To explore the relationship between C-peptide and glycemic control rate and diabetic complications(microvascular complication and cerebral infarction), and provide evidence for stratified treatment of type 2 diabetes based C-peptide.

This is a cross-sectional real-world observational study. According to the inclusion and exclusion criteria, we included 1377 patients with type 2 diabetes mellitus (T2DM), grouped by fasting C-peptide and HOMA-IR. Blood samples were collected after fasting overnight. Logistic regression was used to analyze the relationship among fasting C-peptide, HOMA-IR, C2/C0 ratio, glycemic control rate, and diabetic complications. Restricted cubic spline (RCS) curves based on logistic regression were used to evaluated the relationship between C-peptide, glycemic control rate and DKD.

Group Q3 (1.71 ≤C-peptide <2.51ng/mL) has the lowest incidence of DKD, DR and the using rate of insulin, and higher glycemic control rate. Logistic regression shows that, the possibility of not reaching glycemic control in Q3 and Q4 decreased, compared with the group Q1, after adjusting for age, gender, duration of diabetes, BMI, SBP, DBP, Cr, LDL, TG, TC, HDL. Restricted cubic spline (RCS) curve shows that, when C-peptide≤2.68 ng/mL, the incidence of not reaching glycemic control decreases with C-peptide increasing. The possibility of not reaching glycemic control decreased with C2/C0 increasing, when C-peptide≥1.71ng/mL. RCS curve shows that the relationship between C-peptide and DKD present a U-style curve. When C-peptide<2.84 ng/mL, the incidence of DKD decreased with C-peptide increasing. With the C2/C0 ratio increasing, the incidence of DKD, DR, fatty liver didn’t decrease.

When 1.71 ≤C-peptide < 2.51 ng/mL, patients with T2DM had a higher glycemic control rate. Excessive C-peptide plays different roles in DKD and DR, C-peptide may promote the incidence of DKD but protect patients from DR. Higher C2/C0 ratio is important for reaching glycemic control but can’t reduce the risk of DKD, DR, and fatty liver.

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