P-253: Residual endogenous C-peptide concentration and metabolic control of children and adolescents with type 1 diabetes using different treatment regimens – results from the prospective DPV registry
J Weekes, A Eckert, D Klose, A Lemmer, M Wabitsch, H Schenk-Huber, M -A Burckhardt, T Hoertenhuber, O Kordonouri, S Lanzinger, C KamrathAbstract
Introduction
C-peptide is a marker for the beta-cell reserve of people with type 1 diabetes (T1D), which can lead to better metabolic control.
Objectives
To investigated the impact of residual C-peptide levels on metabolic outcomes in children using either multiple daily injections (MDI), sensor-augmented insulin pumps (SAPs) or automated insulin delivery (AID) systems.
Methods
Data from children aged 0.5-< 18 years with new-onset T1D between 2020 and 2024 from the DPV registry and a C-peptide measurement taken approximately one year (± 6 months) after clinical onset were evaluated. Age-stratified medians were used in order to categorize C-peptide levels as low (<median) or high (≥median). To analyse the association between residual C-peptide concentration with the metabolic outcomes HbA1c, time in range (TIR), time above range (TAR), and time below range (TBR), regression models, adjusted for age, sex, immigrant background and year of diabetes diagnosis were used.
Results
Data from 1085 children (55.0% males) were analysed. 443 patients used MDI (39.9%), 262 SAP (24.2%), and 390 AID (35.9%) treatment. C-peptide concentration did not differ between treatment groups when adjusted for age. Estimated mean (95% CI) HbA1c for high vs low C-peptide groups were 6.8% (6.7-7.0) vs 7.4% (7.2-7.5) in MDI users (P < 0.001), 6.9% (6.7-7.1) vs 7.1% (6.9-7.3) in SAP users (P = 0.097), and 6.7% (6.6-6.9) vs 7.0% (6.8-7.1) in AID users (P = 0.038), with adjusted differences for the mean HbA1c of 0.51% (95% CI 0.27-0.75), 0.21% (-0.09-0.52), and 0.25% (-0.01-0.50), respectively. Furthermore, significantly higher TIR and lower TAR in those with higher residual C-peptide were observed in all three treatment groups, while TBR was not different.
Conclusions
Real-world data from the DPV registry show that higher residual C-peptide is associated with better metabolic control one year after diagnosis. Diabetes technology can only partially compensate for a diminished beta-cell reserve.