Considering Insulin Secretory Capacity as Measured by a Fasting C-Peptide/Glucose Ratio in Selecting Glucose-Lowering Medications
Exp Clin Endocrinol Diabetes DOI: 10.1055/a-1242-9809Type 2 diabetes mellitus is a heterogeneous disease. Recently introduced new
subclassifications promise more efficacious, tailored treatments which could
complement current guidelines. In the differentiation of the new diabetes
subphenotypes, assessment of insulin secretion is one of the essential
components. Based on a large number of insulin secretion measurements, we
propose fasting C-peptide/glucose ratio (CGR) as an adequate and
practicable estimate of insulin secretion. CGR discriminates insulin deficiency
from insulin hypersecretion. We suggest using insulin secretion, determined from
CGR, as an essential input for therapeutic decisions at the beginning or
modification of diabetes treatment. Furthermore, we propose 3 practical steps to
guide decisions in the subtype-specific therapy of diabetes mellitus. The first
step consists of detecting insulin deficiency indicated by a low CGR with the
need for immediate insulin therapy. The second step is related to high CGR and
aims at lowering cardiovascular risk associated with diabetes. The third step is
the consideration of a de-escalation of glucose-lowering therapy in individuals
with mild diabetes subphenotypes. [...] © Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents | Abst...
Source: Experimental and Clinical Endocrinology and Diabetes - Category: Endocrinology Authors: Fritsche, Andreas Heni, Martin Peter, Andreas Gallwitz, Baptist Kellerer, Monika Birkenfeld, Andreas L. H äring, Hans-Ulrich Wagner, Robert Tags: Commentary Source Type: research
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