Classification of diabetes in patients with end-stage renal disease. Validation of clinical criteria according to fasting plasma C-peptide.
An epidemiologic study of end-stage diabetic nephropathy in France (Uremidiab) was performed, aiming to establish the prevalence of both types of diabetes in dialysis patients. Because discrimination between type I and type II diabetes remains mostly clinical, our aim was to evaluate what the most fitted clinical criteria were. We studied 494 hemodialyzed diabetic patients. A first classification (Cn) was offered by the nephrologist. Clinical data of 472 patients (22 patients of the 494 have been excluded) were then collected with a standardized questionnaire, allowing one diabetologist of us to establish the diagnosis of type of diabetes (classification Cd). Plasma C-peptide at this stage of the disease was expected to be very discriminative, measured in 88 patients and defined classification Ccp (< or = 0.6 ng/ml = "negative C-peptide" = type I, > 0.6 ng/ml = "positive C-peptide" = type II). Classification Cd observed 98 type I and 374 type II diabetes. Cn overestimated type I diabetes, 37% of type II diabetes being misclassified because insulin-treated. Classification Ccp observed 74 positive C-peptide patients, classified as type II, among whom 45 were insulin-treated. Only 3 patients were discordant for classification Cd and Ccp. Predictive value of "negative C-peptide" and "positive C-peptide" were 100% and 96% respectively. Multiple regression analysis of the Ccp classification was performed with the clinical criteria and showed very significant correlation with: age at the time of diagnosis of diabetes (AGE), maximal body mass index ever reached (BMI MAX) and delay between diagnosis and consistent insulin use (DI).(ABSTRACT TRUNCATED AT 250 WORDS)
Benhamou
P Y
PY
Service d'Endocrinologie-Diabétologie, CHRU, Grenoble, France.
Marwah
T
T
Balducci
F
F
Zmirou
D
D
Borgel
F
F
Cordonnier
D
D
Halimi
S
S
Papoz
L
L
D000328:Adult; D000368:Aged; D002096:C-Peptide / Q000097:blood*; D003920:Diabetes Mellitus / Q000097:blood / Q000145:classification* / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000150:complications* / Q000453:epidemiology; D005215:Fasting / Q000097:blood; D005260:Female; D005602:France; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D015203:Reproducibility of Results; D012189:Retrospective Studies
D002096:C-Peptide