Correlation between Glucose/C-Peptide Ratio and the Risk of Disease Progression in Diabetic Nephropathy Patients: A Clinical Retrospective Analysis

Abstract

The aim of this study is to analyze the correlation between the glucose/C-peptide ratio and the risk of disease progression in patients with diabetic nephropathy. Ninety-three patients with diabetic nephropathy, who were treated in the Chun’an Branch of Zhejiang Provincial People’s Hospital, China, from January 2016 to January 2019, were recruited as subjects. In accordance with the disease progression, the patients were divided into a progression group (n = 59) and a nonprogression group (n = 34). Clinical data were compared between the two groups. Pearson’s correlation was applied to analyze the correlation of age, postprandial glucose/C-peptide, glycosylated hemoglobin, insulin resistance index, serum cystatin C, uric acid, 24 h urinary albumin excretion rate (24 hUAER), and estimated glomerular filtration rate (eGFR). Univariate and multivariate logistic regression models were utilized to analyze the influencing factors for the risk of disease progression in patients with diabetic nephropathy. The receiver operating characteristic (ROC) curve was employed to assess the predictive value of postprandial glucose/C-peptide on the risk of disease progression in patients with diabetic nephropathy. Results. The age differences, postprandial glucose/C-peptide, glycosylated hemoglobin, insulin resistance index, serum cystatin C, uric acid, 24 hUAER, and eGFR were significantly different between the two groups $\left(P<0.05\right)$ . Pearson’s linear correlation analysis exhibited that postprandial glucose/C-peptide, insulin resistance index, serum cystatin C, and uric acid were positively correlated with 24 hUAER (r = 0.514, 0.345, 0.311, 0.279, $P<0.05$ ). Age, postprandial glucose/C-peptide, insulin resistance index, serum cystatin C, and uric acid were negatively correlated with eGFR (r = −0.210, −0.610, −0.351, −0.347, and −0.274, $P<0.05$ ). Univariate logistic regression analysis displayed that age (OR = 0.938; $P=0.043$ ), postprandial glucose/C-peptide (OR = 0.851; $p\le 0.001$ ), insulin resistance index (OR = 0.219; $p\le 0.001$ ), serum cystatin C (OR = 0.113; $p\le 0.001$ ), and uric acid (OR = 0.989; $P=0.001$ ) were risk factors for the risk of disease progression in patients with diabetic nephropathy. Multivariate logistic regression analysis exhibited that postprandial glucose/C-peptide (OR = 0.747; $P=0.004$ ), insulin resistance index (OR = 0.072; $P=0.012$ ), serum cystatin C (OR = 0.023; $P=0.020$ ), and uric acid (OR = 0.967; $P=0.039$ ) were independent risk factors for the risk of disease progression in patients with diabetic nephropathy. The ROC curve results demonstrated that the AUC of postprandial glucose/C-peptide predicting the risk of disease progression in patients with diabetic nephropathy was 0.931. Postprandial glucose/C-peptide, insulin resistance index, serum cystatin C, and uric acid are correlated with 24hUAER and eGFR. Postprandial glucose/C-peptide, insulin resistance index, serum cystatin C, and uric acid are independent risk factors for the risk of disease progression in patients with diabetic nephropathy. Among them, postprandial glucose/C-peptide can be employed as a crucial indicator to predict the risk of disease progression in diabetic nephropathy patients.