Pancreatic B-cell response to a test-meal in lean and obese diabetic patients: relation to metabolic control

We have measured fasting C-peptide reactivity (CPR) as well as CPR responses to a test meal in 83 diabetic patients and 41 non diabetic controls. In comparison to controls, basal CPR was decreased in lean insulin-treated diabetics with stable or brittle diabetes and in obese patients with brittle diabetes. Lean and obese maturity-onset diabetics had increased CPR levels and so had obese insulin-treated patients. Nevertheless, the CPR response to the test meal was clearly inadequate in all diabetics. In control patients, there was a positive correlation between fasting blood glucose and CPR levels. On the contrary, lean diabetics demonstrated a negative correlation between these parameters. Hemoglobin A1 levels were negatively correlated to fasting CPR levels in lean diabetics, indicating the importance of residual B-cell function for diabetes control. These correlations were obscured in obese diabetics. In our patients, circulating insulin antibodies had apparently no deleterious effect on metabolic control.