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Urinary C-peptide creatinine ratio to differentiate type 2 diabetes mellitus from type 1 in pediatric patients

Abstract

Type 2 diabetes mellitus (T2DM) is frequently misdiagnosed in children and treated as type 1 DM (T1DM) with insulin. Urinary C-peptide to creatinine ratio (UCPCR) can be used to measure ß cell function and endogenous insulin. We aimed to assess the value of UCPCR to differentiate T2DM from T1DM in pediatric patients. We assessed UCPCR from urine sample taken 2 h after lunch in 50 children with T1DM and 30 children with T2DM (duration of the disease ≥ 2 years and without renal impairment). Fasting and postprandial C-peptide levels were also evaluated in all included children. Receiver operating characteristic (ROC) curve was performed to assess the optimal UCPCR cutoff level to differentiate T2DM from T1DM in children. UCPCR was significantly lower in children with T1DM compared with those with T2DM (P < 0.001). There was a significant positive correlation between UCPCR and fasting C-peptide, postprandial C-peptide, and age of onset. There was a significant negative correlation between the UCPCR and both HbA1c and duration of DM in T1DM. Fasting C-peptide had a sensitivity of 63%, a specificity of 84% at a cutoff point ≥ 1.3 ng/ml to differentiate T2DM from T1DM. Postprandial C-peptide had a sensitivity of 87%, a specificity of 86% at a cutoff point ≥ 3.2 ng/ml to differentiate T2DM from T1DM. Finally, UCPCR had a sensitivity of 97%, a specificity of 88% at a cutoff point ≥ 0.28 nmol/nmol to differentiate T2DM from T1DM in pediatric patients.

Conclusion: UCPCR is an easy noninvasive reliable marker to differentiate T2DM from T1DM in pediatric patients.

What is Known:
• Type 2 DM (T2DM) is frequently misdiagnosed in children and treated as type 1 DM (T1DM) with insulin.
• Urinary C-peptide to creatinine ratio (UCPCR) can be used to measure ß cell function and endogenous insulin.
What is New:
• We revealed that UCPCR had a sensitivity of 97%, a specificity of 88% at a cutoff point ≥ 0.28 nmol/nmol to differentiate T2DM from T1DM.
• UCPCR is an easy noninvasive dependable marker to diagnose T2DM from T1DM in pediatric patients.

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Abbreviations

BMI:

Body mass index

DM:

Diabetes mellitus

ELIZA:

Enzyme-linked immunosorbent assay

MODY:

Maturity onset diabetes of the young

ROC:

Receiver operating characteristics

SD:

Standard deviation

SGOT:

Serum glutamic oxaloacetic transaminases

SGPT:

Serum glutamic pyruvic transaminases

T1DM:

Type 1 diabetes mellitus

T2DM:

Type 2 diabetes mellitus

UCPCR:

Urinary C-peptide creatinine ratio

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Author information

Wafaa Elzahar: collecting the study data, writing the manuscript, doing the statistical analysis, recruitment of patients. Ahmed Arafa: collecting the study data, writing the manuscript, doing the statistical analysis, recruitment of patients. Doaa El Amrousy: writing the manuscript, doing the statistical analysis. Amira Youssef: doing the laboratory investigation of the study, help in writing the manuscript. Adel Erfan: the idea of the research, supervising the work of research, revising and approval of the manuscript.

Correspondence to Doaa El Amrousy.

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Research involving human participants

The study was approved by local Ethics Committee of faculty of Medicine of our University and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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The authors declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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Elzahar, W., Arafa, A., Youssef, A. et al. Urinary C-peptide creatinine ratio to differentiate type 2 diabetes mellitus from type 1 in pediatric patients. Eur J Pediatr (2020). https://doi.org/10.1007/s00431-020-03606-7

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Keywords

  • UCPCR
  • T1DM
  • T2DM
  • Children