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Simple, cheap C-peptide helps patients get proper diabetes diagnosis and treatment

A simple and inexpensive test to measure the body's insulin levels will help clinicians determine what type of diabetes patient has, which means many people with diabetes may change treatment.

This test has meant many more diabetes patients getting the correct diagnosis of the type of diabetes they have and is the focus of meetings at the Diabetes UK Professional Conference in Liverpool on Thursday March 7th.

Researchers at the University of Exeter Medical School have developed simple and inexpensive ways to measure C-peptide and have shown that this test can reveal which treatment is most effective for people with diabetes. Clinicians at the Western General Hospital in Edinburgh have been using the new test on every person thought to have type 1 diabetes in their clinic for over three years and have shown that some actually have other types of diabetes and can stop being treated with insulin .

C-peptide is produced at the same time and in the same quantities as insulin, which regulates our blood sugar level. By measuring C-peptide levels, doctors can now tell how much insulin a person is producing on their own, even when they are taking insulin injections as a treatment.

The Exeter team has developed a new urine test for C-peptide, and has shown that a simple blood test, if seen by a person in the clinic, can also accurately measure the C-peptide, replacing previous methods were expensive and time consuming. These tests are now available in virtually every hospital in the UK, and cost as little as £ 10.

The team will demonstrate how urine and blood, C-peptide, can be used to robustly identify what type of diabetes a person has and determine which treatment will work for them. This is critical to proper treatment, training, and follow-up care. By offering this test to people intended to have Type 1 diabetes in their clinic, the Edinburgh researchers have shown that many are high in C-peptide, increasing the possibility of other types of diabetes. Some of these patients have been able to stop insulin and switch to tablet treatment. This testing also found that in some of these patients who had diabetes had a genetic cause that is important both for treatment and for other people in their families.

The new test is already in most NHS trusts, and is now offered to anyone diagnosed with type 1 diabetes for at least 3 years in Glasgow and Edinburgh.

Professor Mark Strachan, of the Western General Hospital, Edinburgh, said, “We have now measured C-peptide in over 750 people with a doctor diagnosis of type 1 diabetes who attended our clinic at the Western General Hospital. So far, we've got a new diagnosis of genetic diabetes in eight people, and changed the diagnosis of type 2 diabetes in the other 28 people. This has allowed us to make changes to the treatment in many of these people and in 12 people we have actually been able to stop using insulin therapy. "

Dr. Tim McDonald of the University of Exeter Medical School said, “Getting the correct diagnosis of diabetes is absolutely key to getting the best out of treatment and avoiding complications. We have shown that C-peptide is cheaper, more accurate, and easier to use than previous methods. It is really gratifying to see that this is making a difference in improving the health of the patient already. My lab alone has received 7,000 test samples in the past 12 months. "

Dr. Angus Jones, of the University of Exeter Medical School, said, “It can be extremely difficult for clinicians to differentiate between Type 1 and Type 2, and a number of genetic sub-types, of diabetes. Up to 15 percent of insulin-treated patients are diagnosed. That number rises to 40 percent of people who develop type 1 diabetes after the age of 30, as identifying type 1 diabetes at that age is very difficult. Treatment for this varies a lot; this is why being able to confirm when a person has the correct diagnosis is so important. For example people with type 1 diabetes need lifelong insulin injections and become very unwell without this treatment, but most people with type 2 and genetic subtypes of diabetes can be treated effectively with pills. By measuring C-peptide in a person being treated with insulin, we can ensure that you are getting the correct diagnosis and the best treatment for you. "

Dr. Emily Burns is Head of Research Communications at Diabetes UK. She said:

Getting the correct diagnosis of diabetes is so important, it means people are getting the right treatment for you and could avoid serious complications. But the different forms of diabetes can be difficult to diagnose accurately. A researcher at the University of Exeter has led the way in improving how we diagnose diabetes, and in making the tests widely available to ensure that as many people as possible can benefit. "

The team's research also shows that C-peptide testing is handy in clinics. They identified optimal storage conditions for the samples that were previously thought to be unstable, so sample collection is now much easier. They showed that using a certain preservative means that blood C-peptide is stable for more than 24 hours. For the first time, that is, it makes sense to conduct a test in order to be measured in primary care and outpatient clinics. This evidence together removed crucial barriers that had previously blocked widespread adoption of this test in routine clinical care.

The group also demonstrated how urine and blood, C-peptide, can be used to robustly identify the correct subcategory of diabetes, which is critical to proper treatment and follow-up. They showed that C-Peptide can be used as a cheap and practical test to identify children and young adults with a genetic form of diabetes that requires expensive genetic testing to confirm the diagnosis.

The team set out to conduct clinical studies that show that C-peptide is a key indicator of how well a drug is working in any patient on certain diabetes drugs. C-peptide is able to layer in response to expensive therapy in insulin-treated diabetes - meaning the test can identify individuals who will not benefit from this drug.