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World J Diabetes. Feb 15, 2015; 6(1): 145-150
Published online Feb 15, 2015. doi: 10.4239/wjd.v6.i1.145
Pathological consequences of C-peptide deficiency in insulin-dependent diabetes mellitus
Ahmad Ghorbani, Reza Shafiee-Nick
Ahmad Ghorbani, Reza Shafiee-Nick, Pharmacological Research Center of Medicinal Plants, School of Medicine, Mashhad University of Medical Sciences, 91375-3316 Mashhad, Iran
Reza Shafiee-Nick, Department of Pharmacology, School of Medicine, Mashhad University of Medical Sciences, 91375-3316 Mashhad, Iran
Author contributions: Ghorbani A wrote the first draft; both authors contributed to the work, reviewed and edited the manuscript and approved the final version.
Supported by Mashhad University of Medical Sciences.
Conflict-of-interest: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Reza Shafiee-Nick, Pharm D, PhD, Department of Pharmacology, School of Medicine, Mashhad University of Medical Sciences, Pardis Campus, Azadi Square, 91375-3316 Mashhad, Iran. shafieer@mums.ac.ir
Telephone: +98-51-38002256 Fax: +98-51-38828567
Received: September 9, 2014
Peer-review started: September 9, 2014
First decision: October 14, 2014
Revised: November 3, 2014
Accepted: December 16, 2014
Article in press: December 17, 2014
Published online: February 15, 2015
Processing time: 144 Days and 11 Hours
Abstract

Diabetes is associated with several complications such as retinopathy, nephropathy, neuropathy and cardiovascular diseases. Currently, insulin is the main used medication for management of insulin-dependent diabetes mellitus (type-1 diabetes). In this metabolic syndrome, in addition to decrease of endogenous insulin, the plasma level of connecting peptide (C-peptide) is also reduced due to beta cell destruction. Studies in the past decade have shown that C-peptide is much more than a byproduct of insulin biosynthesis and possess different biological activities. Therefore, it may be possible that C-peptide deficiency be involved, at least in part, in the development of different complications of diabetes. It has been shown that a small level of remaining C-peptide is associated with significant metabolic benefit. The purpose of this review is to describe beneficial effects of C-peptide replacement on pathological features associated with insulin-dependent diabetes. Also, experimental and clinical findings on the effects of C-peptide on whole-body glucose utilization, adipose tissue metabolism and tissues blood flow are summarized and discussed. The hypoglycemic, antilipolytic and vasodilator effects of C-peptide suggest that it may contribute to fine-tuning of the tissues metabolism under different physiologic or pathologic conditions. Therefore, C-peptide replacement together with the classic insulin therapy may prevent, retard, or ameliorate diabetic complications in patients with type-1 diabetes.

Keywords: C-peptide; Diabetes; Insulin; Nephropathy; Neuropathy

Core tip: In type-1 diabetes, in addition to decrease of endogenous insulin, the plasma level of connecting peptide (C-peptide) is also reduced due to beta cell destruction. Therefore, it may be possible that C-peptide deficiency be involved in the development of diabetic complications such as retinopathy, nephropathy, neuropathy and cardiovascular diseases. In this paper, beneficial effects of C-peptide replacement on pathological features associated with type-1 diabetes are described. Also, experimental and clinical findings that support the hypoglycemic, antilipolytic and vasodilator effects of C-peptide are discussed.