Proinsulin Marks Type 1 Diabetes Partial Remission
Proinsulin Marks Type 1 Diabetes Partial Remission. Functional beta cells are preserved to a variable extent following diagnosis of childhood type 1 diabetes, releasing insulin, C-peptide and uncleaved proinsulin. Proinsulin is considered a marker of beta cell stress, and increased levels (relative to insulin) are seen in type 2 diabetes and following islet transplantation. Its role in type 1 diabetes is more contentious: do high levels of proinsulin reflect beta cell distress or healthy function during partial remission?
This question was investigated by Dr Anne Kaas (Glostrup University Hospital, Denmark) and The Hvidøre Study Group on childhood diabetes. They investigated the relationship between remission status and meal-stimulated proinsulin, C-peptide, glucagon like peptide-1 (GLP-1) and glucagon in children and adolescents during the first 12 months after diagnosis with T1DM. The patients (n= 275) were assessed at 1, 6 and 12 months after diagnosis, and partial remission was defined as an insulin dose-adjusted hemoglobin A1c ≤9%. Some readers might question this definition.
Those in partial remission had higher proinsulin and lower GLP-1 and glucagon levels as compared with patients not in remission. Those in remission at 6 and 12 months had higher levels of proinsulin, and an inverse relationship between proinsulin and HbA1C was found at 1 and 6 months; proinsulin was strongly associated with C-peptide at 1, 6, and 12 months. In contrast, glucagon and GLP-1 were lower in remitters than in non-remitters at 6 and 12 months.
The authors conclude that proinsulin, GLP-1, and glucagon are significantly associated with partial clinical remission, patients in remission having higher proinsulin and lower GLP-1 and glucagon levels compared to patients not in remission. Proinsulin is a marker of preserved beta cell function following diagnosis of type 1 diabetes, although not necessarily of beta cell health.
Since proinsulin was strongly associated with C-peptide, it confirms that the C-peptide test is a valid means by which to measure endogenous insulin production. This would indicate that the higher the C-peptide result, the higher the endogenous insulin production. This is a great test for the insulin-dependent diabetic (including those with type 1 diabetes) to measure just how dependent they are on insulin injections. In our case, we are completely independent of exogenous insulin. We believe the Roman Diet helps us maintain that independence by keeping the remaining beta cells free of added stress from dietary glycemic loads, antigens and heavy digestion.
Mapping, monitoring and measuring are a continuous cycle when living with diabetes. You begin with a certain course of treatment in mind, which you mapped out with the help of your medical professional. You monitor your progress and measure it against your goals. Upon evaluation, you may find a new course must be charted to compensate for successes and challenges.
Evaluating progress and results of the Health-e-Solutions lifestyle is essential to #MasterDiabetes the healthiest way possible. This downloadable e-publication equips you with the key evaluation tools you need, along with some of the research behind them, to determine where you want to go and how to get there. We give you important tools to help you chart your course and stay on track to reach your destination.
SOURCE PAPER: Kaas A, Andersen ML, Fredheim S, Hougaard P, Buschard K, Petersen JS, de Beaufort C, Robertson KJ, Hansen L, Mortensen HB, Nielsen LB; Hvidoere Study Group on childhood diabetes. Proinsulin, GLP-1, and glucagon are associated with partial remission in children and adolescents with newly diagnosed type 1 diabetes. Pediatric Diabetes 2012: 13: 51–58