Type 2 diabetes mellitus is a heterogeneous disease. Recently introduced new subclassifications promise more efficacious, tailored treatments which could complement current guidelines. In the differentiation of the new diabetes subphenotypes, assessment of insulin secretion is one of the essential components. Based on a large number of insulin secretion measurements, we propose fasting C-peptide/glucose ratio (CGR) as an adequate and practicable estimate of insulin secretion. CGR discriminates insulin deficiency from insulin hypersecretion. We suggest using insulin secretion, determined from CGR, as an essential input for therapeutic decisions at the beginning or modification of diabetes treatment. Furthermore, we propose 3 practical steps to guide decisions in the subtype-specific therapy of diabetes mellitus. The first step consists of detecting insulin deficiency indicated by a low CGR with the need for immediate insulin therapy. The second step is related to high CGR and aims at lowering cardiovascular risk associated with diabetes. The third step is the consideration of a de-escalation of glucose-lowering therapy in individuals with mild diabetes subphenotypes.

中文翻译：

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在选择降糖药物时考虑通过空腹 C 肽/葡萄糖比来衡量的胰岛素分泌能力。

2型糖尿病是一种异质性疾病。最近引入的新子分类有望提供更有效、更量身定制的治疗方法，可以补充当前的指南。在新的糖尿病亚表型的分化中，胰岛素分泌的评估是必不可少的组成部分之一。基于大量的胰岛素分泌测量，我们建议空腹 C 肽/葡萄糖比率 (CGR) 作为胰岛素分泌的充分且可行的估计。CGR 区分胰岛素缺乏和胰岛素分泌过多。我们建议使用由 CGR 确定的胰岛素分泌作为糖尿病治疗开始或修改治疗决策的重要输入。此外，我们提出了 3 个实际步骤来指导糖尿病亚型特异性治疗的决策。第一步包括检测低 CGR 表明的胰岛素缺乏，需要立即进行胰岛素治疗。第二步与高 CGR 相关，旨在降低与糖尿病相关的心血管风险。第三步是考虑在患有轻度糖尿病亚表型的个体中降级降糖治疗。