-invasive method for identifying non-type 1 diabetes in pediatric patients with diabetes duration exceeding 2 years.
  • UCPCR can reliably differentiate type 1 diabetes from other forms in the pediatric outpatient setting.
  • UCPCR showed limited ability to discriminate between MODY and type 2 diabetes.
Abstract

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