Estimation of plasma glucose fluctuation with a combination test of hemoglobin A1c and 1,5-anhydroglucitol

Yamanouchi, Toshikazu; Moromizato, Hitoshi; Shinohara, Takaomi; Minoda, Susumu; Miyashita, Hideo; Akaoka, Ieo

doi:10.1016/0026-0495(92)90168-a

Cited by 51 publications

(43 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, 1,5-AG was significantly correlated with glycemic variability under various study conditions, including wellcontrolled diabetes. [28][29][30] In contrast, Kim et al 11 suggested that 1,5-AG did not correlate with glycemic variability and was only correlated with mean glucose and postprandial hyperglycemia in patients with moderately controlled diabetes (HbA1c £ 8%).…”

Section: Discussionmentioning

confidence: 94%

Evaluation of Glycemic Variability in Well-Controlled Type 2 Diabetes Mellitus

Chon

Lee²,

Fraterrigo³

et al. 2013

Diabetes Technology & Therapeutics

View full text Add to dashboard Cite

Aims: It is necessary to evaluate glucose variability and postprandial hyperglycemia in patients with well-controlled type 2 diabetes mellitus because of the limitations associated with hemoglobin A1c (HbA1c) measurements. We evaluated parameters reflecting postprandial hyperglycemia and glycemic variability in patients with optimal HbA1c. Patients and Methods: Thirty-nine patients with HbA1c levels below 7% were recruited to the study. A continuous glucose monitoring system (CGMS) was applied for two 72-h periods. 1,5-Anhydroglucitol (1,5-AG) and fructosamine (FA) were measured as parameters for postprandial hyperglycemia and glucose variability. Using CGMS data, the following postprandial hyperglycemia parameters were calculated: mean postprandial maximum glucose (MPMG) and area under the curve for glucose above 180 mg/dL (AUC-180). To measure glycemic variability, we calculated mean amplitude of glucose excursion (MAGE) using a classical (MAGE c ) and new method (MAGE group of sign [MAGE gos ]). Results: The baseline HbA1c level was 6.3 -0.3%. The mean MPMG was 10.34 -1.84 mmol/L, and the mean AUC-180 was 0.17 -0.23 mmol/L/day. The mean MAGE gos was 3.27 -1.29 mmol/L, and MAGE c was 4.30 -1.43 mmol/L, indicating glycemic variability in our patients. The mean levels of 1,5-AG and FA were 16.7 -7.4 lg/mL and 273.0 -22.5 lmol/L, respectively. In a correlation analysis, FA was significantly correlated with MPMG, AUC-180, MAGE gos , and MAGE c . In contrast, 1,5-AG was only correlated with AUC-180. Conclusions: This study demonstrated postprandial hyperglycemia and glycemic variability in subjects with well-controlled diabetes. FA may reflect postprandial hyperglycemia and glycemic variability, but 1,5-AG may be of limited value for assessing glucose variability in patients with well-controlled type 2 diabetes mellitus.

show abstract

Section: Discussionmentioning

confidence: 94%

Evaluation of Glycemic Variability in Well-Controlled Type 2 Diabetes Mellitus

Chon

Lee²,

Fraterrigo³

et al. 2013

Diabetes Technology & Therapeutics

View full text Add to dashboard Cite

show abstract

“…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).…”

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

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...

show abstract

“…The poor plasma glucose control, as well as the fact that the subjects were not selected from a community basis, and the long DM duration might explain the discrepancy between the Japanese and our patients. However, a lower level of plasma AG in type 1 than in type 2 DM patients may counteract to some of the findings due to our exclusive selection of type 2 DM patients (2,14,22,(24)(25).Our study has demonstrated that AG is as good as HbA1c and fructosamine in short-term evaluation of the glycemic control. Different from HbA1c and fructosamine, AG can be measured directly and, therefore, is not influenced by anemia or hypoalbuminemia, which often exist in long-standing diabetic patients.…”

mentioning

confidence: 77%

1,5-anhydroglucitol levels in type 2 diabetic and non-diabetic subjects in Southern Taiwan

Chen

Hing-Chung

Chih-Hsun³

et al. 2003

Arq Bras Endocrinol Metab

View full text Add to dashboard Cite

Purposes: To estimate plasma 1,5-anhydroglucitol (AG) in diabetic (DM) and non-DM patients in a Chinese population, and to compare it with fructosamine, glycosylated hemoglobin (HbA1c), and fasting glucose (FG) levels. Methods: Case-control study on the significance of AG conducted in a medical center of southern Taiwan, including 356 inpatients (300 non-DM and 56 type 2 DM). Plasma AG, fructosamine, HbA1c and FG were measured on the second day of admission and only those with normal values (except glucose) were enrolled. Glycemic markers of the non-DM patients were examined only once whereas DM patients were sequentially sampled over 3 months. Results: Mean plasma AG levels were lower in DM than in non-DM patients (4.02±2.96 vs 26.68±11.33µg/ml, P<0.001), and lower in non-DM females than males (22.90±9.51 vs 29.45±11.7µg/ml, P<0.05). AG showed a good correlation with FG. Mean plasma AG were inversely correlated with FG, fructosamine and HbA1c in DM patients and worked as well as other glycemic markers in detecting short-term changes in glycemic control. AG levels of DM patients demonstrated no difference with or without smoking, hypertension, micro-and macro-vascular complications. Conclusions: We recommend clinical application of plasma AG in long-standing DM patients for short-term detection and monitoring glycemic condition. Objetivos: Avaliar o 1,5-anidroglucitol (AG) plasmático em pacientes com (DM) e sem (não-DM) diabetes numa população chinesa, e compará-lo à frutosamina, hemoglobina glicada (HbA1c) e glicemia de jejum (GJ). MÈtodos: Estudo caso-controle sobre a significância do AG conduzido em centro médico no sul de Taiwan com 356 pacientes selecionados (300 não-DM e 56 DM2). Os níveis de AG, frutosamina, HbA1c e GJ foram avaliados no 2 o . dia de admissão, e apenas aqueles com resultados normais (exceto GJ) foram incluídos. Esses marcadores foram examinados apenas uma vez nos não-DM, enquanto os DM foram amostrados sequencialmente por 3 meses. Resultados: As concentrações de AG foram mais baixas nos DM do que nos não-DM (4,02±2,96 vs 26,68±11,33µg/ml, P<0,001), e mais baixas nas mulheres do que nos homens não-DM (22,90±9,51 vs 29,45±11,7µg/ml, P<0,05). Houve boa correlação entre AG e GJ. AG plasmático apresentou correlação inversa com a GJ, frutosamina e HbA1c nos pacientes com DM, e mostrou-se tão eficaz quanto outros marcadores na detecção de mudança de curto prazo no controle glicêmico. 1,5-ANHYDROGLUCITOL (AG) IS A six-carbon monosaccharide in 1-deoxy form of glucopyranose. Its 1,5-anhydrohexitol nature was discovered in 1932 and its isomeric structure established in 1943 (1-4). Pitkä-nen (1) first reported on the existence of AG in human plasma and cerebrospinal fluid (CSF) in diabetic patients in 1975. 1,5-anhydro-D-glucitol, 1-deoxyglucose and 1,5-AG are all synonyms of AG. AG can be found in human CSF and plasma, in rats, and even in soil Pseudomonas (2). The concentration of AG is slightly higher in plasma than in CSF, and higher in males than in females (2).AG is mainly generated fr...

show abstract

Estimation of plasma glucose fluctuation with a combination test of hemoglobin A1c and 1,5-anhydroglucitol

Cited by 51 publications

References 21 publications

Evaluation of Glycemic Variability in Well-Controlled Type 2 Diabetes Mellitus

Evaluation of Glycemic Variability in Well-Controlled Type 2 Diabetes Mellitus

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

1,5-anhydroglucitol levels in type 2 diabetic and non-diabetic subjects in Southern Taiwan

Contact Info

Product

Resources

About