, 12 tweets, 7 min read Read on Twitter
This was always going to be a packed out session (even at 5pm!): how we can use c-peptide measurements to improve the diagnosis of #diabetes
What's c-peptide? It's a molecule we make during the process of producing insulin. So it can be used to look at how much insulin you produce: people with #Type1diabetes have very very low c-peptide levels, while people with #Type2diabetes have higher levels.
This means a c-peptide measurement can differentiate between #Type1diabetes & #Type2diabetes. But how? In the past, tests were expensive & inaccurate. The #ExeterDiabetes team changed this...
First, they developed a test using urine samples: it's stable at room temp for a few days, painless and easy to collect.

Then, they turned to a blood sample that could also be made stable. Patients didn't need to fast beforehand and you could do it in the clinic.
And now, they're looking at a finger prick blood test. It's stable for 10 days at room temp, but it's not as sensitive.

But that's ok, because they now have a fancy machine that can measure at the FEMTOMOLAR range (yup that's a thing, 1000x more sensitive).
Prof @athattersley gets a chuckle from the audience when he summarises with "things have changed and nobody told us".

And acknowledges this amazing work has been done by @Mcdtj who can't be here as he's been nominated for the NHS Healthcare Scientist of the year award 👍
Next up, @angusgjones moves us on to diagnosis. C-peptide tests can differentiate between Type 1, Type 2 & MODY.

*But* close to diagnosis, people with Type 1 still produce some insulin. So it's not a great test right at the start - that's why we need antibody tests.
Dr Jones suggests that HCPs use the c-peptide test if their patients diagnosed with #Type2diabetes go onto insulin within 3 years.

It's cheap, easy to measure and can confirm the right diagnosis.
And finally, Prof Mark Strachan, who tells us he's a c-peptide convert.

It started with a patient who he was convinced had Type 1, but she had real trouble managing her blood sugars. It turned out she had monogenic diabetes & Prof Strachan wishes they'd spotted it sooner
So they set out to run c-peptide tests with all of their patients with Type 1. So far, they have tested 757 people. Based on their c-peptide levels, 13 have been re-diagnosed as having Type 2 and 7 have been taken off insulin.
Then there were even more cases of monogenic diabetes - Prof Strachan jokes that he started getting heart palpitations every time an #ExeterDiabetes email came back from the monogenic lab!

Essentially, he was surprised by just how many of his patients didn't have Type 1.
Bottom line, HCPs are definitely misdiagnosing some people. But it's really important that we think about this possibility of reclassifying someone's diabetes - it needs to be discussed in a sensitive, supportive way.
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