Aims

We assessed the association between insulin resistance and blood glucose concentrations at type 2 diabetes diagnosis and future development of diabetes-related complications and mortality.

Materials and Methods

This retrospective cohort study included 864 individuals with type 2 diabetes (median age 60 years) whose fasting C-peptide and HbA1c were measured at diabetes diagnosis. The median follow-up time until death or study end was 16.4 years (IQR 13.3−19.6). The association between C-peptide and mortality/complications was estimated by Cox regression adjusted for sex, age at diabetes diagnosis, smoking, hypertension, BMI, total cholesterol, and HbA1c. C-peptide and HbA1c were converted to Z scores before the Cox regression analysis.

Results

An increase by one standard deviation in fasting C-peptide at diabetes diagnosis was associated with all-cause (HR]1.33; 95% CI 1.12−1.58; p = 0.001) and cancer mortality (HR 1.51; 95% CI 1.13−2.01; p = 0.005) in the fully adjusted model. A increase by one standard deviation in HbA1c at diabetes diagnosis was associated with all-cause mortality (HR 1.24; 95% CI 1.07−1.44; p = 0.005), major cardiovascular events (HR 1.20; 95% CI 1.04−1.39; p = 0.015), stroke (HR 1.36; 95% CI 1.09−1.70; p = 0.006), and retinopathy (HR 1.54; 95% CI 1.34−1.76; p < 0.0001) in the fully adjusted model.

Conclusions

Fasting C-peptide at type 2 diabetes diagnosis is an independent risk factor for total and cancer-related mortality. Thus, treatment of type 2 diabetes should focus not only on normalizing blood glucose levels but also on mitigating insulin resistance.

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