Evaluating the Role of Serum 1,5-Anhydroglucitol Concentrations as an Indicator of Hyperglycemic Changes in Diabetic and Non Diabetic Surgical Patients

Abstract

Purpose: We investigated the relationship between plasma glucose and serum 1,5-anhydroglucitol (1,5-AG) concentrations in surgical patients to determine the role of 1,5-AG concentrations in perioperative glycemic control. Methods:We enrolled 57 patients (19 with and 38 without diabetes) in the study, who underwent hepatectomy under general anesthesia with sevoflurane and remifentanil. Plasma glucose and serum 1,5-AG concentrations were measured and their correlations were evaluated. Results:In all patients, plasma glucose concentrations increased significantly during hepatectomy, but serum 1,5-AG concentrations declined after surgery. Linear regression analysis revealed a weak but significant correlation between the decrease rate of 1,5-AG concentrations and the increase rate of plasma glucose concentrations. Regression analyses revealed this correlation to be more intense in patients without diabetes than in all patients, whereas no correlation was observed in patients with diabetes. These results suggest that serum 1,5-AG concentrations decrease significantly in proportion to increase in plasma glucose concentrations in patients without diabetes, but are less sensitive to such changes in patients with diabetes. Consequently, this indicates that preoperative serum 1,5-AG concentrations in patients with diabetes are too low to be influenced by glycemic fluctuations. In both patient groups, decreased 1,5-AG concentrations did not normalize until 72 h after initiation of surgery. Conclusion:Measurement of 1,5-AG concentrations may be a useful for evaluating glycemic control during anesthesia in patients with normal glycemic metabolism; however, this approach may not be as useful in patients with diabetes as in those without diabetes.