Home urine C‐peptide creatinine ratio (UCPCR) testing can identify type 2 and MODY in pediatric diabetes. Issue 3 (4th January 2013)

• Record Type: Journal Article
• Authors: Besser, Rachel EJ; Shields, Beverley M; Hammersley, Suzanne E; Colclough, Kevin; McDonald, Timothy J; Gray, Zoe; Heywood, James JN; Barrett, Timothy G; Hattersley, Andrew T
• Is Part Of: Pediatric diabetes. Volume 14:Issue 3(2013)
• Page Start: 181
• Page End: 188
• Publication Date: 2013-01-04
• Subjects: Diabetes in children -- Periodicals; 616.462
• DOI: 10.1111/pedi.12008
• Languages: English
• ISSNs: 1399-543X

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="pedi12008-sec-0001" sec-type="section"> <title>Background</title> <p>Making the correct diabetes diagnosis in children is crucial for lifelong management. Type 2 diabetes and maturity onset diabetes of the young (MODY) are seen in the pediatric setting, and can be difficult to discriminate from type 1 diabetes. Postprandial urinary C‐peptide creatinine ratio (UCPCR) is a non‐invasive measure of endogenous insulin secretion that has not been tested as a diagnostic tool in children or in patients with diabetes duration <5 yr. We aimed to assess whether UCPCR can discriminate type 1 diabetes from MODY and type 2 in pediatric diabetes.</p> </sec> <sec id="pedi12008-sec-0002" sec-type="section"> <title>Methods</title> <p>Two‐hour postprandial UCPCR was measured in 264 patients aged <21 yr (type 1, n = 160; type 2, n = 41; and MODY, n = 63). Receiver operating characteristic curves were used to identify the optimal UCPCR cutoff for discriminating diabetes subtypes.</p> </sec> <sec id="pedi12008-sec-0003" sec-type="section"> <title>Results</title> <p>UCPCR was lower in type 1 diabetes [0.05 (<0.03–0.39) nmol/mmol median (interquartile range)] than in type 2 diabetes [4.01 (2.84–5.74) nmol/mmol, p < 0.0001] and MODY [3.51 (2.37–5.32) nmol/mmol, p < 0.0001]. UCPCR was similar in type 2 diabetes and MODY (p = 0.25), so patients were combined for subsequent analyses. After 2‐yr duration, UCPCR ≥ 0.7 nmol/mmol has 100% sensitivity [95% confidence interval (CI): 92–100] and 97% specificity (95% CI: 91–99) for identifying non‐type 1 (MODY + type 2 diabetes) from type 1 diabetes [area under the curve (AUC) 0.997]. UCPCR was poor at discriminating MODY from type 2 diabetes (AUC 0.57).</p> </sec> <sec id="pedi12008-sec-0004" sec-type="section"> <title>Conclusions</title> <p>UCPCR testing can be used in diabetes duration greater than 2 yr to identify pediatric patients with non‐type 1 diabetes. UCPCR testing is a practical non‐invasive method for use in the pediatric outpatient setting.</p> </sec> </abstract>