The BMJ Awards 2019: Diabetes Team of the YearBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1232 (Published 20 March 2019) Cite this as: BMJ 2019;364:l1232
- Jacqui Wise, freelance journalist
- London, UK
C peptide testing in diabetes
The catalyst for a project to improve the accuracy of diabetes diagnosis was a patient who had been diagnosed with type 1 diabetes when she was eight years old, says Mark Strachan, consultant in diabetes and endocrinology at Western General Hospital in Edinburgh.
Her glycaemic control was not good and she had significant complications, including retinopathy. It was only much later, after her father was diagnosed with monogenic diabetes, that it was discovered that she had the same gene mutation. She discontinued the insulin which she had been taking for 27 years and started gliclazide tablets. Her diabetes is now well controlled.
In July 2017 the hospital started an ongoing programme of serum C peptide testing of all patients with type 1 diabetes of three years duration or more to see if there were others who had been misclassified. The clinic has tested 757 patients so far and found that 103 have significant detectable C peptide (13.7%). As a result, 28 people have been reclassified as having type 2 diabetes, eight found to have monogenic diabetes, and 12 have stopped taking insulin.
“Making a diagnosis of diabetes is simple but determining the cause of diabetes is not as straightforward. This is bringing precision medicine to the diabetes clinic,” says Strachan. As a result of the project, centres in Glasgow and Borders have started a C peptide programme and Strachan …