Background: This study investigated the natural progression of β-cell function in Chinese autoimmune type 1 diabetic (T1D) patients and clarified factors possibly influencing the course of the disease.
Methods: The natural progression of β-cell function of 325 newly diagnosed Chinese autoimmune T1D patients was assessed by fasting and postprandial C-peptide (FCP and PCP, respectively) levels. β-Cell function failure was defined as FCP <50 pM and PCP <100 pM, whereas preserved β-cell function was defined as FCP >200 pM or PCP >400 pM. β-Cell function that did not meet these criteria was described as residual.
Results: At initial recruitment, 33.3% of patients had β-cell function failure, whereas 41.0% and 25.8% of patients had preserved or residual β-cell function, respectively. The percentage of patients who developed β-cell function failure during follow-up at 12, 24, 36, and 48 months after recruitment to the study was 55.8%, 75.6%, 86.7%, and 92.7%, respectively. Moreover, the slope of the β-cell function curve decreased over time, indicating that the pattern of its decline was non-linear and tapering. Seven percent of patients did not develop β-cell function failure within 4 years after diagnosis. Patients with lower initial FCP levels were more likely to develop β-cell function failure.
Conclusions: Chinese autoimmune T1D patients have considerable residual β-cell function at initial diagnosis, and the manner of progression of β-cell function failure is non-linear with a tapering decay rate. Furthermore, initial FCP levels may predict β-cell function failure in Chinese autoimmune T1D patients.
摘要: 背景 本研究探索了中国自身免疫1型糖尿病患者胰岛功能衰退模式，并寻找可能影响疾病进程的因素。 方法 入组325例初诊自身免疫1型糖尿病患者，随访观察其空腹C肽(FCP)和餐后C肽(PCP)的变化。FCP<50pmol/L且PCP<100pmol/L定义为β细胞功能衰竭，FCP>200pmol/L或PCP>400pmol/L定义为β细胞功能保留，FCP、PCP水平介于上述范围之间定义为β细胞功能残余。 结果 入组时，33%的患者β细胞功能衰竭，41%的患者β功能保留，25.8%的患者β细胞功能残余。入组后第12、24、36、48个月随访时，胰岛β细胞功能衰竭的患者比例分别达到55.8%、75.6%、86.7%和92.7%。β细胞功能随时间变化曲线呈现出非线性特征，其斜率随时间逐渐变小。入组后4年内随访时仍有约7%的患者β细胞功能未衰竭。入组FCP水平越低，患者在随访过程中越容易出现β细胞功能衰竭。 结论 中国自身免疫1型糖尿病患者初诊时胰岛β细胞功能尚可，诊后β细胞功能下降的速度呈现出非线性的先快后慢特征。初诊FCP水平可作为预测患者胰岛β细胞功能衰竭的指标。.
Keywords: 1型糖尿病; C-peptide; C-肽; autoimmune; type 1 diabetes mellitus; β-cell function; β细胞功能; 自身免疫.
© 2019 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.