Urine C-peptide creatinine ratio can be used to assess insulin resistance and insulin production in people without diabetes: an observational study
Open accessAbstract
Objectives: The current assessment of insulin resistance (IR) in epidemiology studies relies on the blood measurement of C-peptide or insulin. A urine C-peptide creatinine ratio (UCPCR) can be posted from home unaided. It is validated against serum measures of the insulin in people with diabetes. We tested whether UCPCR could be a surrogate measure of IR by examining the correlation of UCPCR with serum insulin, C-peptide and HOMA2 (Homeostasis Model Assessment 2)-IR in participants without diabetes and with chronic kidney disease (CKD). Design: Observational study. Setting: Single-centre clinical research facility. Participants: 37 healthy volunteers and 30 patients with CKD (glomerular filtration rate 15–60) were recruited. Primary and secondary endpoints: Serum insulin, C-peptide and glucose at fasting (0), 30, 60, 90 and 120 min were measured during an oral glucose tolerance test (OGTT). Second-void fasting UCPCR and 120 min post-OGTT UCPCR were collected. HOMA2-IR was calculated using fasting insulin and glucose. The associations between UCPCR and serum measures were assessed using Spearman's correlations. Results: In healthy volunteers, fasting second-void UCPCR strongly correlated with serum insulin (r s =0.69, p<0.0001), C-peptide (r s =0.73, p<0.0001) and HOMA2-IR (r s =−0.69, p<0.0001). 120 min post-OGTT UCPCR correlated strongly with C-peptide and insulin area under the curve. In patients with CKD, UCPCR did not correlate with serum C-peptide, insulin or HOMA2-IR. Conclusions: In participants with normal renal function, UCPCR may be a simple, practical method for the assessment of IR in epidemiology studies.
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Median post-OGTT UCPCR was 3.8 nmol/mmol (IQR 2.4-7.0) in 38 non-diabetic controls.
“and median post OGTT (n=38) UCPCR was 3.8 (IQR 2.4-7.0) in 38 non-diabetic controls (21).”
From Most people with long-duration type 1 diabetes in a large population-based study are insulin microsecretors (2015) · cites this paper as [21]
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- Authors
- Oram, R. A., Rawlingson, A., Shields, B. M., Bingham, C., Besser, R. E. J., McDonald, T. J., Knight, B. A., & Hattersley, A. T.
- Affiliations
- University of Exeter (GB)
- Royal Devon & Exeter NHS Foundation Trust (GB)
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
- Corresponding author
- Oram, Richard A
- ORCID
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2013-12
- Volume
- 3
- Issue
- 12
- Pages
- e003193
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC3884748
- OpenAlex
- W2134197986
- Cited by
- 25
- References
- 17
- Citations by year
- 2026: 3 · 2025: 1 · 2023: 4 · 2022: 2 · 2021: 3 · 2020: 5 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 2 · 2014: 2
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMJ Open (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Figshare (submittedVersion)
- Open Research Exeter (University of Exeter) (submittedVersion, cc-by)
- Royal Devon and Exeter Research Repository (Royal Devon and Exeter) (submittedVersion)
- Funders
- Wellcome Trust (067463)
- National Institute for Health and Care Research (NF-SI-0611-10219)
- Diabetes UK (11/0004171)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Keywords
- insulin resistance, insulin secretion, C-peptide, HOMA2-IR, chronic kidney disease, oral glucose tolerance test, non-invasive biomarkers, healthy volunteers
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