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Residual endogenous insulin secretion in Japanese children with type 1A diabetes

Shigetaka Sugihara1,2, Toru Kikuchi3,2, Tatsuhiko Urakami4,2

  • 1Department of Pediatrics, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.

Clinical Pediatric Endocrinology : Case Reports and Clinical Investigations : Official Journal of the Japanese Society for Pediatric Endocrinology
|January 15, 2021
PubMed

Insights

Serum C-peptide levels decrease over time in children with type 1 diabetes, correlating with higher HbA1c. Few patients maintain C-peptide levels, with responders often being adolescent females with specific HLA haplotypes.

Area of Science:

  • Endocrinology
  • Immunology
  • Pediatric Diabetes Research

Background:

  • Serum C-peptide immunoreactivity (CPR) is a marker of endogenous insulin production in type 1 diabetes.
  • Assessing CPR trends over time is crucial for understanding disease progression and potential for residual beta-cell function.

Purpose of the Study:

  • To investigate changes in serum C-peptide immunoreactivity (CPR) levels in children with type 1 diabetes over time.
  • To correlate CPR levels with glycemic control (HbA1c) and identify characteristics of patients with sustained insulin production.

Main Methods:

  • Analysis of longitudinal data from a multi-center nationwide type 1 diabetes study.
  • Measurement of serum CPR levels at two distinct periods (2013/2014 and 2016/2017).
  • Correlation analysis between CPR, HbA1c, duration since diagnosis, age, and HLA genotype.

Main Results:

  • CPR levels significantly decreased with longer duration since type 1 diabetes diagnosis.
  • Higher HbA1c levels were associated with lower CPR (< 0.1 or < 0.3 ng/mL).
  • A small subset of patients ('Responders') maintained CPR ≥ 0.6 ng/mL, predominantly adolescent females with HLA DR4-DQ4.

Conclusions:

  • Endogenous insulin production declines significantly over time in most children with type 1 diabetes.
  • Sustained CPR is rare and may be associated with specific demographic and genetic factors.
  • Transition to adult care may pose challenges for glycemic control due to depleted insulin secretion.

Keywords:
Japanese childrenhuman leukocyte antigen (HLA)serum C-peptide immunoreactivity (CPR)type 1A diabetes mellitus (T1AD)

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