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Associations of CGM Metrics With Stimulated C-Peptide Measures in Youth With Recent-Onset Type 1 Diabetes

Anna Neyman1,2, Linda A DiMeglio1, Colleen Bauza3

  • 1Indiana University School of Medicine, Indianapolis, IN.

Diabetes Care
|June 4, 2025
PubMed

Insights

Continuous glucose monitoring (CGM) shows moderate correlation with C-peptide levels in type 1 diabetes trials. However, CGM metrics are not yet accurate enough to replace C-peptide measurements in clinical studies.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Clinical Trials

Background:

  • Type 1 diabetes (T1D) management relies on assessing residual beta-cell function.
  • Stimulated C-peptide measurements are a key outcome in T1D clinical trials.
  • Continuous glucose monitoring (CGM) offers frequent glucose data but its utility as a surrogate for C-peptide is under investigation.

Purpose of the Study:

  • To evaluate if Continuous glucose monitoring (CGM) metrics can serve as a surrogate for stimulated C-peptide outcomes in type 1 diabetes clinical trials.
  • To determine the correlation between CGM parameters and C-peptide levels up to 52 weeks post-diagnosis.

Main Methods:

  • A cohort of 103 children with type 1 diabetes was studied.
  • Continuous glucose monitoring (CGM) data was collected and compared with C-peptide measurements obtained via mixed-meal tolerance tests.
  • Statistical analyses, including Spearman correlations and multivariate modeling, were performed on data collected up to 52 weeks.

Main Results:

  • At 52 weeks, CGM metrics demonstrated moderate correlation with C-peptide area under the curve.
  • The strongest correlations were observed for time-in-range (70-180 mg/dL), time below 70 mg/dL, and glucose coefficient of variation.
  • A multivariate model using these CGM metrics achieved a correlation of 0.63 and predicted peak C-peptide concentrations with 68.4% sensitivity and 75% specificity.

Conclusions:

  • CGM measures correlate with stimulated C-peptide levels in children with type 1 diabetes.
  • The current strength of correlation and the predictive accuracy (sensitivity and specificity) of CGM-derived measures are insufficient to replace C-peptide measurements in clinical trials.
  • Further research may be needed to refine CGM-based surrogates for beta-cell function assessment.
Abstract

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