The clinical utility of C-peptide measurement in diabetology

C-peptide is produced in equal amounts to insulin and is the best measure of endogenous insulin secretion in patients with diabetes. Measurement of insulin secretion using C-peptide can be helpful in clinical practice: differences in insulin secretion are fundamental to different requirements in the treatment of diabetes. An important clinical role of C-peptide is differentiating between type 1 and type 2 diabetes. Low basal C-peptide can be considered as criterion for transferring the patients, initially diagnosed as type 2 diabetes, in the type 1 diabetes group. C-peptide level may be a good predictor of the clinical partial remission during the first year of type 1 diabetes. Latent autoimmune diabetes in adults (LADA) is a special form of diabetes that is clinically similar to type 2 diabetes but with positivity for pancreatic autoantibodies and lower C-peptide levels. The measurement of C-peptide level and of immunological markers may represent important additional tools for establishing the correct diagnosis. The natural course of these patients shows that C-peptide will decrease with time in parallel with the curve for C-peptide in classical type 1 diabetic patients. Persistence of C-peptide is an important clinical feature of MODY. It is particularly important to identify these patients as they are commonly misdiagnosed as type 1 diabetes and treated with insulin, C-peptide can be used to assist in patient selection for islet cell transplantation and post-transplant monitoring. High uncorrected fasting C-peptid in the presence of hyperglycemia may suggest insulin resistance.