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Evaluation of β-cell function in diabetic Taiwanese children using a 6-min glucagon test

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Abstract

This study evaluates the effects of glucagon 30 μg/kg (maximal 1 mg) on β-cell function in children by C-peptide determined before and 6 min after intravenous administration. From 1990 to 2005, 118 Taiwanese children with newly diagnosed diabetes mellitus (98 children with type 1 and 20 children with type 2) and 29 normal Taiwanese children were enrolled in this study. Fasting and 6-min post-glucagon C-peptide levels were analyzed. In the pre-pubertal group, the median fasting serum C-peptide levels were 0.2 and 0.8 nmol/l in type 1 diabetes and normal children, respectively. These levels rose to 0.3 and 1.9 nmol/l after glucagon stimulation. In the pubertal group, the median fasting serum C-peptide levels were 0.3, 1.0 and 0.9 nmol/l in type 1 diabetes, type 2 diabetes and normal children, respectively. They rose to 0.4, 2.5 and 2.7 nmol/l after glucagon stimulation. Both fasting and post-glucagon C-peptide levels in type 1 diabetes patients were significantly lower than those of normal children and children with type 2 diabetes. The optimal cut-off values to distinguish type 1 diabetes patients from those with type 2 as determined by the receiving operating characteristic curve were 0.7 and 1.1 nmol/l, respectively. The sensitivities of both C-peptide values were 93%. The post-glucagon C-peptide level was more powerful in distinguishing type 1 diabetes from type 2 diabetes with higher specificity (95% vs. 85%). The 6-min glucagon test is valuable in assessing β-cell function in children and can help pediatricians in the differential diagnoses of diabetes mellitus in children.

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Abbreviations

GAD65:

65-ka glutamic acid decarboxylase

IA-2:

tyrosine phosphatase

IAA:

insulin auto-antibodies

BMI:

body mass index

ROC:

Receiving Operating Characteristic

AUC:

areas under the ROC curves

References

  1. 1.

    Alford FP, Henriksen JE, Rantzau C, Vaag A, Hew LF, Ward GM, Beck-Nielsen H (1998) Impact of family history of diabetes on the assessment of β-cell function. Metabolism 47:522–528

  2. 2.

    American Diabetes Association (2000) Type 2 diabetes in children and adolescents. Pediatrics 105:671–680

  3. 3.

    Arnqvist HJ, Littorin B, Nystrom L, Schersten B, Ostman J, Blohme G, Lithner F, Wibell L (1993) Difficulties in classifying diabetes at presentation in young adults. Diabetic Med 10:606–613

  4. 4.

    Ashcroft FM, Ashcroft SJH (1980) Glucoreceptor mechanisms and the control of insulin release and biosynthesis. Diabetologia 18:5–15

  5. 5.

    Ashcroft FM, Rorsman P (1989) Electrophysiology of the pancreatic beta-cell. Prog Biophys Mol Biol 54:87–143

  6. 6.

    Berger B, Stenstrom G, Sundkvist G (2000) Random C-peptide in the classification of diabetes. Scand J Clin Lab Invest 60:687–694

  7. 7.

    Castillo MJ, Scheen AJ, Lefebvre PJ (1995) Modified glucagon test allowing simultaneous estimation of insulin secretion and insulin sensitivity: application to obesity, insulin-dependent diabetes mellitus, and noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab 80:393–399

  8. 8.

    Elder DA, Prigeon RL, Wadwa RP, Dolan LM, D’Alessio DA (2006) β-cell function, insulin sensitivity, and glucose tolerance in obese diabetic and nondiabetic adolescents and young adults. J Clin Endocrinol Metab 91:185–191

  9. 9.

    Faber OK, Binder C (1977) C-peptide response to glucagon. A test for the residual β-cell function in diabetes mellitus. Diabetes 26:605–610

  10. 10.

    Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36

  11. 11.

    Hother-Nielson O, Faber O, Sorensen NS, Beck-Nielsen H (1988) Classification of newly diagnosed diabetic patients as insulin-requiring or non-insulin-requiring based on clinical and biochemical variables. Diabetes Care 11:531–537

  12. 12.

    Kolendorf K, Thorsteinsson B, Billesbolle P, Poulsen S (1982) Correlation between the routine 6-min. C-peptide value and the AUC after I.V. glucagon injection in NIDDM patients. Horm metabol Res 14:675–676

  13. 13.

    Koskinen P, Viikari J, Irjala K, Kaihola HL, Seppala P (1985) C-peptide determination in the choice of treatment in diabetes mellitus. Scand J Clin Lab Invest 45:589–597

  14. 14.

    Madsbad S, Krarup T, McNair P, Christiansen C, Faber OK, Transbol I, Binder C (1981) Practical clinical value of the C-peptide response to glucagon stimulation in the choice of treatment in diabetes mellitus. Acta Med Scand 210:153–156

  15. 15.

    Maldonado M, Hampe CS, Gaur LK, D’Amico S, Iyer D, Hammerle LP, Bolgiano D, Rodriguez L, Rajan A, Lernmark A, Balasubramanyam A (2003) Ketosis-prone diabetes: dissection of a heterogeneous syndrome using an immunogenetic and β-cell function classification, prospective analysis, and clinical outcomes. J Clin Endocrinol Metab 88:5090–5098

  16. 16.

    McCulloch DK, Palmer JP (1991) The appropriate use of B-cell function testing in the preclinical period of type 1 diabetes. Diabetic Med 8:800–804

  17. 17.

    Petersen KF, Befroy D, Dufour S, Dziura J, Ariyan C, Rothman DL, DiPietro L, Cline GW, Shulman GI (2003) Mitochondrial dysfunction in the elderly : possible role in insulin resistance. Science 300:1140–1142

  18. 18.

    Poulsen S, Billesbolle P, Kolendorf K, Thorsteinsson B (1985) The C-peptide response to glucagon injection in IDDM and NIDDM patients. Horm Metabol Res 17:39–40

  19. 19.

    Salmos E, Marri G, Marks V (1965) Promotion of insulin secretion by glucagon. Lancet 2:415–416

  20. 20.

    Sakura H, Ashcroft SJH, Terauchi Y, Kadowaki T, Ashcroft FM (1998) Glucose modulation of ATP-sensitive K-currents in wild-type, homozygous and heterozygous glucokinase knock-out mice. Diabetologia 41:654–659

  21. 21.

    Taha D, Umpaichitra V, Banerji MA, Castells S (2006) Type 2 diabetes mellitus in African-American adolescents: impaired beta-cell function in the face of severe insulin resistance. J Pediatr Endocrinol Metab 19:135–142

  22. 22.

    The Expert Committee on the diagnosis and classification of diabetes mellitus (1997) Report of the Expert Committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 20:1183–1197

  23. 23.

    Wei JN, Sung FC, Lin CC, Lin RS, Chiang CC, Chuang LM (2003) National surveillance for type 2 diabetes mellitus in Taiwanese children. JAMA 290:1345–1350

  24. 24.

    Welborn TA, Webb PG, Bonser AM (1981) Basal C-peptide in the discrimination of type I from Type II Diabetes. Diabetes Care 4:616–619

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Correspondence to Wen-Yu Tsai.

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Tung, Y., Lee, J., Tsai, W. et al. Evaluation of β-cell function in diabetic Taiwanese children using a 6-min glucagon test. Eur J Pediatr 167, 801–805 (2008). https://doi.org/10.1007/s00431-007-0594-9

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Keywords

  • Glucagon test
  • Type 1 diabetes
  • Type 2 diabetes
  • β-cell
  • C-peptide