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Cited by 261Diabetes and associated disordersDiabetes Management and ResearchPancreatic function and diabetes

Prevalence of detectable C-peptide according to age at diagnosis and duration of type 1 diabetes

Davis, Asa K., DuBose, Stephanie N., Haller, Michael J., Miller, Kellee M., DiMeglio, Linda A., Bethin, Kathleen E., Goland, Robin S., Greenberg, Ellen M. +6 more·2015·Diabetes Care
DOI 10.2337/dc14-1952
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Abstract

OBJECTIVE: It is generally accepted that complete β-cell destruction eventually occurs in individuals with type 1 diabetes, which has implications for treatment approaches and insurance coverage. The frequency of residual insulin secretion in a large cohort of individuals at varying ages of diagnosis and type 1 diabetes duration is unknown. RESEARCH DESIGN AND METHODS: The frequency of residual insulin secretion was determined by measurement of nonfasting serum C-peptide concentration in 919 individuals with type 1 diabetes according to prespecified groups based on age at diagnosis and duration of disease (from 3 to 81 years' duration). Stimulated C-peptide was measured in those with detectable nonfasting values and a group of those with undetectable values as control. RESULTS: The overall frequency of detectable nonfasting C-peptide was 29%, decreasing with time from diagnosis regardless of age at diagnosis. In all duration groups, the frequency of C-peptide was higher with diagnosis age >18 years compared with ≤18 years. Nineteen percent of those with undetectable nonfasting C-peptide were C-peptide positive upon stimulation testing. CONCLUSIONS: The American Diabetes Association’s definition of type 1 diabetes as “usually leading to absolute insulin deficiency” results in clinicians often considering the presence of residual insulin secretion as unexpected in this population. However, our data suggest that residual secretion is present in almost one out of three individuals 3 or more years from type 1 diabetes diagnosis. The frequency of residual C-peptide decreases with time from diagnosis regardless of age at diagnosis, yet at all durations of disease, diagnosis during adulthood is associated with greater frequency and higher values of C-peptide.

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  • When sensitive C-peptide measurements are performed, 30-80% of people with long-term type 1 diabetes are found to be insulin microsecretors.

    “When sensitive C-peptide measure ments are performed, 30–80% of people with long-term type 1 diabetes are found to be insulin microsecretors.64–67”

    From Type 1 diabetes (2018) · cites this paper as [64]

  • Adult-onset type 1 diabetes mellitus is associated with higher values of C-peptide than in childhood-onset type 1 diabetes mellitus.

    “Similarly, adult-onset T1DM is associated with higher values of C-peptide than in childhood-onset T1DM69, which might be difficult to distinguish from levels observed in T2DM.”

    From The epidemiology of type 1 diabetes mellitus in older adults (2025) · cites this paper as [69]

  • Some adults with type 1 diabetes maintain some insulin secretion for years after diagnosis and may not require insulin treatment at diagnosis.

    “Although profound insulin deficiency is the hallmark of type 1 diabetes, some adults with type 1 diabetes maintain some insulin secretion for years after diagnosis and may not require insulin treatment at diagnosis (5), leading to diagnostic uncertainty about the type of diabetes and its management.”

    From The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) (2021) · cites this paper as [5]

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Authors
Davis, A. K., DuBose, S. N., Haller, M. J., Miller, K. M., DiMeglio, L. A., Bethin, K. E., Goland, R. S., Greenberg, E. M., Liljenquist, D. R., Ahmann, A. J., Marcovina, S. M., Peters, A. L., Beck, R. W., & Greenbaum, C. J.
Affiliations
  • Virginia Mason Medical Center (US)
  • Jaeb Center for Health Research (US)
  • University of Florida (US)
  • Indiana University School of Medicine (US)
  • University at Buffalo, State University of New York (US)
  • Columbia University (US)
  • Rocky Mountain Diabetes and Osteoporosis Center (US)
  • Oregon Health & Science University (US)
  • Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, WA
  • University of Southern California (US)
Corresponding author
Davis, Asa K.
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2014-12-17
Volume
38
Issue
3
Pages
476-481
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc14-1952
OpenAlex
W1982948566
Cited by
261
References
19
Citations by year
2026: 18 · 2025: 18 · 2024: 22 · 2023: 24 · 2022: 28 · 2021: 27 · 2020: 24 · 2019: 21 · 2018: 24 · 2017: 20 · 2016: 18 · 2015: 16
FWCI
11.79
Type
journal article
Language
en
Open access
closed
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Funders
Leona M. and Harry B. Helmsley Charitable Trust
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
Keywords
type 1 diabetes, C-peptide, residual insulin secretion, age at diagnosis, disease duration, beta cell destruction, insulin deficiency, diagnostic criteria
MeSH terms
Insulin Secretion, Adolescent, Adult, Aged, Aged, 80 and over, C-Peptide, Child, Child, Preschool, Diabetes Mellitus, Type 1, Female, Humans, Insulin, Male, Middle Aged, Prevalence, Insulin-Secreting Cells, Young Adult

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