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. 2022 Mar;130(3):200-204.
doi: 10.1055/a-1242-9809. Epub 2020 Sep 18.

Considering Insulin Secretory Capacity as Measured by a Fasting C-Peptide/Glucose Ratio in Selecting Glucose-Lowering Medications

Andreas Fritsche  1   2   3 , Martin Heni  1   2   3 , Andreas Peter  1   3   4 , Baptist Gallwitz  2   3 , Monika Kellerer  5 , Andreas L Birkenfeld  1   2   3 , Hans-Ulrich Häring  1   2   3 , Robert Wagner  1   2   3
Affiliations

Considering Insulin Secretory Capacity as Measured by a Fasting C-Peptide/Glucose Ratio in Selecting Glucose-Lowering Medications

Andreas Fritsche et al. Exp Clin Endocrinol Diabetes. 2022 Mar.

Abstract
in English, German

Type 2 diabetes mellitus is a heterogeneous disease. Recently introduced new subclassifications promise more efficacious, tailored treatments which could complement current guidelines. In the differentiation of the new diabetes subphenotypes, assessment of insulin secretion is one of the essential components. Based on a large number of insulin secretion measurements, we propose fasting C-peptide/glucose ratio (CGR) as an adequate and practicable estimate of insulin secretion. CGR discriminates insulin deficiency from insulin hypersecretion. We suggest using insulin secretion, determined from CGR, as an essential input for therapeutic decisions at the beginning or modification of diabetes treatment. Furthermore, we propose 3 practical steps to guide decisions in the subtype-specific therapy of diabetes mellitus. The first step consists of detecting insulin deficiency indicated by a low CGR with the need for immediate insulin therapy. The second step is related to high CGR and aims at lowering cardiovascular risk associated with diabetes. The third step is the consideration of a de-escalation of glucose-lowering therapy in individuals with mild diabetes subphenotypes.

Type 2 diabetes mellitus is a heterogeneous disease. Recently introduced new subclassifications promise more efficacious, tailored treatments which could complement current guidelines. In the differentiation of the new diabetes subphenotypes, assessment of insulin secretion is one of the essential components. Based on a large number of insulin secretion measurements, we propose fasting C-peptide/glucose ratio (CGR) as an adequate and practicable estimate of insulin secretion. CGR discriminates insulin deficiency from insulin hypersecretion. We suggest using insulin secretion, determined from CGR, as an essential input for therapeutic decisions at the beginning or modification of diabetes treatment. Furthermore, we propose 3 practical steps to guide decisions in the subtype-specific therapy of diabetes mellitus. The first step consists of detecting insulin deficiency indicated by a low CGR with the need for immediate insulin therapy. The second step is related to high CGR and aims at lowering cardiovascular risk associated with diabetes. The third step is the consideration of a de-escalation of glucose-lowering therapy in individuals with mild diabetes subphenotypes.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1 a
Fig. 1 a
Association between fasting C-peptide / glucose ratio (CGR) and HOMA 2-B in individuals with normal glucose tolerance, prediabetes and newly diagnosed type 2 diabetes. b Association between fasting C-peptide / glucose ratio (CGR) and Homa2-B in newly diagnosed type 2 diabetes. Vertical lines indicate proposed limits for insulin deficiency (CGR<2) and non-insulin based therapy (CGR>5) c CGR on day of admission in 330 individuals with diabetes admitted to hospital for diabetes treatment, red lines indicate median CGR of the respective type of diabetes
Fig. 2
Fig. 2
Use of CGR for diabetes therapy. DPP4i=Dipeptidylpeptidase-4 inhibitor; SGLT2i=Sodium dependent glucose co-transporter-2 inhibitor; GLP1-RA=glucagon like peptide 1 receptor agonist, TZD=thiazolidinedione, SU=sulfonylurea.
See this image and copyright information in PMC

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