Urine C-peptide creatinine ratio is a noninvasive alternative to the mixed-meal tolerance test in children and adults with type 1 diabetes
Open accessAbstract
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 (age of diagnosis median 14 years [interquartile range 10–22]; 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 and 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.
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Urine post-meal C-peptide creatinine ratio is an alternative to serum C-peptide testing.
“Measurement of urine post meal C-peptide creatinine ratio (UCPCR) is an alternative to serum C-peptide testing(4–7).”
From Most people with long-duration type 1 diabetes in a large population-based study are insulin microsecretors (2015) · cites this paper as [6]
UCPCR requires only a single spot urine sample and remains stable for 3 days at room temperature, which makes large community studies feasible because samples can be posted.
“UCPCR involves a single, spot urine measurement and has the advantage of long term stability (3 days) at room temperature which facilitates large scale community studies as samples can be posted.”
From Most people with long-duration type 1 diabetes in a large population-based study are insulin microsecretors (2015) · cites this paper as [6]
Home UCPCR is highly correlated with MMTT serum C-peptide in type 1 diabetes, and both urine and serum were equally sensitive in detecting very low level C-peptide in long-standing type 1 diabetes.
“However a home UCPCR is highly correlated with MMTT serum C-peptide in T1D (6) and both urine and serum were equally sensitive in detecting very low level C peptide in long standing T1D(1).”
From Most people with long-duration type 1 diabetes in a large population-based study are insulin microsecretors (2015) · cites this paper as [6]
Home UCPCR correlates with 90-minute serum C-peptide in the mixed meal tolerance test.
“We have shown that a home UCPCR correlates with 90 minute serum C-peptide in the mixed meal tolerance test (MMTT)(6; 7).”
From Most people with long-duration type 1 diabetes in a large population-based study are insulin microsecretors (2015) · cites this paper as [6]
Any bias from the variable meal or insulin administration is small and would only make C-peptide less likely to be detected.
“Any bias is small from the variable meal(6) or insulin administration(10) and would only result in C-peptide being less likely to be detected.”
From Most people with long-duration type 1 diabetes in a large population-based study are insulin microsecretors (2015) · cites this paper as [6]
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References 15 · Cited by 82
- Authors
- Besser, R. E. J., Ludvigsson, J., Jones, A. G., McDonald, T. J., Shields, B. M., Knight, B. A., & Hattersley, A. T.
- Affiliations
- University of Exeter (GB)
- Linköping University (SE)
- Corresponding author
- Hattersley, Andrew T.
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2011-02-17
- Volume
- 34
- Issue
- 3
- Pages
- 607-609
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC3041191
- OpenAlex
- W2167169684
- Cited by
- 82
- References
- 15
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 7 · 2023: 5 · 2022: 7 · 2021: 4 · 2020: 7 · 2019: 1 · 2018: 4 · 2017: 4 · 2016: 10 · 2015: 3 · 2014: 4 · 2013: 9 · 2012: 6
- FWCI
- 4.18
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Care (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- Royal Devon and Exeter Research Repository (Royal Devon and Exeter) (submittedVersion)
- Funders
- Centre of Excellence for Environmental Decisions, Australian Research Council
- National Institute for Health and Care Research (ACF-2008-23-001, DRF-2010-03-72)
- Diabetes UK
- European Commission (223211)
- Vetenskapsrådet
- Barndiabetesfonden
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 1 diabetes, mixed meal tolerance test, endogenous insulin secretion, C-peptide, non-invasive biomarkers, sensitivity and specificity
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, C-Peptide, Creatinine, Diabetes Mellitus, Type 1, Female, Glucose Tolerance Test, Humans, Male, Middle Aged, Young Adult
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