Antiphospholipase A2 receptor antibody-positive membranous nephropathy in the kidney donor: Lessons from a serendipitous transplantation

Primary membranous nephropathy (PMN) is an autoimmune disease limited to the kidney that is characterized by the presence of circulating PLAR2 antibodies in 70% of the cases and usually positivity for PLA2R and IgG4 by immunohistochemistry (IHC) staining. We report the first documented case of PMN (PLA2R positive) in a deceased kidney donor, transplanted to two different recipients and their clinical and immunological evolution through serial biopsies. Recipient A's first allograft biopsy (Day 26) was compatible with a MN with both positive PLA2R and IgG4 subepithelial deposits in IHC. The donor's preimplantation kidney biopsies were retrieved and reexamined, revealing MN, with high intensity for PLA2R and IgG4 in IHC. Recipient B's protocol allograft biopsy, performed later at 3 months, also revealed histology compatible with MN but without the presence of PLA2R nor IgG4 in IHC. At 1-year follow-up, both recipients maintain graft function. Serial protocol biopsies were performed in both patients showing disappearance of IgG4 in recipient A but the persistence of PLA2R in IHC. We can conclude that, given the reversal of PMN changes in the grafts, it could be considered to transplant a patient from an asymptomatic deceased donor with PMN as long as he maintains unaltered renal function.

Clinical Utility and Evolution of Donor Serum Lactate During Normothermic Regional Perfusion in Uncontrolled Donation After Circulatory Death

BACKGROUND

Kidney transplantation from uncontrolled donor after circulatory death (uDCD) showed a higher incidence of delayed graft function and primary failure. The aim of this study was to study basal and kinetic evolution of lactate values in uDCD preserved on normothermic regional perfusion (NRP) as a predictive factor of kidney suitability exposed to prolong ischemic conditions.

METHODS

Descriptive and prospective study of a cohort of out-of-hospital cardiac arrest patients admitted to the emergency room as potential uDCD. Donors meeting the inclusion criteria were preserved on NRP for at least 2 hours before procurement. Serum lactate levels were determined at arrival as basal level and at 30 minutes intervals and compared with adequate renal perfusion in the operating room (OR).

RESULTS

Forty-five donors met inclusion criteria. Of these, 38 went to the OR (84.5%). No differences were found in basal lactate between accepted and rejected kidneys (203.08 ± 59.21 vs 175.43 ± 75.32 mg/dL, respectively); neither lactate, hematologic, hepatic transaminases, creatinine, or blood gas analysis sequential values evolved while on NRP. Lactate receiver operating characteristic curve failed to predict viability at different time points and did not correlate with the macroscopic kidney poor perfusion in the OR.

CONCLUSIONS

The baseline and kinetic evolution of plasma lactate values while on NRP, were not useful tools to predict the final OR kidney viability owing to previous severe ischemic insult.

The development of a predictive model of graft function in uncontrolled donors after circulatory death: validity of a pulsatile renal preservation machine cut-off value for kidney acceptance

BACKGROUND

The criteria for kidney suitability in uncontrolled donors after circulatory death (uDCD) procured after regional normothermic perfusion are based on macroscopic appearance and renal haemodynamic values with final renal resistance (FRR). However, these criteria have not been analysed to predict the future graft function. This study presents a model to predict the outcome in uDCD kidneys and define the predictive FRR value.

METHODS

All uDCD kidney transplants performed in our hospital from 2004 to 2016 were included. Donors and recipients and pre-transplantation data are described. The endpoint was glomerular filtration rate (GFR) ≥30 mL/min at 6 months after transplantation.

RESULTS

A total of 194 recipients were included. FRR in donors ≥60 years old was (mean ± SD) 0.27 ± 0.11 versus 0.22 ± 0.09 mmHg/mL/min in donors <60 years (P = 0.042). Kidney survival was 88.2% versus 84% at 12 months and 60.7% versus 30.8% at 120 months (P = 0.067). For the group of recipients from donors ≥60 years, the FRR was 0.37 ± 0.08 mmHg/mL/min in the GFR <30 mL/min group versus 0.18 ± 0.06 mmHg/mL/min in the GFR ≥30 mL/min group (P < 0.001). The value FRR ≥0.3 mmHg/mL/min predicts 59-79% of GFR <30 mL/min [odds ratio = 2.16, 95% confidence interval (CI) 1.80-6.40; P < 0.001]. The predictive accuracy of FRR for GFR by ROC curve was 0.968 (95% CI). The best cut-off for FRR was 0.3 mmHg/mL/min to predict GFR at 6 months with a sensitivity of 67%, specificity of 100%, positive predictive value of 83% and negative predictive value of 92%.

CONCLUSIONS

Our results suggest that in uDCD donors the combination of donor age ≥60 years together with FRR ≥0.3 mmHg/mL/min could predict poor outcome at 6 months after transplantation in low immunological risk recipients.

Predictive and Comparative Study Between Clinic Consensus Document for Pancreas Acceptance and Predictive Value of Preprocurement Pancreas Allocation Suitability Score (P-PASS)

The strict selection of pancreas for transplant has forced the development of different documents to select the suitable organ in order to minimize the risks and complications of the transplant. In 2008, Eurotransplant published the Preprocurement Pancreas Allocation Suitability Score (P-PASS) for pretransplant selection. In 2001 the Hospital Clinic of Barcelona developed a Clinical Consensus Document (CCD).

OBJECTIVES

We aimed to analyze the predictive decision of the pancreas acceptance to offers received in the hospital, according to the CCD criteria and compare it with the recommended value of suitability for accepting the pancreas according to the P-PASS value.

MATERIAL AND METHODS

We performed a retrospective comparative study between the criteria of selection of the CCD for pancreas from 2016-2017 in comparison with the values obtained if the P-PASS had been used: ≤ 17, acceptance criteria and P-PASS; > 17, risk criteria. We defined the organ reported as rejected or accepted. The accepted organ could be procured and transplanted or discarded.

RESULTS

With the CCD criteria, 7 more organs were transplanted than if we only applied the potential P-PASS criteria. In contrast, P-PASS would have ruled out an additional 9% of pancreases in relation to CCD criteria.

CONCLUSIONS

According our experience, it is difficult to find an adequate prediction model to select pancreas for transplantation. The application of the DCC criteria increases the number of organs valid for transplantation. At present, new criteria should be re-evaluated within multicenter studies.

Relatives' Perception After Tissue Donation Experience: Results of a Postdonation Phone Survey

INTRODUCTION

Postmortem tissue donation (TD) requires the establishment of strategies for family approach to clearly explain the characteristics of multi-tissue donation. In a tertiary university hospital with a long tradition of tissue generation, we designed a survey to be applied to tissue donor families to evaluate global hospital care, care from Transplant Coordinators (TC), quality and content of information given about TD, experience, and motivations after TD process.

METHODOLOGY

A prospective phone survey of 10 multiple-choice items was conducted to all TD relatives that agreed to donate one or more tissues.

RESULTS

From the 166 calls made to TD relatives, 75 (45%) were answered: 50 were cornea donors and 25 were multiple-tissues donors. None of the relatives denied participating, the rest were not found. No statistical differences in demographical variables were found between both types of TD. The hospital and TC care perception, the quality of the given information about the processes of TD, the postdonation experiences in terms of procedures, and the impression about body appearance for relatives regardless of the type of donation, corneas or multiple tissues, were evaluated as good or very good for most of the TD relatives. Our study showed that 83% of the family members would agree to donate again; 40% of the relatives were surprised to be offered the option to donate; 10% did not know if they would donate again. Solidarity was the leading reason for TD.

CONCLUSION

The relatives' perception of care is a critical component of the quality evaluation of the TD process. The global evaluation results support our strategies for family approach.

Successful Pancreas Transplantation From a Deceased Donor Intoxicated With Oral Antidiabetic Agent: A Case Report

Simultaneous kidney pancreas transplantation (SKP) is a common procedure for the patient with long-term type 1 diabetes mellitus (DM) with terminal renal failure. It is unusual to consider the pancreas from a deceased donor who died after an acute intoxication with oral antidiabetic agent (OAA), which would suggest an abnormal functionality of the organ and preclude the potential use of the graft. We present a case of a successful pancreatic transplantation from a donor who died of acute cerebral edema secondary to severe hypoglycemia induced by OAA acute intoxication.

Telephone Consent in Tissue Donation: Effectiveness and Efficiency in Postmortem Tissue Generation

One reason for the loss of donors is the impossibility to contact family members for an interview. We sought to determine the effectiveness [(donors/total deaths) x 100] and efficiency [(donors/potential donors) x 100] of the telephone interview to obtain tissue for transplant purposes.

METHODS

A prospective, comparative cross-sectional study was performed on the personal and telephone interviews with family members during the tissue donation application process from January 1, 2004 to December 31, 2005.

RESULTS

Of the 3625 deaths hospital registered, we obtained 770 potential donors (21%). On 65% of occasions (503/770), the interview was held personally; on 29% (222/770), it had to be held over the telephone; and on 6% (45/770), family members could not be located. The refusals by family members over the telephone represented 48% (106/222), and the refusals during personal interviews were 37% (188/503). A positive family answer was obtained over the telephone on 116/431 donations (27%), and in the physical presence of the coordinator for 315/431 donors (73%). The donations obtained over the telephone were only for corneas in 83% (96/116) of cases, and for multiple tissues in 17% (20/116). The donor-generation effectiveness reached 9% in personal interviews and 12% if the telephone interviews were included. The donor generation efficiency reached 43% for personal interviews and 59% when telephone interviews were included. The use of the telephone enabled a 16% increase in tissue generation with a year-on-year increase of 4%.

CONCLUSIONS

The telephone has shown itself to be a useful tool for obtaining tissues postmortem.

Comparison of a high-carbohydrate and a high-monounsaturated fat, olive oil-rich diet on the susceptibility of LDL to oxidative modification in subjects with Type 2 diabetes mellitus

AIMS

To compare the effects of a high-carbohydrate (CHO) diet and a high-monounsaturated fatty acid (MUFA) diet on LDL oxidative resistance in free-living individuals with Type 2 diabetes mellitus.

METHODS

Twenty-two men and women out-patients with Type 2 diabetes, with mean age 61 years and in fair metabolic control (HbA1c<8.0%), were enrolled at a university hospital lipid clinic in a randomized, crossover feeding trial comparing two isocaloric diets for 6 weeks each: CHO (fat, 28% energy) and MUFA (fat, 40% energy) based on virgin olive oil. Outcome measurements were changes in LDL susceptibility to oxidation, body weight, glycaemic control, and lipoprotein profiles.

RESULTS

Planned and observed diets were well matched. Participants preferred the MUFA diet over the CHO diet. The lag time of conjugated diene formation during Cu2+-induced LDL oxidation was similar after the CHO and MUFA diets (36.4 +/- 12.2 min and 36.0 +/- 13.7 min, respectively). Body weight, glycaemic control, total triglycerides, and total, LDL- and HDL-cholesterol levels also were similar after the two diets. Compared with the CHO diet, the MUFA diet lowered VLDL-cholesterol by 35% (P=0.023) and VLDL triglyceride by 16% (P=0.016).

CONCLUSIONS

Natural food-based high-CHO and high-MUFA diets have similar effects on LDL oxidative resistance and metabolic control in subjects with Type 2 diabetes. A MUFA diet is a good alternative to high-CHO diets for nutrition therapy of diabetes because it also has a beneficial effect on the lipid profile and superior patient acceptance.

The process of adult living liver donation

OBJECTIVE

To evaluate both the opinion that living liver donors have of the process and the psychological, economic, and social consequences of donation.

MATERIAL AND METHODS

Six months after the donation, an anonymous survey was sent to 22 donors of the right liver lobe between March 2000 and December 2002.

RESULTS

15 surveys were returned with all of the questions answered. Almost all the donors had no prior knowledge of living donation. When they were considered to be suitable donors, all of them felt happy, 21% were scared and 15% felt joy and insecurity. The information provided was well understood and accurately described the experiences of 93% of donors. All donors understood the vital risk, and 93% understood that transplantation is not always completely successful. All donors would repeat the experience. Mean hospital stay was 12.6 days. Mean convalescence was 50.6 days. Salaried donors were on sick leave for a mean of 96.4 days (21-150 days), causing financial problems in six cases (36%), due to no financial compensation and compulsory redundancy in one case. All donors had completely recovered at six months after donation.

DISCUSSION

Adult living donation of the right liver lobe is an accepted therapeutic alternative. In order to regulate medical and economic protection to avoid additional disturbances after donation, the public, patients, and physicians require more complete information about living donation.

The living kidney donation process: the donor perspective

OBJECTIVE

To evaluate the living kidney donation (LKD) process using donors' opinions on the impact on social, emotional, and financial aspects affecting donor quality of life.

MATERIALS AND METHODS

From May 2000 to December 2002, we studied 22 donors of living kidneys at the Hospital Clinic, Barcelona, Spain, who completed an anonymous survey 6 months after donation.

RESULTS

Most donors (86%) had themselves informed the recipient about their wish to donate, the other 14% were asked by family members. Eighty-eight percent stated that the information provided to the donor about the evaluation process was well explained and understood whereas 12% disagreed with the statement. At the time of thin decision, 90.5% of donors understood the vital risk. For 95%, the explanations about the process corresponded with the actual experience. One hundred percent of donors stated after donation that they would again favor it. Mean hospital stay was 6 days (range, 3-9 days). Those donors with a labor contract have been out of work for an average of 57.8 days (range, 18 days to 6 months). Twenty-five percent of donors admitted financial effects as a result of donation. All but 1 felt completely recovered with the same quality of life after donation.

DISCUSSION

LKD is a good therapeutic alternative. Some aspects should be developed, such as more information about living donation and the need to considering donors as healthy persons without loss of earnings. Recognition of the benefits of living donation requires more wide participation of all citizens nationally.

High-monounsaturated fat, olive oil-rich diet has effects similar to a high-carbohydrate diet on fasting and postprandial state and metabolic profiles of patients with type 2 diabetes

Whether metabolic control in type 2 diabetes mellitus (DM) is best achieved with the traditional high-carbohydrate (CHO), low-fat diet or a low-CHO, high-fat diet is still controversial. In a randomized crossover study, we compared the effects of a low-fat (30% of daily energy) diet and a high-fat (40% of daily energy), high-monounsaturated-fat diet for 6 weeks each on fasting and postprandial glucose, insulin, and lipoprotein concentrations in 12 patients with well-controlled type 2 DM (fasting blood glucose, 176 +/- 54 mg/dL; hemoglobin A1c, 6.4% +/- 0.7%) and no overt dyslipidemia (serum total cholesterol, 235 +/- 43 mg/dL; triglycerides, 180 +/- 63 mg/dL). Home-prepared foods were used and olive oil was the main edible fat, accounting for 8% and 25% of daily energy requirements in the low-fat and high-fat diets, respectively. For postprandial studies, the same mixed meal containing 36% fat was used in both dietary periods. Body weight and fasting and 6-hour postprandial blood glucose, insulin, and lipoprotein levels were similar after the two diets. The mean incremental area under the curve of serum triglycerides 0 to 6 hours after the challenge meal, adjusted for baseline levels, did not change significantly after the high-fat diet compared with the low-fat diet (1,484 +/- 546 v 1,714 +/- 709 mg x 6 h/dL, respectively, P = .099). Mean postprandial triglyceride levels at 6 hours were increased about 2 times over fasting levels and were still greater than 300 mg/dL after either diet. A diet high in total and monounsaturated fat at the expense of olive oil is a good alternative diet to the traditional low-fat diet for patients with type 2 DM. However, ongoing postprandial hypertriglyceridemia with either diet points to the need for other therapies to decrease triglyceride-rich lipoproteins (TRL) and the inherent atherogenic risk in type 2 diabetics.

Effects of insulin administration in a group of high-risk, non-diabetic, first-degree relatives of Type 1 diabetic patients: an open pilot trial

AIMS

To elucidate the effect of prophylactic insulin, in a treatment schedule previously demonstrated to achieve beta-cell rest, in a group of high-risk, non-diabetic first-degree relatives of Type 1 diabetic patients.

METHODS

Ten high risk subjects for Type 1 diabetes mellitus (DM) (seven male/three female, aged 19.8+/-9.6 years) defined as: first-degree relatives of Type 1 DM patients, islet cell autoantibodies (ICA) > or =20 Juvenile Diabetes Foundation (JDF) units twice, first phase insulin response (FPIR) to glucose in an intravenous glucose tolerance test < or =10th percentile of a control group were included in an open pilot trial. Five were treated with subcutaneous insulin: 0.1 IU/kg body weight/day of neutral protamine hagedorn (NPH) insulin once a day. Five declined treatment and were used as controls. Control and treatment groups did not differ in terms of age, ICA, insulin autoantibodies (IAA), glutamic acid dehydrogenase (GAD) and FPIR.

RESULTS

Three out of five subjects in both groups developed Type 1 DM during follow-up: after 21, and 32-57 months in the insulin-treated group and after 4, and 18-60 months in the untreated group. Three out of six subjects who developed overt diabetes had a FPIR below the 2nd percentile of the control value at the onset of the study. All subjects who developed diabetes were positive for antibodies to GAD and expressed the HLA-DR3 or DR4 alleles, whereas only one of the non-progressors had these parameters (P < 0.05). During follow-up, a decrease in ICA titres was observed in the group which received prophylactic insulin in contrast with the untreated group. GAD, as well as insulin secretory capacity, remained unchanged in both groups.

CONCLUSION

The subcutaneous administration of insulin (0.1 IU/kg body weight/day of NPH insulin once a day) in our group of high-risk subjects for Type 1 DM produced only a minor effect in some immunological markers (ICA), without preventing the development of overt disease. The efficacy and safety of insulin used at either a different dose or by a different route, as well as its potential effect in the early phases of prediabetes, warrants further investigation.

Recurrence of immunological markers for type 1 (insulin-dependent) diabetes mellitus in immunosuppressed patients after pancreas transplantation

BACKGROUND

Type 1 (insulin dependent) diabetes mellitus (IDDM) is an autoimmune disease in which autoantibodies against islet cells develop concomitantly with or even preceding diagnosis. Because the recurrence of diabetes can be the cause of graft failure in patients with pancreas transplantation, we studied the possible recurrence of IDDM immunomarkers after transplantation.

METHODS

The following determinations were performed every 1-2 years after transplantation in 50 immunosuppressed IDDM patients with simultaneous kidney and pancreas transplantation (bladder drainage of exocrine secretion): islet cell antibodies (ICA) by direct immunofluorescence, antibodies against glutamic acid decarboxylase (GADab) by radiobinding assay, and the oral glucose tolerance test. The mean follow-up was 4.1+/-6.3 (range 1 to 9 years).

RESULTS

GADab were detected in 11 patients after transplantation, 10 of whom had been positive beforehand. ICA reappearance after transplantation was detected in seven patients (14%). The presence of ICA was related to GADab positivity (P=0.001) and HLA DR3 patients (P=0.04), but not with pancreatitis and rejection episodes, immunosuppression induction therapy, or donor HLA haplotype. During follow-up, an abnormal oral glucose tolerance test was more frequent in ICA-positive patients (P=0.02), with no differences in metabolic control or insulin secretion.

CONCLUSION

We conclude that GADab persist and ICA reappear despite immunosuppressive therapy in patients with functioning pancreas transplants. The relevance and the risk that this implies for IDDM development should be determined.

High proinsulin levels in late PRE-IDDM stage

AIM

To analyse the fasting proinsulin levels in first degree relatives of patients with insulin-dependent diabetes mellitus (IDDM) with different risk for developing the disease.

PATIENTS AND METHODS

Non siblings first degree relatives, 33, of IDDM patients were separated into three groups with different risk for developing IDDM: Group 1, 14 first degree relatives (eight male/six female), aged from 18 to 57 years, normal first phase insulin release (FPIR) in the intravenous glucose tolerance test, negative ICA; Group 2, 11 first degree relatives (six male/five female), aged from 16 to 62 years, normal FPIR and ICA < 20 JDF U; Group 3, eight first degree (six male/two female), from 16 to 52 years, FPIR diminished and ICA > 20 JDF U. All patients had normal oral glucose tolerance test at the initiation of the study. We tested fasting proinsulin (PRO) and insulin (IRI) levels by radioimmunoassay (RIA) and the PRO/IRI ratio.

RESULTS

Four first degree from the group 3 developed IDDM after 2-32 months. No differences were observed in-fasting PRO levels and PRO/IRI ratio between the groups. However, the PRO (21.7 +/- 5.8 pmol/l) and PRO/IRI ratio (0.29 +/- 0.10) levels of the subjects who developed IDDM were significantly higher (P < 0.05) than those values obtained in subjects who did not developed the disease.

CONCLUSION

these data indicate that fasting PRO levels and the PRO/IRI ratio may be an additional marker in post-puberty first-degree relatives of IDDM patients with immunological and metabolic evidence of high risk for developing the disease.

[Presence of markers predictive of type I pre-diabetes mellitus status in relatives of patients with type I diabetes mellitus]

BACKGROUND

The aim of this study was to analyze the predictive factors of IDDM in first degree relatives of IDDM patients.

SUBJECTS AND METHODS

From 1992 to 1994, 1,053 first degree relatives were screened for measuring islet cell antibodies (ICA) by indirect immunofluorescence (iFl). In all ICA positive subjects, beta cell function was analyzed by intravenous glucose tolerance test (IVGTT) and other immunologic parameters were also studied: anti-insulin antibodies (IAA) by radiobinding and antibodies to glutamic acid decarboxylase (GADAb) by ELISA methods.

RESULTS

ICA were found in 3.1% of the first degree relatives. IVGTT showed a significant decrease in acute first phase of insulin response to glucose (IRI 1 minute + 3 minute) in those with ICA > or = 20 JDF units. In patients with ICA > or = 20 JDF units, 20% were found to be positive for IAA and 40% were positive for GAdAb. Thirty-one percent (10/32) of ICA positive first degree relatives fulfilled prediabetes criteria. During follow-up, 40% (4/10) of these prediabetic patients developed IDDM.

CONCLUSION

This study confirms the possibility of identifying among first degree relatives of IDDM patients the subgroup with high risk of developing IDDM thus allowing the initiation of therapy for preventing or delaying IDDM onset.

Effects of insulin administration on beta-cell function in subjects at high risk for type I diabetes mellitus

The aim of the study was to determine the appropriate dose of subcutaneous insulin to induce "beta-cell rest" without any hypoglycemic risk, as the first stop in the investigation of its potential effect in preventing or delaying clinical diabetes mellitus onset in high-risk subjects. Four subjects at high risk for type I diabetes mellitus (first-degree relatives, islet cell antibodies (ICA)-positive, and with diminished first-phase insulin secretion) were compared with four healthy individuals. After hospitalization, urinary C-peptide excretion (UCP) and 24-hour serum profiles for glucose were measured before and after administration of NPH insulin 0.1, 0.2, and 0.3 U x kg body weight per day subcutaneously in a single dose on 4 consecutive days. After insulin 0.1 U x kg body weight, a significant inhibition of endogenous insulin secretion was observed in high-risk subjects, but not in control subjects. There was no further inhibition when a higher insulin dose (0.2 and 0.3) was administered. A sustained beta-cell rest was obtained after 3, 6, and 12 months of treatment with 0.1 U x kg body weight per day as outpatient therapy in high-risk subjects. With this dose, no subject developed hypoglycemia (plasma glucose <50 mg/dL), whereas this adverse effect was detected after 0.2 and 0.3 U x kg body weight in both groups. In conclusion, our results indicate that administration of NPH insulin 0.1 U x kg bodyweight per day induces beta-cell rest without the undesirable effect of hypoglycemic episodes. This is a preliminary study to investigate the potential beneficial effect of insulin in preventing or delaying type I diabetes mellitus in subjects at high risk for the disease.

[Insulin treatment in diabetes mellitus type II: the usefulness of the breakfast test]

BACKGROUND

Insulin treatment in patients with type-II diabetes mellitus (DMII) is normally undertaken by clinical criteria. The aim of the present was to study the efficacy of a standard mixed meal (breakfast test) to predict the need for insulin therapy to thereby evaluate whether it is possible to obtain more objective criteria for the indication of insulin treatment.

METHODS

Fifty-six patients with DMII were studied to evaluate the need for insulin therapy over a one-year period. Serum glucose and basal C peptide and their maximum values were determined in all the patients following stimulation with the breakfast test. Insulin treatment was initiated according to exclusively clinical criteria during admission. The patients were followed as out patients for a minimum of 3 months. Treatment at the end of follow up (insulin or no insulin) was evaluated and the results of the test were retrospectively analyzed.

RESULTS

The basal C peptide (BCP) values were significantly lower in the individuals requiring insulin in comparison to those who did not require insulin (mean +/- SD 0.64 +/- 0.28 versus 1.18 +/- 0.41 nmol/l, p < 0.0001) similar to what was found with the stimulated maximum C peptide values (MCP) (1.48 +/- 0.77 versus 2.49 +/- 0.63 nmol/l, p < 0.0001). On considering a BCP of less than 0.9 nmol/l for the patients with insulin treatment the sensitivity of BCP was 83.6% and the specificity 78.9%. For a BCP value of less than 1.9 nmol/l sensitivity was 77.7% and specificity 78.9%. Using the values together, sensitivity was 66.6% and specificity 84.4%.

CONCLUSIONS

The breakfast test is useful to indicate the need for insulin therapy in patients with type II diabetes mellitus but is not more useful than a determination of isolated basal C peptide.