Relationship Between β-Cell Function, Metabolic Control, and Microvascular Complications in Type 2 Diabetes Mellitus

• DOI: 10.1089/dia.2014.0214
• Publication Date: 2015-01-09T19:10:39Z
• Authors: Lihua Zhao; Jing Ma; Shaoxin Wang; Yun Xie
• Keywords: Adult; Blood Glucose; Glycated Hemoglobin; Male; C-Peptide; Fasting; Glucose Tolerance Test; Middle Aged; Body Mass Index; 3. Good health; 03 medical and health sciences; Cross-Sectional Studies; Logistic Models; 0302 clinical medicine; Diabetes Mellitus, Type 2; Non-alcoholic Fatty Liver Disease; Area Under Curve; Insulin-Secreting Cells; Humans; Female; Insulin Resistance; Diabetic Angiopathies; Aged

This study investigated the relationship among β-cell function, metabolic control, and diabetic microvascular complications in patients with type 2 diabetes mellitus (T2DM).In total, 885 patients with type 2 diabetes mellitus (DM) were recruited from January 2012 to January 2014 and grouped into three groups according to the area under the curve of C-peptide [AUC(C-pep)] during the 75-g oral glucose tolerance test. Logistic regression analyses were used to evaluate the association between C-peptide and microvascular complications.The prevalence of diabetic microvascular complications decreased from the first to the third AUC(C-pep) tertile (P < 0.01 for all), whereas the rates of nonalcoholic fatty liver disease (NAFLD) was positively associated with AUC(C-pep) values. Patients with lower AUC(C-pep) tertile exhibited higher levels of glycosylated hemoglobin and high-density lipoprotein cholesterol and longer duration of DM; however, levels of triglycerides, fasting C-peptide, 2-h C-peptide, body mass index, and homeostasis model assessment of insulin resistance index were lower compared with the third tertile. Comparison among patients with a similar DM duration showed a higher level of AUC(C-pep) was inversely associated with prevalence of microvascular complications. The odds ratios for nephropathy, retinopathy, and neuropathy in the lowest versus the highest AUC(C-pep) tertile were 3.10 (95% confidence interval, 2.01-4.78), 2.83 (1.73-4.64), and 2.04 (1.37-3.04) after adjustment for confounding factors.Higher AUC(C-pep) levels were associated with a decreased prevalence of microvascular complications and a good level of glycemic control, whereas higher endogenous insulin levels were linked to the components of metabolic syndrome and increased rates of NAFLD.