Association of low fasting C-peptide levels with cardiovascular risk, visit-to-visit glucose variation and severe hypoglycemia in the Veterans Affairs Diabetes Trial (VADT)
Posted on 2021-12-09 - 04:26
Abstract Aims Low C-peptide levels, indicating beta-cell dysfunction, are associated with increased within-day glucose variation and hypoglycemia. In advanced type 2 diabetes, severe hypoglycemia and increased glucose variation predict cardiovascular (CVD) risk. The present study examined the association between C-peptide levels and CVD risk and whether it can be explained by visit-to-visit glucose variation and severe hypoglycemia. Materials and methods Fasting C-peptide levels at baseline, composite CVD outcome, severe hypoglycemia, and visit-to-visit fasting glucose coefficient of variation (CV) and average real variability (ARV) were assessed in 1565 Veterans Affairs Diabetes Trial participants. Results There was a U-shaped relationship between C-peptide and CVD risk with increased risk with declining levels in the low range (< 0.50 nmol/l, HR 1.30 [95%CI 1.05–1.60], p = 0.02) and with rising levels in the high range (> 1.23 nmol/l, 1.27 [1.00–1.63], p = 0.05). C-peptide levels were inversely associated with the risk of severe hypoglycemia (OR 0.68 [0.60–0.77]) and visit-to-visit glucose variation (CV, standardized beta-estimate − 0.12 [SE 0.01]; ARV, − 0.10 [0.01]) (p < 0.0001 all). The association of low C-peptide levels with CVD risk was independent of cardiometabolic risk factors (1.48 [1.17–1.87, p = 0.001) and remained associated with CVD when tested in the same model with severe hypoglycemia and glucose CV. Conclusions Low C-peptide levels were associated with increased CVD risk in advanced type 2 diabetes. The association was independent of increases in glucose variation or severe hypoglycemia. C-peptide levels may predict future glucose control patterns and CVD risk, and identify phenotypes influencing clinical decision making in advanced type 2 diabetes.
CITE THIS COLLECTION
Koska, Juraj; Nuyujukian, Daniel S.; Bahn, Gideon D.; Zhou, Jin J.; Reaven, Peter D. (2021). Association of low fasting C-peptide levels with cardiovascular risk, visit-to-visit glucose variation and severe hypoglycemia in the Veterans Affairs Diabetes Trial (VADT). figshare. Collection. https://doi.org/10.6084/m9.figshare.c.5743477.v1
Select your citation style and then place your mouse over the citation text to select it.
Daniel S. Nuyujukian
Gideon D. Bahn
Jin J. Zhou
Peter D. Reaven
present study examinedaverage real variabilitymethods fasting c63 ], p60 ], p17 – 100 – 1composite cvd outcome60 – 0cardiometabolic risk factorslow fasting cconclusions low c05 – 1day glucose variationestimate − 001 ]; arvvisit glucose variationincreased cvd risklow cglucose variation− 0increased risk01 ])cvd riskincreased withinhr 1ci 1se 0cardiovascular riskstandardized betashaped relationshiprising levelsindicating betaglucose cvdeclining levelscell dysfunction77 ])50 nmol23 nmol05 ).