目的:本系统综述和荟萃分析旨在探讨血浆连接肽(C肽)对1型糖尿病(T1D)和2型糖尿病(T2D)的预测能力。并为糖尿病分类提供循证指南。
方法:我们在PubMed,MEDLINE,EMBASE和Scopus。引用从1942年到2021年筛选。应用系统评价和荟萃分析(PRISMA)清单的质量标准和首选报告项目。该方案已在国际前瞻性系统评价登记册(PROSPERO)(CRD42022355088)注册。
结果:总共筛选了23,658份摘要,审查了46篇全文。其中,12篇文章可用于荟萃分析。包括因种族而异的研究,年龄,时间,以及个人的比例。所有研究的主要结果指标是C肽。据报道,C肽与糖尿病的分类或诊断之间存在显着关联。此外,更低的浓度或C-肽的<0.20nmol/L的截止值指示T1D。此外,荟萃分析揭示了C肽在区分T1D和T2D方面的预测能力。使用固定和随机效应模型的结果是一致的。I-squared值(98.8%)证实了效果估计的变异性是由于异质性而不是所有选定研究中的抽样误差。
结论:血浆C肽与糖尿病亚型的准确分类和诊断高度相关,并具有预测作用。在空腹或随机状态下,T1D更可能血浆C-肽截止值<0.20(mmol/L),并且指示T2D截止值>0.30(mmol/L)。
OBJECTIVE: This systematic
review and meta-analysis aimed to investigate the predictive ability of plasma connecting peptide (C-peptide) levels in discriminating type 1 diabetes (T1D) from type 2 diabetes (T2D) and to inform evidence-based guidelines in diabetes classification.
METHODS: We conducted a holistic
review and meta-analysis using PubMed, MEDLINE, EMBASE, and Scopus. The citations were screened from 1942 to 2021. The quality criteria and the preferred reporting items for systematic reviews and meta-analysis checklist were applied. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42022355088).
RESULTS: A total of 23,658 abstracts were screened and 46 full texts reviewed. Of the 46 articles screened, 12 articles were included for the meta-analysis. Included studies varied by race, age, time, and proportion of individuals. The main outcome measure in all studies was C-peptide levels. A significant association was reported between C-peptide levels and the classification and diagnosis of diabetes. Furthermore, lower concentrations and the cutoff of <0.20 nmol/L for fasting or random plasma C-peptide was indicative of T1D. In addition, this meta-analysis revealed the predictive ability of C-peptide levels in discriminating T1D from T2D. Results were consistent using both fixed- and random-effect models. The I2 value (98.8%) affirmed the variability in effect estimates was due to heterogeneity rather than sampling error among all selected studies.
CONCLUSIONS: Plasma C-peptide levels are highly associated and predictive of the accurate classification and diagnosis of diabetes types. A plasma C-peptide cutoff of ≤0.20 mmol/L is indicative of T1D and of ≥0.30 mmol/L in the fasting or random state is indicative of T2D.