ESPE Abstracts

Introduction: Residual C-peptide secretion has been associated with less hypoglycemic events and lower glycemic variability in patients with Diabetes Mellitus type 1 (DM1), primarily in adults. The authors sought to evaluate the association between residual C-peptide secretion in pediatric patients with DM1 and glycemic control variables.

Methods: Cross-sectional study conducted in a level II hospital, in DM1 patients younger than 18 years old, treated with continuous subcutaneous insulin infusion, with a C-peptide value available between August 2021 and April 2022. Glycemic control variables were obtained through the insulin pumps, and were compared between individuals with undetectable C-peptide (<0.02ng/ml) and with residual secretion (≥0.02ng/ml).

Results: The sample included 36 participants, with a mean age of 12 years. Individuals with detectable C-peptide had an older age at diagnosis (9.8 years [3.6] vs 4.4 years [2.0], P<0,001) and shorter disease duration (42.5 months [22.4] vs 81.8 [37.3], P=0,001), compared with those with no c-peptide secretion, but no differences were found regarding sex or current age. C-peptide secretion was associated with less time below range (<70mg/dl) (3.9% [3.6] vs 7.2% [4.6], P=0.021), maintaining statistical significance after adjusting for potential confounding variables (disease duration and glycated hemoglobin) through logistic regression (P=0.024). Individuals with detectable C-peptide had less hypoglycemic events per week (1.4 [1.6] vs 2.8 [2.2], P=0.03), and less glycemic variability but without statistical significance (45.8% [6.2] vs 49.1% [5.1], P=0.130). No differences were found in glycated hemoglobin values, time in range and above range, mean glycemia or insulin doses.

Conclusion: Residual C-peptide secretion in pediatric DM1 patients seems to be associated with less time in hypoglycemia, suggesting that this might be a relevant marker regarding glycemic control. It also suggests that more intensive goals might be proposed more safely in these patients, with lower hypoglycemic risk. More studies are needed to evaluate potential c-peptide secretion preservation therapies.