Insulin sensitivity assessed using urine C peptide creatinine ratio (UCPCR) in pregnancy: cross-sectional analysis of an English multiethnic cohort.

AIMS: To assess urinary C peptide creatinine ratio (UCPCR) used in a modified Matsuda equation to measure insulin sensitivity (IS) in pregnancy. RESEARCH AND DESIGN METHODS: In this cross-sectional study, two IS measurements were calculated in 73 pregnant women at ~28 weeks of gestation by two separate methods using modified Matsuda equations. The first using the 0 and 120 min serum C peptide concentration during a 75 g oral glucose tolerance test (OGTT) and the second using the 0 and 120 min UCPCR values. The calculated IS measurements from the two methodologies were evaluated using Person's test and linear regression analysis. The relationship between ISOGTT UCPCR and the fasting second void UCPCR and 120 min UCPCR was assessed using Pearson correlation and linear regression analysis after logarithmic transformation of the variables. Statistical analysis was performed using SPSS V.22. RESULTS: The IS measured using serum C peptide (ISOGTTc-pep) in the modified Matsuda equation correlated with the IS measurement using serum UCPCR (ISOGTT-UCPCR) (r 0.704, p<0.0001). A strong correlation was found between the ISOGTT-UCPCR and the fasting UCPCR (r -0.916, p<0.0001), displaying a hyperbolic relationship. CONCLUSION: The UCPCR provides a practical methodology to assess IS and ß-cell function in pregnancy.

Partial anomalous pulmonary venous connection in a dog.

A 2-year-old male intact Belgian Malinois was presented for exercise intolerance. A grade III/VI left basilar systolic murmur was detected. Echocardiography revealed moderate right atrial and ventricular dilation and increased pulmonic outflow velocity. Thoracic radiographs showed right heart enlargement and a dilated caudal vena cava. In addition, on the left lateral projection, an enlarged aberrant right cranial pulmonary lobar vein was suspected to be diverging ventrally from the course of the right cranial lobar bronchus and inserting more ventrally than normal in the region of the right atrium. A left-to-right pulmonary vascular shunt was suspected, and the patient underwent further diagnostics under general anesthesia. An agitated saline study was positive, suggestive of a concurrent right to left shunt. A right heart catheterization was performed. Angiography was inconclusive. Oximetry testing revealed an increase in oxygen saturation within the right atrium at the level of the caudal cava supportive of a left-to-right shunt in this region. Computed tomography angiography revealed a large single pulmonary vein that anomalously entered into the caudolateral aspect of the right atrium (left-to-right shunt) and was suspicious for a small arteriovenous malformation between the right caudal pulmonary artery and the right pulmonary vein returning to the left atrium (right to left shunt). The patient was diagnosed with a partial anomalous pulmonary venous connection and a possible arteriovenous malformation.

Urinary C peptide creatinine ratio in pregnant women with normal glucose tolerance and type 1 diabetes: evidence for insulin secretion.

HYPOTHESIS: In pregnancy, urinary C peptide creatinine ratio (UCPCR) reflects endogenous insulin secretion in women with normal glucose tolerance and type 1 diabetes. RESEARCH DESIGN AND METHODS: UCPCR and serum C peptide were measured in 90 glucose-tolerant women at 0 and 120 min during a 75 g oral glucose tolerance test (OGTT) at 28 weeks of gestation. UCPCR was measured in 2 samples obtained over 10 weeks apart in 7 pregnant women with longstanding type 1 diabetes. RESULTS: UCPCROGTT and serum C peptideOGTT of glucose-tolerant women were significantly correlated at 0 and 120 min (rs0.675, 0.541 respectively, p<0.0001). All 7 pregnant women with type 1 diabetes had detectable first sample UCPCR (median (range) 49 (6-1038) pmol/mmol) that rose in 6 women by 477 (29-1491) pmol/mmol. CONCLUSIONS: Detectable UCPCR in pregnant women with normal glucose tolerance and type 1 diabetes is likely to reflect endogenous insulin secretion and hence ß-cell activity.