C-Peptid als Surrogatparameter einer residualen Beta-Zellfunktion bei Typ-1-Diabetes und ihre mögliche klinische Bedeutung

Zusammenfassung

C-Peptid, ein Molekül, welches in äquimolarer Konzentration zu Insulin produziert wird, hat sich als Biomarker für die Insulinsekretion bei Menschen mit Typ-1-Diabetes etabliert. Die Messung des C-Peptidspiegels kann in der klinischen Praxis hilfreich sein, um die Restfunktion der insulinproduzierenden β-Zellen zu beurteilen, insbesondere bei Menschen unter Insulintherapie. Sinkende C-Peptidwerte spiegeln dabei eine Verschlechterung der β-Zellfunktion wider. Während die C-Peptid-Sekretion in den ersten Monaten nach Diagnosestellung des Typ-1-Diabetes ein zuverlässiger Prädiktor für eine klinische Teilremission sein kann, gibt es zunehmend Hinweise auf eine persistierende β-Zellfunktion bei Menschen mit langjährigem Typ-1-Diabetes. Bei der Mehrzahl der Menschen mit langjährigem Typ-1-Diabetes ist C-Peptid auch in geringen Mengen nachweisbar, insbesondere wenn hochempfindliche Assays verwendet werden. Trotz erheblicher Fortschritte in der Insulintherapie erreichen in Deutschland nur etwa 44% der Menschen mit Typ-1-Diabetes eine ausreichende Glukoseeinstellung, um Langzeitkomplikationen zu vermeiden. Die Verbesserung der Überlebensrate der verbleibenden β-Zellen, gemessen an der erhaltenen C-Peptid-Konzentration, steht im Mittelpunkt vieler krankheitsmodifizierender Studien. Eine krankheitsmodifizierende Therapie zur Erhaltung der β-Zellfunktion könnte eine alternative oder ergänzende Behandlungsoption zur Insulintherapie bei Typ-1-Diabetes darstellen. Ziel dieser Übersichtsarbeit ist es, die Bedeutung des C-Peptids und seine Rolle bei der Diagnose, Überwachung und Behandlung des Typ-1-Diabetes darzustellen.

Abstract

C-peptide, a molecule produced in equimolar concentration to insulin, has been established as a biomarker for insulin secretion in individuals with type 1 diabetes. The measurement of C-peptide levels can be beneficial in clinical practice for the assessment of residual insulin-producing β-cell function, particularly in individuals undergoing insulin therapy. A decline in C-peptide levels is indicative of a deterioration in β-cell function. While C-peptide secretion in the initial months following the diagnosis of type-1-diabetes can be a reliable predictor of clinical partial remission, there is mounting evidence of persistent β-cell function in individuals with long-standing type 1 diabetes. In the majority of individuals with long-standing type 1 diabetes, C-peptide is detectable, particularly when highly sensitive assays are employed. Despite significant advancements in insulin therapy, only approximately 44% of individuals with type-1-diabetes in Germany achieve adequate glucose control to prevent long-term complications. The focus of numerous disease-modifying studies is to enhance the survival rate of residual β-cells, as measured by the maintained C-peptide concentration. Disease-modifying therapy to preserve β-cell function represents a potential alternative or complementary treatment option to insulin therapy in type-1-diabetes. The objective of this review is to elucidate the significance of C-peptide and its function in the diagnosis, monitoring, and treatment of type-1-diabetes.

Schlüsselwörter

C-Peptid - Typ-1-Diabetes - Diagnostik - Betazellen - β-Zellen

Keywords

C-Peptide - Type-1-Diabetes - Diagnostics - Betacells - β-cells

Publication History

Received: 17 June 2024

Accepted after revision: 30 July 2024

Article published online:
04 December 2024

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