Cited by 299Electrolyte and hormonal disordersDiabetes, Cardiovascular Risks, and LipoproteinsAdipokines, Inflammation, and Metabolic Diseases

Plasma Copeptin and the Risk of Diabetes Mellitus

Open access
Enhörning, Sofia, Wang, Thomas J., Nilsson, Peter M., Almgren, Peter, Hedblad, Bo, Berglund, Göran, Struck, Joachim, Morgenthaler, Nils G. +7 more·2010·Circulation

Abstract

BACKGROUND: Animal studies suggest that the arginine vasopressin system may play a role in glucose metabolism, but data from humans are limited. METHODS AND RESULTS: We analyzed plasma copeptin (copeptin), a stable C-terminal fragment of the arginine vasopressin prohormone. Using baseline and longitudinal data from a Swedish population-based sample (n=4742; mean age, 58 years; 60% women) and multivariable logistic regression, we examined the association of increasing quartiles of copeptin (lowest quartile as reference) with prevalent diabetes mellitus at baseline, insulin resistance (top quartile of fasting plasma insulin among nondiabetic subjects), and incident diabetes mellitus on long-term follow-up. New-onset diabetes mellitus was ascertained through 3 national and regional registers. All models were adjusted for clinical and anthropometric risk factors, cystatin C, and C-reactive protein. In cross-sectional analyses, increasing copeptin was associated with prevalent diabetes mellitus (P=0.04) and insulin resistance (P<0.001). During 12.6 years of follow-up, 174 subjects (4%) developed new-onset diabetes mellitus. The odds of developing diabetes mellitus increased across increasing quartiles of copeptin, even after additional adjustment for baseline fasting glucose and insulin (adjusted odds ratios, 1.0, 1.37, 1.79, and 2.09; P for trend=0.004). The association with incident diabetes mellitus remained significant in analyses restricted to subjects with fasting whole blood glucose <5.4 mmol/L at baseline (adjusted odds ratios, 1.0, 1.80, 1.92, and 3.48; P=0.001). CONCLUSIONS: Elevated copeptin predicts increased risk for diabetes mellitus independently of established clinical risk factors, including fasting glucose and insulin. These findings could have implications for risk assessment, novel antidiabetic treatments, and metabolic side effects from arginine vasopressin system modulation.

Integrity signals

Registry

Crossref · 10.1161/circulationaha.109.909663

Cites

37 of 37 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

4 of 15 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Pharmacological blockade of V2R was associated with a 5% incidence of hyperglycemic events during 30 days of tolvaptan treatment in patients with hyponatremia compared to 1% in controls (12/223 vs 2/220).

    “pharmacological blockade of the V2R, a potent stimulus of increased AVP secretion,35 was associated with a 5% incidence in hyperglycemic events during 30 days of tolvaptan treatment in patients with hyponatremia compared to 1% in controls, although numbers were small (12/223 vs 2/220).8”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [8] source
    • cites [35] source
  • Study design and conductcitation

    Given strict HbA1c criteria for new-onset diabetes in the MHR and the requirement of physician diagnosis in NDR and Diabetes 2000, those classified as new-onset diabetes cases are unlikely to be misclassified.

    “On the other hand, given the strict HbA1c criteria for new-onset diabetes in the MHR and the fact that the NDR and Diabetes 2000 registers require a physician diagnosis according to established diagnostic criteria,28, 29 those classified as new-onset diabetes cases in our study are unlikely to be misclassified.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [28] source

      The Research Design and Methods section says NDR data are reported by trained physicians and nurses during clinical visits and gives this study’s definition of type 2 diabetes. It does not say that NDR registration requires a physician diagnosis according to established diagnostic criteria. The MHR criteria and the citing authors’ inference about misclassification are not claims this citation specifically supports. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [29] source
  • Findingown data

    Continuous baseline copeptin was significantly higher in subjects who subsequently developed new-onset diabetes compared with those who did not, regardless of whether subjects with IFG at baseline were included.

    “Continuous copeptin concentration at baseline was significantly higher in subjects who subsequently developed new-onset diabetes compared with those who did not, regardless of whether subjects with IFG at baseline were included (Table 3).”
    Quote in the paperSubstantial claim
  • Findingown data

    The odds of insulin resistance increased with increasing copeptin in crude and adjusted analyses.

    “The odds of insulin resistance increased with increasing copeptin in both crude analysis and after adjustment for model 1 covariates and FBG (Table 2).”
    Quote in the paperSubstantial claim
  • Findingown data

    The association between copeptin and incident diabetes remained significant in subjects with baseline fasting whole blood glucose <5.4 mmol/L (adjusted ORs 1.0, 1.80, 1.92, and 3.48; P=0.001).

    “The association with incident diabetes remained significant in analyses restricted to subjects with fasting whole blood glucose <5.4 mmol/L at baseline (adjusted odds ratios 1.0, 1.80, 1.92, and 3.48; P=0.001).”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 3
  • May combine two claims. 15
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Recent findings show a cross-sectional association between plasma vasopressin and insulin resistance.

    “Interestingly, recent findings also indicate a cross-sectional association between plasma vasopressin and insulin resistance.3”
    Quote in the paperNot a substantial claim1 of 1 sources checked
  • May combine two claims.

    Premisecitation

    Mice lacking the V1bR have lower fasting plasma glucose and increased insulin sensitivity.

    “mice who lack the V1bR have the opposite phenotype of lower fasting plasma glucose and increased insulin sensitivity.21”
    Quote in the paperSubstantial claim1 of 1 sources checked
  • May combine two claims.

    Findingown data

    In subjects without IFG, adding copeptin to classical diabetes risk factors significantly improved the area under the ROC curve, consistent with improved discrimination.

    “In subjects without IFG, there was a significant improvement in the area under the ROC curve when copeptin was added to classical diabetes risk factors, consistent with an improvement in discrimination.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    In subjects free of diabetes, copeptin was positively associated with fasting blood glucose and plasma insulin.

    “In the segment of the population free of diabetes, i.e. in subjects with a range of glucose values that should not affect copeptin through osmolality, copeptin was positively associated with FBG (Figure 1). Additionally, copeptin was positively associated with plasma concentration of insulin (Figure 1).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    IDI was significantly improved by adding copeptin to the personal model in non-diabetic subjects (P=0.01) and non-IFG subjects (P=0.02), but not when added to the clinical model (P=0.35 and P=0.09).

    “IDI was significantly improved by adding copeptin to the personal model for diabetes prediction in both non-diabetic subjects (P=0.01) and in non-IFG subjects (P=0.02) but non-significant when added to the clinical model (P=0.35 in non-diabetic individuals, P=0.09 in non-IFG individuals).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    In subjects free of IFG, adding copeptin increased the area under the ROC curve from 0.663 to 0.713 (P=0.03) for the personal model and from 0.783 to 0.805 (P=0.04) for the clinical model.

    “In subjects free of IFG at baseline, the area under the ROC curve increased from 0.663 to 0.713 (P=0.03) and from 0.783 to 0.805 (P=0.04) when copeptin was added to the personal model and clinical model for diabetes prediction, respectively.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingown data

    When restricted to subjects without IFG, the Cox C-statistic increased from 0.671 to 0.721 in the personal model and from 0.790 to 0.811 in the clinical model.

    “When analyses were restricted to subjects without IFG at baseline, the C-statistic increased from 0.671 to 0.721 in the personal model and from 0.790 to 0.811 in the clinical model.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    Among non-diabetic subjects, copeptin was positively correlated with BMI, insulin, and glucose (Pearson r=0.091, 0.12, and 0.10, respectively; P<0.001 for all).

    “Among non-diabetic subjects at baseline, the Pearson correlation between copeptin and potential confounders, i.e. BMI, insulin and glucose, was 0.091, 0.12 and 0.10, respectively (P<0.001 for all).”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    FBG was the strongest risk factor for new-onset diabetes; each 1 mmol/L increase in baseline FBG increased the risk of future diabetes with an OR of 11.4 (95% CI 7.4-17.5) in the fully adjusted model.

    “As expected, FBG was the strongest risk factor for new-onset diabetes. Each 1 mmol/L increase of FBG at baseline increased the risk of future diabetes with an OR of 11.4 (95% CI 7.4–17.5) in the fully-adjusted model.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    In a reinvestigated subset, increasing copeptin quartile was associated with new-onset diabetes defined by elevated FBG in subjects free of diabetes (OR=1.42, 95% CI 1.04-1.94; P=0.029) and in subjects free of IFG (OR=1.67, 95% CI 1.07-2.63; P=0.025) after full adjustment.

    “Increasing quartile of copeptin was associated with new-onset diabetes using this criterion both in subjects free of diabetes at baseline (OR=1.42 95% CI=1.04–1.94; P=0.029) and in subjects free of IFG at baseline (OR=1.67 95% CI=1.07–2.63; P=0.025) after full adjustment”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Mice lacking the V1aR display impaired glucose tolerance, insulin resistance, and elevated AVP levels.

    “Mice lacking the V1aR display impaired glucose tolerance, insulin resistance and elevated AVP levels20”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] source
  • May combine two claims.

    Premisecitation

    Copeptin is a stable cleavage product of the C-terminal part of the AVP precursor, produced in equimolar amounts with AVP, with a long half-life, and not bound to platelets.

    “Copeptin is a cleavage product of the C-terminal part of the AVP precursor that is produced in equimolar amounts with AVP, a process similar to the generation of insulin and C-peptide. In contrast to AVP, copeptin is stable, has a long half-life, and is not bound to platelets.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [22] source
    • Rests on an assumption: Plasma AVP measurements are unreliable because AVP is unstable in vivo and ex vivo, is rapidly cleared from plasma, and is largely bound to platelets.
  • May combine two claims.

    Interpretationcitation

    Impaired V1aR signalling leads to elevated AVP, which then stimulates V1bR and contributes to insulin resistance and diabetes development.

    “These findings suggest a model in which impaired signalling through the V1aR leads to elevated levels of AVP which in turn stimulates the V1bR and contributes to insulin resistance and diabetes development.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Plasma copeptin reflects vasopressin levels and is elevated in myocardial infarction and predicts prognosis in patients who develop heart failure after myocardial infarction.

    “Plasma copeptin, a marker of vasopressin level, is elevated in myocardial infarction1 and predict prognosis in patients who developed heart failure after myocardial infarction.2”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [1] source
    • cites [2] source
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    AVP action is linked to liver glycogenolysis through V1aR and to insulin and glucagon secretion through V1bR.

    “In addition, AVP action has been linked to liver glycogenolysis (V1aR) and insulin and glucagon secretion (V1bR).14, 15”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [14] source
    • cites [15] source
  • May combine two claims.

    Study design and conductown data

    The differences in risk factors were equally or more pronounced when restricted to subjects free of IFG at baseline, excluding the possibility that findings were solely driven by subjects with IFG at baseline.

    “Importantly, these differences were equally, or more, pronounced when the study population was restricted to subjects free from IFG at baseline, excluding the possibility that our findings regarding established diabetes risk factors and copeptin in relation to new-onset diabetes were solely driven by subjects who had IFG at the MDC-CC baseline exam.”
    Quote in the paperSubstantial claim
16 of 16
  • The paper relies on this without support.

    Plasma AVP measurements are unreliable because AVP is unstable in vivo and ex vivo, is rapidly cleared from plasma, and is largely bound to platelets.

    “There are major concerns regarding the reliability of AVP measurements in plasma, as AVP is an unstable molecule both in vivo and ex vivo, is rapidly cleared from plasma and is largely attached to platelets in the circulation.”
1 of 1

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Authors
Enhörning, S., Wang, T. J., Nilsson, P. M., Almgren, P., Hedblad, B., Berglund, G., Struck, J., Morgenthaler, N. G., Bergmann, A., Lindholm, E., Groop, L., Lyssenko, V., Orho-Melander, M., Newton-Cheh, C., & Melander, O.
Affiliations
  • From the Department of Clinical Sciences, Lund University (S.E., P.M.N., P.A., B.H., G.B., E.L., L.G., V.L., M.O.M., O.M.), and Department of Internal Medicine (S.E., P.M.N., O.M.), Malmö University Hospital, Malmö, Sweden; Cardiology Division (T.J.W., C.N.-C.), Center for Human Genetic Research (C.N.-C.), and Cardiovascular Research Center (T.J.W., C.N.-C.), Massachusetts General Hospital, Harvard Medical School, Boston; Program in Medical and Population Genetics, Broad Institute of Harvard and...
  • Broad Institute (US)
Venue
Circulation
Published
2010-05-18
Volume
121
Issue
19
Pages
2102-2108
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
OpenAlex
W1963947490
Cited by
299
References
37
Citations by year
2026: 7 · 2025: 9 · 2024: 19 · 2023: 11 · 2022: 12 · 2021: 23 · 2020: 27 · 2019: 27 · 2018: 20 · 2017: 18 · 2016: 32 · 2015: 31 · 2014: 17 · 2013: 20 · 2012: 15
FWCI
12.23
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Lund University Publications (Lund University) (submittedVersion)
Funders
  • National Heart, Lung, and Blood Institute (R01HL086875, R01HL083197, R01HL098283, K23HL080025)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK081572)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
Keywords
copeptin, diabetes mellitus, vasopressin, insulin resistance, incident diabetes risk, glucose metabolism, fasting insulin, fasting blood glucose, biomarkers of diabetes risk
MeSH terms
Blood Glucose, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Glycopeptides, Humans, Insulin, Insulin Resistance, Male, Middle Aged, Predictive Value of Tests, Risk Factors, Sweden, Prevalence, Multivariate Analysis, Logistic Models

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