Serum 1,5-anhydroglucitol (1,5 AG): New clinical marker for glycemic control

Yamanouchi, Toshikazu; Akanuma, Yasuo

doi:10.1016/0168-8227(94)90259-3

Cited by 110 publications

(78 citation statements)

References 17 publications

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“…Fructosamine and 1,5-anhydroglucitol (1,5-AG), neither of which are affected by haemoglobin metabolism, have also been used as indicators of glycaemic control in adults [21,22]. However, because 1,5-AG is mainly ingested through food and almost no 1,5-AG is ingested during the neonatal period, serum 1,5-AG levels are undetectable in neonates [23].…”

Section: Discussionmentioning

confidence: 99%

Glycated albumin but not HbA1c reflects glycaemic control in patients with neonatal diabetes mellitus

et al. 2011

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Aims/hypothesis It is difficult to use HbA 1c as an indicator of glycaemic control in patients with neonatal diabetes mellitus (NDM) because of high levels of fetal haemoglobin (HbF) remaining in the blood. In this study, glycated albumin (GA), which is not affected by HbF, and HbA 1c were compared to evaluate whether they reflect glycaemic control in patients with NDM. Methods This study included five patients with NDM. Age at diagnosis was 38±20 days. Insulin therapy was started in all patients, and levels of GA, HbA 1c and HbF were measured monthly for 6 months. One-month average preprandial plasma glucose (aPPG) was calculated using self-monitoring of blood glucose. Results Plasma glucose and GA were elevated (29.7± 13.1 mmol/l [n=5] and 33.3±6.9% [n=3], respectively) but HbA 1c was within normal limits (5.4±2.6% [35.5± 4.9 mmol/mol]; n=4) at diagnosis. With diabetes treatment, aPPG (r=−0.565, p=0.002), GA (r=−0.552, p=0.003) and HbF (r=−0.855, p<0.0001) decreased with age, whereas HbA 1c increased (r=0.449, p=0.004). GA was strongly positively correlated with aPPG (r=0.784, p<0.0001), while HbA 1c showed no correlation with aPPG (r=0.221, p=0.257) and was significantly inversely correlated with HbF (r=−0.539, p=0.004). Conclusions/interpretation GA is a useful indicator of glycaemic control in patients with NDM, whereas HbA 1c is influenced by age-related changes in HbF and does not accurately reflect glycaemic control.

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Section: Discussionmentioning

confidence: 99%

Glycated albumin but not HbA1c reflects glycaemic control in patients with neonatal diabetes mellitus

et al. 2011

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“…The relative insensitivity of 1,5AG in these patients may be due to excessive depletion of the body pool of 1,5AG. Such depletion has been observed to occur in severe hyperglycemia as a result of persistent glucosuria (19). Additionally, a dynamic mass balance two-compartment model has been developed for 1,5AG (20), and it demonstrates that the tissue compartment is two to three times the mass of the plasma compartment.…”

Section: Concordance Of Longitudinal Changesmentioning

confidence: 99%

“…With this finding, Japanese research groups demonstrated reduced concentrations of 1,5AG in serum of hyperglycemic patients in comparison with euglycemic subjects (12,13). Additionally, a gradual normalization of 1,5AG values for patients responding to antidiabetic therapies (14) has been demonstrated, and studies have shown that 1,5AG measurements reflect glycemic status over the previous 48 h to 2 weeks. Dietary variation does not appreciably affect the efficacy of such measurements because the content of 1,5AG is similar in various starches (mean, 2.5 Ϯ 1.1 g/g), meats and seafood (0.9 Ϯ 0.6 g/g), vegetables (0.4 Ϯ 0.2 g/g), fruits (0.7 Ϯ 0.6 g/g), and beverages (0.8 Ϯ 0.7 g/g) (10).…”

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confidence: 99%

Circulating 1,5-Anhydroglucitol Levels in Adult Patients With Diabetes Reflect Longitudinal Changes of Glycemia

et al. 2004

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OBJECTIVE -1,5-Anhydroglucitol (1,5AG) is a major circulating polyol arising primarily from ingestion and excreted competitively with glucose. Japanese studies have demonstrated reduced concentrations of 1,5AG in serum in hyperglycemic patients in comparison with euglycemic subjects and a gradual normalization of 1,5AG values for patients responding to antihyperglycemic therapies. In this first U.S. study, we assessed the ability of 1,5AG measurements to monitor glycemic control in a cohort of 77 patients with diabetes (22 with type 1 diabetes, 55 with type 2 diabetes) who presented with suboptimal glycemic control at baseline (defined as HbA 1c Ն7%).RESEARCH DESIGN AND METHODS -Each patient received therapies consisting of combinations of diabetes education, nutritional counseling, and addition or dose adjustment of various insulins or oral antihyperglycemic medications. Therapy was targeted to reduce mean HbA 1c by Ն1.0% over the monitoring period. 1,5AG, HbA 1c , fructosamine, and random glucose measurements were performed at baseline and at 2, 4, and 8 weeks after the initiation of therapy.RESULTS -1,5AG, fructosamine, and glucose values progressed significantly toward euglycemia by week 2 of monitoring (Wilcoxon's signed-rank test, P Ͻ 0.05), with median changes of 93, Ϫ7, and Ϫ13% for 1,5AG, fructosamine, and glucose, respectively. In contrast, HbA 1c values did not respond significantly to therapy until week 4. On an individual patient basis, 89.6% of patients displayed longitudinal changes of 1,5AG from baseline to week 8 in concordance with HbA 1c . 1,5AG was also highly correlated with HbA 1c and fructosamine (Spearman ϭ Ϫ0.6459 and Ϫ0.6751, respectively; both P Ͻ 0.0001).CONCLUSIONS -We conclude that 1,5AG responds sensitively and rapidly to changes in glycemia and monitors glycemic control in accordance with established markers.

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“…Future studies with larger sample sizes may show differences between subpopulations, such as type 1 versus type 2 diabetes (there were no significant differences in these groups in this study). It should be noted that 1,5-AG measurement may be less useful in the setting of intrinsic renal disease (26) and in pregnancy (27), where the renal threshold for glucose is altered.…”

Section: Conclusion -In a Previousmentioning

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

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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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Serum 1,5-anhydroglucitol (1,5 AG): New clinical marker for glycemic control

Cited by 110 publications

References 17 publications

Glycated albumin but not HbA1c reflects glycaemic control in patients with neonatal diabetes mellitus

Glycated albumin but not HbA1c reflects glycaemic control in patients with neonatal diabetes mellitus

Circulating 1,5-Anhydroglucitol Levels in Adult Patients With Diabetes Reflect Longitudinal Changes of Glycemia

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

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