Salivary C-peptide A useful biochemical marker for insulin-dependent diabetes mellitus

Dr. Natheer H Al-Rawi Ph.D (Oral Pathology) College of Dentistry/ University of Sharjah/UAE

What is C-peptide? 31 amino acids polypeptide Made from pro insulin which split into insulin and C-peptide What are its functions? Activate cell signal transduction pathway. Stimulate Na+, K+ ATPase and eNOS Prevent diabetic Nephropathy

Why to measure C peptide? It provide a reliable info of cells secretory activity. C peptide measurements are preferable to insulin measurements because: Longer life (2-5 times more) Lack of hepatic excretion Slower metabolic clearance rate Lack of cross-reactivity with antibodies to insulin

Physiological Background of C-peptide: Healthy Individuals: Pancreatic cells produce proinsulin Proinsulin split into insulin and C-peptide. C-peptide and insulin are released into circulation. Type 1 Diabetes: Pancreatic cells cease to function. No proinsulin is produced Nor insulin nor C-peptide are formed

Diagnostic Uses:
Measuring C peptide in patients injecting insulin can help to determine how much of their own natural insulin these patients are still producing. C peptide is easily detectable because antibodies that are sensitive to it are readily available, whereas antibodies to insulin are much more difficult to obtain. The amount of C peptide in the blood can indicate the presence or absence of disease: Low amount : Insulin produced is too low or absent (Type 1 DM) Abnormal high amount: Insulinoma Normal amounts: Body making plenty of insulin but the body is not responding properly (Type 2 DM) Low amount with hypoglycemia : Insulin abuse

How it is measured?

ELISA RIA

Why Saliva ? 1. Easy sampling 2. Does not disturb intimacy when control is needed. 3. Multiple samples could be collected providing more information than that of single blood sample

Study Outline Patients Sample Tests

15 IDDM 41 NIDDM

Blood

Saliva

FBS

C peptide

Results & Discussion:

Significant elevation in serum FBS and salivary C peptide levels in Type 2 DM. Non significant difference in serum C peptide between the two groups. Low C peptide levels in type 1 DM indicates low insulin production. Significant Negative correlation between serum FBS and salivary C-peptide (? Damage cells hyperglycemia , low insulin levels and low C- peptide
Group FBS(mg/dl) Serum C-peptide (mol/L) Salivary cpeptide(mol/L)

IDDM
NIDDM IDDM vs NIDDM

91.07 6.82
184 84.5 2.91 E-5**

0.628 0.6
1.84 1.35 0.08 (NS)

0.147 0.3
0.336 0.6 7.32E-9**

Correlation Groups IDDM NIDDM

Serum C-peptide vs FBS 0.33 -0.12

Salivary C-peptide vs FBS -0.04* 0.17

Serum C-peptide vs Salivary Cpeptide 0.422 -0.19

Conclusion:
Estimating salivary levels of C-peptide with FBS can provide simple method of measuring cell activity and to monitor proper use of insulin therapy in Type 1 DM without the need of invasive vene punctures

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