Issue 149 Item 8 C-Peptide Improves Sensory Nerve Function in Type 1 Diabetes

Treatment with C-peptide improves sensory nerve function in patients with type 1 diabetes Intensified insulin treatment can slow the progression of various diabetic complications, the authors explain, but nothing has been shown to prevent the development of diabetic neuropathy.

Dr. John Wahren and colleagues from Karolinska Institutet in Stockholm, examined whether 3 months of C-peptide treatment could exert a beneficial effect on early peripheral nerve function abnormalities in 26 patients with type 1 diabetes.

Sensory and motor nerve conduction velocities, as well as compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) amplitudes, were similar at baseline for the C-peptide-treated patients and 20 placebo-treated patients. Metabolic control of diabetes was also similar in the two groups, they report in the February issue of Diabetes.

After 6 weeks of treatment, the C-peptide group showed a significant increase in sensory nerve conduction velocity, which persisted as a 5% improvement after 12 weeks, the authors report. This change resulted in a restoration of sensory nerve conduction velocity to 80% of normal values.

“The significance of the 5% improvement in sensory nerve conduction velocity stems from the fact that C-peptide could and, for the first time in humans, did improve nerve conduction velocity in type 1 diabetic patients,” Dr. Wahren told Reuters Health. “No other treatment has been able to achieve that.”

Motor nerve conduction velocity also improved after 6 weeks of C-peptide treatment, the report indicates, but this improvement had disappeared by 12 weeks.

CMAP did not change in either patient group, the researchers note, but SNAP increased significantly in the placebo group. On the other hand, vibration threshold decreased significantly (compared with placebo) after 12 weeks of C-peptide treatment.

“C-peptide is after all a biologically active peptide hormone of potential importance for the therapy and/or the prevention of long-term complications of type 1 diabetes,” Dr. Wahren concluded. “Molecular and cellular mechanisms of C-peptide action are becoming increasingly understood, and supportive in vivo data from patients and animals accumulate.”

“Phase 2 B clinical trials to establish proof of this concept in patients with diabetic neuropathy are now under way,” Dr. Wahren added. Diabetes 2003;52:536-541.

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