1,5-Anhydro-D-glucitol Evaluates Daily Glycemic Excursions in Well-Controlled NIDDM

Kishimoto, Michihiko; Yamasaki, Yoshimitsu; Kubota, Minoru; Arai, Katsumi; Morishima, Toyohiko; Kawamori, Ryuzo; Kamada, Takenobu

doi:10.2337/diacare.18.8.1156

Cited by 79 publications

(48 citation statements)

References 11 publications

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“…clinical study conducted in Japan, it was shown that 1,5-AG could be a useful index of glucose excursions in patients with reasonably well-controlled diabetes (mean A1C 7.1%) (15). Preliminary data from another study in Japan showed that 1,5-AG was an independent predictor of postprandial hyperglycemia and was more sensitive and specific than A1C (22).…”

Section: Conclusion -In a Previousmentioning

confidence: 99%

“…Thus, 1,5-AG responds sensitively and rapidly to changes in serum glucose, reflecting even transient elevations of glucose within a few days (13,14). 1,5-AG has been shown to reflect daily glycemic excursions in patients with A1Cs at or near goal (15). In contrast, A1C is an index of average glucoses over a much longer period of time (2-3 months), encompassing both hyperglycemia and hypoglycemia.…”

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confidence: 99%

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1,5-Anhydroglucitol and Postprandial Hyperglycemia as Measured by Continuous Glucose Monitoring System in Moderately Controlled Patients With Diabetes

Dungan¹,

Buse

Largay³

et al. 2006

Diabetes Care

214

176

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OBJECTIVE -Postprandial hyperglycemia is often inadequately assessed in diabetes management. Serum 1,5-anhydroglucitol (1,5-AG) drops as serum glucose rises above the renal threshold for glucose and has been proposed as a marker for postprandial hyperglycemia. The objective of this study is to demonstrate the relationship between 1,5-AG and postprandial hyperglycemia, as assessed by the continuous glucose monitoring system (CGMS) in suboptimally controlled patients with diabetes.RESEARCH DESIGN AND METHODS -Patients with type 1 or type 2 diabetes and an HbA 1c (A1C) between 6.5 and 8% with stable glycemic control were recruited from two sites. A CGMS monitor was worn for two consecutive 72-h periods. Mean glucose, mean postmeal maximum glucose (MPMG), and area under the curve for glucose above 180 mg/dl (AUC-180), were compared with 1,5-AG, fructosamine (FA), and A1C at baseline, day 4, and day 7.RESULTS -1,5-AG varied considerably between patients (6.5 Ϯ 3.2 g/ml [means Ϯ SD]) despite similar A1C (7.3 Ϯ 0.5%). Mean 1,5-AG (r ϭ Ϫ0.45, P ϭ 0.006) correlated with AUC-180 more robustly than A1C (r ϭ 0.33, P ϭ 0.057) or FA (r ϭ 0.38, P ϭ 0.88). MPMG correlated more strongly with 1,5-AG (r ϭ Ϫ0.54, P ϭ 0.004) than with A1C (r ϭ 0.40, P ϭ 0.03) or FA (r ϭ 0.32, P ϭ 0.07).CONCLUSIONS -1,5-AG reflects glycemic excursions, often in the postprandial state, more robustly than A1C or FA. 1,5-AG may be useful as a complementary marker to A1C to assess glycemic control in moderately controlled patients with diabetes. Diabetes Care 29:1214 -1219, 2006T he importance of tight glycemic control in preventing the complications of diabetes has been well documented (1-3). More recently, studies indicate that postprandial glucose may be an independent risk factor for the development of macrovascular complications (4 -6). Many patients who are otherwise well controlled by HbA 1c (A1C), the current standard indicator of overall glycemia, also have significant postprandial hyperglycemia (7). Currently, available markers for measuring glycemic control, including A1C and fructosamine (FA), only reflect average glucose, potentially missing important hyperglycemic excursions that may be balanced out by hypoglycemia. Therefore, an alternative marker that robustly reflects postprandial glucose excursions could be useful in the management of patients with diabetes.Plasma 1,5-anhydroglucitol (1,5-AG) is a naturally occurring dietary polyol that has been proposed as a marker for postprandial hyperglycemia. An automated assay (Glycomark) has recently been approved in the U.S. as a short-term marker for glycemic control (8), and a similar assay has been in use in Japan for over a decade (9). During normoglycemia, 1,5-AG is maintained at constant steadystate levels due to a large body pool compared with the amount of intake (10) and due to a lack of metabolism (10,11). Normally, in the kidneys, 1,5-AG is filtered and completely reabsorbed (12). However, with elevated serum glucose concentrations (generally Ͼ180 mol/l, the average renal threshold fo...

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Section: Conclusion -In a Previousmentioning

confidence: 99%

mentioning

confidence: 99%

1,5-Anhydroglucitol and Postprandial Hyperglycemia as Measured by Continuous Glucose Monitoring System in Moderately Controlled Patients With Diabetes

Dungan¹,

Buse

Largay³

et al. 2006

Diabetes Care

214

176

View full text Add to dashboard Cite

show abstract

“…whose HbA1c levels are at or near the goal [7,8], and 1,5-AG levels have been reported to reflect postprandial glucose values in diabetic patients [9,10]. 1,5-AG levels are also considered a useful indicator of glycemic control, because they correlate with fasting plasma glucose and HbA1c levels [11,12], and they have been suggested to be a predictor of microvascular complications, such as diabetic retinopathy [13].…”

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confidence: 99%

Correlation between baseline serum 1,5-anhydroglucitol levels and 2-hour post-challenge glucose levels during oral glucose tolerance tests

et al. 2011

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The resulTs of recent studies indicate that postprandial hyperglycemia may be an independent risk factor for the development of macrovascular complications [1,2]. Although tight glycemic control is important to prevent complications of diabetes [3][4][5], many patients who are well controlled based on their HbA1c values have post-challenge hyperglycemia in oral glucose tolerance tests (OGTTs) [6]. 1,5-Anhydroglucitol (1,5-AG), a major 6-carbon dietary monosaccharide, is thought to reflect daily glycemic excursions, especially in patients Endocrine Journal 2011, 58 (1), [13][14][15][16][17] Correlation between baseline serum 1,5-anhydroglucitol levels and 2-hour post-challenge glucose levels during oral glucose tolerance tests Abstract. Since there is increasing evidence that postprandial hyperglycemia is a risk factor for the development of macrovascular complications, it is important to predict postprandial hyperglycemia in the early stages of glucose intolerance, and routine medical checkups provide a good opportunity to do so. The aim of this study was to evaluate the usability of 1,5-anhydroglucitol (1,5-AG) in routine medical checkups. The subjects were 77 Japanese men who participated in a routine medical checkup. First, we performed 75 g oral glucose tolerance tests (OGTTs), and examined the changes in glucose and 1,5-AG levels measured at 0, 30, 60, 90, 120, and 180 minutes (min). 1,5-AG levels did not significantly change until 90 min after the glucose load. Second, a linear regression analysis showed an inverse correlation between the 2-hour postchallenge glucose (2h-PG) and baseline 1,5-AG levels during the OGTT (P = 0.001, r 2 = 0.13), and the correlation was still significant after adjustment for age (2h-PG = 170 + 0.83 × (age in years) -3.23 × (1,5-AG), P = 0.002, adjusted r 2 = 0.12).Finally, to investigate the test characteristics of 1,5-AG levels as a predictor of a 2h-PG level ≥200 mg/dL, we plotted a receiver operating characteristic (ROC) curve. The area under the ROC curve was 0.78, and the maximal sum of sensitivity and specificity (78% and 72%, respectively) was obtained at a 1,5-AG cutoff level of <14.2 μg/mL. We conclude that 1,5-AG values may provide an ancillary predictor of 2h-PG of 75 g OGTTs in routine medical checkups.

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“…1992, 1996), reflecting even transient elevations of glucose within the past few days and thereby serving as a measurement which is informative of glycemic excursions even in patients with normal HbA1cs (Kishimoto et al. 1995). Indeed, 1,5‐AG has been associated with risk of developing diabetes independently of HbA1c and fasting glucose concentrations (Juraschek et al.…”

Section: Introductionmentioning

confidence: 99%

A computational model of 1,5-AG dynamics during pregnancy

et al. 2017

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The importance of 1,5‐anhydroglucitol (1,5‐AG) as an intermediate biomarker for diabetic pregnancy is multi‐fold: (1) it serves as a reliable indicator of moderate‐level glycemic control, especially during early gestation; (2) it has been associated with increased risk of diabetes, independent of HbA1c and fasting glucose; and (3) it is an independent risk factor for the development of eclampsia during pregnancy. However, the clinical use of this biomarker during pregnancy has been underutilized due to physiological changes in glomerular filtration rate, plasma volume, and other hemodynamic parameters which have been hypothesized to bias gestational serum 1,5‐AG concentrations. Here, we develop an in‐silico model of gestational 1,5‐AG by combining pre‐existing physiological data in the literature with a two‐compartment mathematical model, building off of a previous kinetic model described by Stickle and Turk (1997) Am. J. Physiol., 273, E821. Our model quantitatively characterizes how renal and hemodynamic factors impact measured 1,5‐AG during normal pregnancy and during pregnancy with gestational diabetes and diabetes mellitus. During both normal and diabetic pregnancy, we find that a simple two‐compartment model of 1,5‐AG kinetics, with all parameters but reabsorption fraction adjusted for time in pregnancy, efficiently models 1,5‐AG kinetics throughout the first two trimesters. Allowing reabsorption fraction to decrease after 25 weeks permits parameters closer to expected physiological values during the last trimester. Our quantitative model of 1,5‐AG confirms the involvement of hypothesized renal and hemodynamic mechanisms during pregnancy, clarifying the expected trends in 1,5‐AG to aid clinical interpretation. Further research and data may elucidate biological changes during the third trimester that account for the drop in 1,5‐AG concentrations, and clarify physiological differences between diabetes subtypes during pregnancy.

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1,5-Anhydro-D-glucitol Evaluates Daily Glycemic Excursions in Well-Controlled NIDDM

Abstract: The findings suggest that the plasma 1,5-AG concentration can be a useful index of the daily excursion of blood glucose, especially in patients with well-controlled NIDDM.

Cited by 79 publications

References 11 publications

1,5-Anhydroglucitol and Postprandial Hyperglycemia as Measured by Continuous Glucose Monitoring System in Moderately Controlled Patients With Diabetes

1,5-Anhydroglucitol and Postprandial Hyperglycemia as Measured by Continuous Glucose Monitoring System in Moderately Controlled Patients With Diabetes

Correlation between baseline serum 1,5-anhydroglucitol levels and 2-hour post-challenge glucose levels during oral glucose tolerance tests

A computational model of 1,5-AG dynamics during pregnancy

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