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Serum C-peptide as a Predictor of Coronary Artery Disease in Middle-Aged Patients With Type 2 Diabetes Mellitus: A Cross-Sectional Analytical Study

Year: 2024

Type: article

Abstract: Introduction Type 2 diabetes mellitus is a major public health problem. Coronary artery disease (CAD) is the major cause of morbidity and mortality due to diabetes. A subset of these patients develops this complication relatively early. Identifying such patients at increased risk of CAD using an appropriate marker is important in prevention. Insulin resistance plays an important role in the development and progression of atherosclerotic CAD. Measurement of serum C-peptide may help in identifying those with increased insulin resistance characterized by higher levels. This study was conducted to find the association between fasting C-peptide (FCP) levels and CAD in middle-aged patients with type 2 diabetes mellitus. Materials and methods This cross-sectional analytical study was done at the Medicine Outpatient Department of Government Medical College, Kannur, Kerala, South India. Type 2 diabetic patients aged 41-60 years were included. Patients on insulin, chronic liver disease, malignancy, critical illness, and an estimated glomerular filtration rate (eGFR) less than 45 ml/min/1.73 m2 were excluded. After a detailed clinical evaluation, blood samples were collected for FCP and other biochemical tests. A chemiluminescent immunoassay was used for measuring serum C-peptide levels. An independent t-test compared mean FCP levels between those with and without CAD, while binary logistic regression identified CAD risk factors and strength of association. The receiver operating characteristic (ROC) curve determined the cutoff value for predicting CAD. Results Among the 229 patients included, 50 (21.83%) had evidence of CAD. On an independent t-test, patients with CAD had significantly higher serum FCP levels (2.36 ± 0.80 vs. 1.86 ± 0.58 ng/ml, p < 0.001) than those without CAD. On binary logistic regression analysis, the association of serum FCP levels with CAD was found to be statistically significant (p = 0.001), with odds of CAD increasing by 2.98 times for each unit increase in FCP levels. On the ROC curve, FCP was found to have a good predictive ability with an area under curve (AUC) of 0.71 (0.61-0.80); using a cutoff value of FCP ≥ 2.13 ng/ml, the sensitivity, specificity, and accuracy for predicting CAD were 70%, 69%, and 69.2%, respectively. When patients with CAD were categorized based on quartiles of FCP levels, the majority of patients with CAD were in upper quartiles (Q3 and Q4) with higher serum C-peptide levels, further indicating an association between elevated C-peptide levels and CAD. Conclusion In this study, a significant positive association was observed between serum FCP levels and CAD in type 2 diabetic patients aged 41-60 years. The odds of CAD increased nearly threefold for each unit rise in serum FCP levels. Patients with a higher risk of CAD can be identified by using an optimal cutoff value of serum FCP. These findings underscore the potential role of FCP in early identification of patients at increased risk for CAD.

Source: Cureus

DOI: 10.7759/cureus.74422

Authors: Sarosh Kumar, Balakrishnan Valliyot

Institution: Kannur Medical College

Language: English

Topic: Diabetes, Cardiovascular Risks, and Lipoproteins

Subfield: Endocrinology, Diabetes and Metabolism

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4404672507