Urine C-Peptide Creatinine Ratio Is a Noninvasive Alternative to the Mixed-Meal Tolerance Test in Children and Adults With Type 1 Diabetes
- Rachel E.J. Besser, MBBS1,
- Johnny Ludvigsson, PHD2,
- Angus G. Jones, MBBS1,
- Timothy J. McDonald, MSC1,3,
- Beverley M. Shields, PHD1,
- Bridget A. Knight, PHD1 and
- Andrew T. Hattersley, DM1
- 1Peninsula National Institute for Health Research Clinical Research Facility, Peninsula Medical School, University of Exeter, Exeter, U.K.
- 2Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- 3Department of Clinical Biochemistry, Royal Devon & Exeter NHS Foundation Trust, Exeter, U.K.
- Corresponding author: Andrew T. Hattersley, .
R.E.J.B. and J.L. contributed equally to this study.
OBJECTIVE Stimulated serum C-peptide (sCP) during a mixed-meal tolerance test (MMTT) is the gold standard measure of endogenous insulin secretion, but practical issues limit its use. We assessed urine C-peptide creatinine ratio (UCPCR) as an alternative.
RESEARCH DESIGN AND METHODS Seventy-two type 1 diabetic patients (diagnosed median 14 years [interquartile range 10–22] previously; diabetes duration 6.5 [2.3–32.7]) had an MMTT. sCP was collected at 90 min. Urine for UCPCR was collected at 120 min following a home evening meal.
RESULTS MMTT 120-min UCPCR was highly correlated to 90-min sCP (r = 0.97; P < 0.0001). UCPCR ≥0.53 nmol/mmol had 94% sensitivity/100% specificity for significant endogenous insulin secretion (90-min sCP ≥0.2 nmol/L). The 120-min postprandial evening meal UCPCR was highly correlated to 90-min sCP (r = 0.91; P < 0.0001). UCPCR ≥0.37 nmol/mmol had 84% sensitivity/97% specificity for sCP ≥0.2 nmol/L.
CONCLUSIONS UCPCR testing is a sensitive and specific method for detecting insulin secretion. UCPCR may be a practical alternative to serum C-peptide testing, avoiding the need for inpatient investigation.
- Received November 9, 2010.
- Accepted December 11, 2010.
- © 2011 by the American Diabetes Association.
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