Letter: Basal C-peptide Level as a Surrogate Marker of Subclinical Atherosclerosis in Type 2 Diabetes Patients (Diabetes Metab J 2011;35:41-9)

Min Suk Lee; Hae Jin Kim

doi:10.4093/dmj.2011.35.2.188

Articles

Page Path: HOME > Diabetes Metab J > Volume 35(2); 2011 > Article

Letter Letter: Basal C-peptide Level as a Surrogate Marker of Subclinical Atherosclerosis in Type 2 Diabetes Patients (Diabetes Metab J 2011;35:41-9): Min Suk Lee, Hae Jin Kim; Diabetes & Metabolism Journal 2011;35(2):188-189.
DOI: https://doi.org/10.4093/dmj.2011.35.2.188
Published online: April 30, 2011

4,330 Views
22 Download

Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.

Corresponding author: Hae Jin Kim. Department of Endocrinology and Metabolism, Ajou University School of Medicine, San 5 Woncheon-dong, Yeongtong-gu, Suwon 443-721, Korea. jinkim@ajou.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Full Article

Download PDF

REFERENCES

Patients with type 2 diabetes mellitus (T2DM) are at high risk for coronary heart disease, cerebrovascular disease or stroke, and peripheral vascular disease. These macrovascular diseases are common causes of morbidity and mortality among people with diabetes [1,2]. Therefore, there has been considerable clinical interest in the development of novel biomarkers that may help in the detection of individuals at high risk for cardiovascular diseases [3].

In a recent issue of Diabetes & Metabolism Journal, Kim and colleagues presented an article regarding basal C-peptide level as a surrogate marker of subclinical atherosclerosis in type 2 diabetic patients [4]. The authors found a simple positive correlation between basal C-peptide and intima-media thickness (IMT). The multiple regression analysis also showed that basal C-peptide significantly correlated with IMT (P=0.043) but did not correlate with the ten-year coronary heart disease (CHD) risk as defined by the United Kingdom Prospective Diabetes Study (UKPDS) risk engine (P=0.226). The study concluded that basal C-peptide was related to cardiovascular predictors (IMT) of T2DM, suggesting that basal C-peptide provides a further indication of cardiovascular disease.

Although it yielded interesting results, the study by Kim et al. left some questions to be answered. The relationships between insulin or C-peptide and atherosclerosis or the risk of cardiovascular disease are controversial. The result of their study was consistent with those of previous studies that showed that levels of fasting plasma proinsulin, C-peptide, and insulin due to cross-reacting RIA were associated with common carotid artery IMT independent of several conventional risk factors for atherosclerosis [5]. However, some studies have reported that C-peptide level was associated with diabetic microvascular but not macrovascular complications in patients with T2DM [6]. Others have reported that early thickening and damage to the arterial wall in T2DM might be related to relative fasting hypoinsulinaemia [7].

These differences in results may be originated to differences in the clinical characteristics of the study subjects. In the present study, the IMT measurement was performed in hospitalized patients in only one of two involved institutes. Kim et al. did not explain how many subjects were included in IMT measurement or whether there were differences in the clinical characteristics between those who underwent IMT measurement and those who did not.

As mentioned, basal C-peptide level has a strong association with insulin resistance and is a better surrogate than insulin for estimating insulin resistance. In the present study, however, C-peptide level had a simple negative correlation with HbA1c, suggesting that glycemic control in the more insulin-resistant patients was more intensive. Selvin et al. [8] reported several important associations between A1C and known risk factors for cardiovascular disease and suggested that A1C is independently related to carotid IMT. Kim et al. [2] also reported that changes in the mean IMT correlated with average values of HbA1c (r=0.219, P=0.007) in Korean type 2 diabetic patients, whereas the present study reported that HbA1c, a possible risk factor of cardiovascular diseases, did not correlate with IMT. It could influence the result that C-peptide did not correlate with the ten-year CHD risk according to the UKPDS risk engine, although it correlated with IMT, a cardiovascular predictor of T2DM.

Although their study had some limitations, this study of Kim and colleagues is an important work because they not only suggested a candidate surrogate marker of atherosclerosis in T2DM patients, but also illustrated the role of insulin in the pathogenesis of atherosclerosis in T2DM. We greatly appreciate the efforts of the authors in conducting such an intriguing work.

REFERENCES

1. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998;339:229-234. Article PubMed
2. Kim HJ, Ahn CW, Kang ES, Myoung SM, Cha BS, Won YJ, Lim SK, Kim KR, Huh KB, Lee HC. The level of 2-h post-challenge glucose is an independent risk factor of carotid intima-media thickness progression in Korean type 2 diabetic patients. J Diabetes Complications 2007;21:7-12. Article PubMed
3. Ridker PM, Brown NJ, Vaughan DE, Harrison DG, Mehta JL. Established and emerging plasma biomarkers in the prediction of first atherothrombotic events. Circulation 2004;109(25):Suppl 1. IV6-IV19. Article PubMed
4. Kim ST, Kim BJ, Lim DM, Song IG, Jung JH, Lee KW, Park KY, Cho YZ, Lee DH, Koh GP. Basal C-peptide level as a surrogate marker of subclinical atherosclerosis in type 2 diabetic patients. Diabetes Metab J 2011;35:41-49. Article PubMed PMC
5. Bokemark L, Wikstrand J, Wedel H, Fagerberg B. Atherosclerosis and Insulin Resistance sstudy (AIR). Insulin, insulin propeptides and intima-media thickness in the carotid artery in 58-year-old clinically healthy men. The Atherosclerosis and Insulin Resistance study (AIR). Diabet Med 2002;19:144-151. Article PubMed
6. Kim BY, Jung CH, Mok JO, Kang SK, Kim CH. Association between serum C-peptide levels and chronic microvascular complications in Korean type 2 diabetic patients. Acta Diabetol Epub 2011 Jan 7. DOI: 10.1007/s00592-010-0249-6.Article PDF
7. Elkeles RS, Diamond JR, El-Bahghouti N, Dhanjil S, Nicolaides A, Geroulakos G, Renton S, Anyaoku V, Richmond W, Mather H, Sharp P. Relative fasting hypoinsulinaemia and ultrasonically measured early arterial disease in type 2 diabetes. The SENDCAP Study Group, St. Mary's, Ealing, Northwick Park Diabetes Cardiovascular Disease Prevention Study. Diabet Med 1996;13:247-253. Article PubMed
8. Selvin E, Coresh J, Golden SH, Boland LL, Brancati FL, Steffes MW. Glycemic control, atherosclerosis, and risk factors for cardiovascular disease in individuals with diabetes: the atherosclerosis risk in communities study. Diabetes Care 2005;28:1965-1973. PubMed

Figure & Data

References

Citations

Citations to this article as recorded by

PubReader

Cite

CITE: export Copy Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Letter: Basal C-peptide Level as a Surrogate Marker of Subclinical Atherosclerosis in Type 2 Diabetes Patients (Diabetes Metab J 2011;35:41-9)

Diabetes Metab J. 2011;35(2):188-189. Published online April 30, 2011

DOI: https://doi.org/10.4093/dmj.2011.35.2.188

XML Download