When Inappropriate Use of Insulin is Dangerous: The Utility of C-Peptide Assay in the Era of Cardioprotective Antidiabetic Drugs

Sara Volpe, Cosimo Tortorella, Vincenzo Solfrizzi, Giuseppina Piazzolla Interdisciplinary Department of Medicine, University of Bari “Aldo Moro” Medical School, Bari, 70124, ItalyCorrespondence: Giuseppina PiazzollaInterdisciplinary Department of Medicine, University of Bari “Aldo Moro” Medical Scho...

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Autores principales:	Volpe S, Tortorella C, Solfrizzi V, Piazzolla G
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	diabetes metabolic syndrome hypoglycemia obesity dulaglutide quality of life. Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/8a0096c139cf46d2a2a81c33a5c39f2c
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spelling	oai:doaj.org-article:8a0096c139cf46d2a2a81c33a5c39f2c2021-12-02T16:16:09ZWhen Inappropriate Use of Insulin is Dangerous: The Utility of C-Peptide Assay in the Era of Cardioprotective Antidiabetic Drugs1178-7007https://doaj.org/article/8a0096c139cf46d2a2a81c33a5c39f2c2021-08-01T00:00:00Zhttps://www.dovepress.com/when-inappropriate-use-of-insulin-is-dangerous-the-utility-of-c-peptid-peer-reviewed-fulltext-article-DMSOhttps://doaj.org/toc/1178-7007Sara Volpe, Cosimo Tortorella, Vincenzo Solfrizzi, Giuseppina Piazzolla Interdisciplinary Department of Medicine, University of Bari “Aldo Moro” Medical School, Bari, 70124, ItalyCorrespondence: Giuseppina PiazzollaInterdisciplinary Department of Medicine, University of Bari “Aldo Moro” Medical School, Policlinico, Piazza G. Cesare 11, Bari, 70124, ItalyFax +39 080 5478126Email giuseppina.piazzolla@uniba.itIntroduction: New antidiabetic drugs have simplified treatment regimens in patients with type-2 diabetes (T2D). More importantly, they have proven to reduce cardiovascular risk by lowering insulin-resistance, blood pressure and body weight, in addition to avoiding inappropriate insulin therapy, responsible for hypoglycemic episodes and weight gain. In this context, accurate assessment of the metabolic status of T2D patients becomes essential. The C-peptide assay is a simple but often overlooked test that can provide a fundamental contribution to the correct disease classification and optimal therapeutic management of diabetic patients.Clinical Case: We report the case of a 72-year-old patient, treated with insulin for 26 years after a diagnosis of type-1 diabetes (T1D), resulting in inadequate glycemia control and a severe evolution of cardiovascular complications. After an accurate evaluation of the clinical history, phenotype and laboratory data, including the determination of C-peptide serum levels, a diagnosis was made of T2D not T1D. Considering the patient’s very high cardiovascular risk and dysmetabolic profile, insulin therapy was discontinued and more appropriate therapy with dulaglutide and metformin was instituted. These overall therapeutic modifications yielded remarkable clinical advantages in terms of the glycometabolic profile, weight reduction, abdominal circumference and body mass index decrease, as well as a better quality of life, with complete resolution of the dangerous hypoglycemic episodes.Conclusion: In the era of new cardioprotective antidiabetic drugs, we believe the importance of the C-peptide assay should be re-evaluated in order to avoid misdiagnosis and to improve the therapeutic approach to T2D.Keywords: diabetes, metabolic syndrome, hypoglycemia, obesity, dulaglutide, quality of lifeVolpe STortorella CSolfrizzi VPiazzolla GDove Medical Pressarticlediabetesmetabolic syndromehypoglycemiaobesitydulaglutidequality of life.Specialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 14, Pp 3517-3521 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	diabetes metabolic syndrome hypoglycemia obesity dulaglutide quality of life. Specialties of internal medicine RC581-951
spellingShingle	diabetes metabolic syndrome hypoglycemia obesity dulaglutide quality of life. Specialties of internal medicine RC581-951 Volpe S Tortorella C Solfrizzi V Piazzolla G When Inappropriate Use of Insulin is Dangerous: The Utility of C-Peptide Assay in the Era of Cardioprotective Antidiabetic Drugs
description	Sara Volpe, Cosimo Tortorella, Vincenzo Solfrizzi, Giuseppina Piazzolla Interdisciplinary Department of Medicine, University of Bari “Aldo Moro” Medical School, Bari, 70124, ItalyCorrespondence: Giuseppina PiazzollaInterdisciplinary Department of Medicine, University of Bari “Aldo Moro” Medical School, Policlinico, Piazza G. Cesare 11, Bari, 70124, ItalyFax +39 080 5478126Email giuseppina.piazzolla@uniba.itIntroduction: New antidiabetic drugs have simplified treatment regimens in patients with type-2 diabetes (T2D). More importantly, they have proven to reduce cardiovascular risk by lowering insulin-resistance, blood pressure and body weight, in addition to avoiding inappropriate insulin therapy, responsible for hypoglycemic episodes and weight gain. In this context, accurate assessment of the metabolic status of T2D patients becomes essential. The C-peptide assay is a simple but often overlooked test that can provide a fundamental contribution to the correct disease classification and optimal therapeutic management of diabetic patients.Clinical Case: We report the case of a 72-year-old patient, treated with insulin for 26 years after a diagnosis of type-1 diabetes (T1D), resulting in inadequate glycemia control and a severe evolution of cardiovascular complications. After an accurate evaluation of the clinical history, phenotype and laboratory data, including the determination of C-peptide serum levels, a diagnosis was made of T2D not T1D. Considering the patient’s very high cardiovascular risk and dysmetabolic profile, insulin therapy was discontinued and more appropriate therapy with dulaglutide and metformin was instituted. These overall therapeutic modifications yielded remarkable clinical advantages in terms of the glycometabolic profile, weight reduction, abdominal circumference and body mass index decrease, as well as a better quality of life, with complete resolution of the dangerous hypoglycemic episodes.Conclusion: In the era of new cardioprotective antidiabetic drugs, we believe the importance of the C-peptide assay should be re-evaluated in order to avoid misdiagnosis and to improve the therapeutic approach to T2D.Keywords: diabetes, metabolic syndrome, hypoglycemia, obesity, dulaglutide, quality of life
format	article
author	Volpe S Tortorella C Solfrizzi V Piazzolla G
author_facet	Volpe S Tortorella C Solfrizzi V Piazzolla G
author_sort	Volpe S
title	When Inappropriate Use of Insulin is Dangerous: The Utility of C-Peptide Assay in the Era of Cardioprotective Antidiabetic Drugs
title_short	When Inappropriate Use of Insulin is Dangerous: The Utility of C-Peptide Assay in the Era of Cardioprotective Antidiabetic Drugs
title_full	When Inappropriate Use of Insulin is Dangerous: The Utility of C-Peptide Assay in the Era of Cardioprotective Antidiabetic Drugs
title_fullStr	When Inappropriate Use of Insulin is Dangerous: The Utility of C-Peptide Assay in the Era of Cardioprotective Antidiabetic Drugs
title_full_unstemmed	When Inappropriate Use of Insulin is Dangerous: The Utility of C-Peptide Assay in the Era of Cardioprotective Antidiabetic Drugs
title_sort	when inappropriate use of insulin is dangerous: the utility of c-peptide assay in the era of cardioprotective antidiabetic drugs
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/8a0096c139cf46d2a2a81c33a5c39f2c
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When Inappropriate Use of Insulin is Dangerous: The Utility of C-Peptide Assay in the Era of Cardioprotective Antidiabetic Drugs

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