Serum 1,5-Anhydroglucitol: Risk Factor of Acute Ischemic Stroke and Transient Ischemic Attack in Well-Controlled Diabetes

Abstract

Background: Serum 1,5-anhydroglucitol (1,5-AG) levels are a measure that provides information on daily glycemic variations. We evaluated whether 1,5-AG could be a possible marker of acute ischemic stroke (AIS) or transient ischemic attacks (TIA) in patients with diabetes mellitus (DM). Methods: We retrospectively reviewed electronic medical records of 5,294 AIS/TIA patients. Of the 5,294, 1,898 had diabetes and in 1,246, serum 1,5-AG levels were measured (group S). Group S was divided into 2 subgroups: hemoglobin A1c (HbA1c) <7% (S-low) and >7% (S-high). As controls, 394 outpatients with diabetes (group C) without AIS/TIA were likewise divided into subgroups, C-low and C-high according to HbA1c level. In each HbA1c subgroup, the association between serum 1,5-AG (≥14 vs. <14 µg/mL) and stroke was examined using multivariable logistic regression (MLR) with stepwise variable selection. In model 1, the OR and 95% CI was examined adjusted for age and gender. Known risk factors for stroke; hypertension, dyslipidemia, alcohol consumption, smoking, and estimated glomerular filtration rate were included in model 2. Results: Overall, serum 1,5-AG levels were lower in group S than in group C. Serum 1,5-AG levels were low in subgroups S-high and C-high, showing no differences in mean values. However, mean serum 1,5-AG levels in S-low was statistically lower than that in C-low. MLR analysis showed that the OR for low (<14 µg/mL) 1,5-AG for stroke was statistically significant only in well-controlled diabetes (OR [95% CI] 2.19 [1.54–3.10]) in model 1 and (2.26 [1.56–3.28]) model 2. Conclusions: Low serum 1,5-AG levels could be a possible marker for AIS/TIA risk in patients with well-controlled DM.

Combining serum 1,5-anhydroglucitol with fasting plasma glucose to detect diabetes mellitus in a community-based population with hypertension

“…It has been demonstrated confirmed that low serum 1.5-Ag levels may be a marker of acute ischemic stroke (AIS) or transient ischemic attack (TIA) risk in well-controlled diabetics (25). Nevertheless，studies have shown that 1,5-AG may be an important indicator not only for the evaluation of coronary heart disease and stroke (25)(26)(27)(28), but also for the assessment of nephropathy and retinopathy (29)(30)(31). There is evidence that 1,5-AG is a reliable glycemic marker for type 2 diabetes, even in patients with stages 1-3 chronic kidney disease (29).…”

“…Given that a large portion of the Chinese population suffers from elevated postprandial blood glucose alone but has normal fasting blood glucose, and the contribution of postprandial high blood glucose to cardiovascular disease is clear, the probability of developing cardiovascular and cerebrovascular diseases in diabetic patients with hypertension is significantly higher than that in patients with hypertension or diabetes alone. It has been demonstrated confirmed that low serum 1.5-Ag levels may be a marker of acute ischemic stroke (AIS) or transient ischemic attack (TIA) risk in well-controlled diabetics (25). Nevertheless，studies have shown that 1,5-AG may be an important indicator not only for the evaluation of coronary heart disease and stroke (25)(26)(27)(28), but also for the assessment of nephropathy and retinopathy (29)(30)(31).…”

Diabetes, Vascular Aging and Stroke: Old Dogs, New Tricks?

“…Finally, biomarkers have been sought to improve stroke prognosis and assessment. Despite their plethora, no convincing findings have yet established their use [ 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 , 142 , 143 , 144 , 145 , 146 , 147 , 148 , 149 , 150 , 151 , 152 , 153 ].…”

“…Lastly, low serum 1,5-anhydroglucitol (1,5-AG) levels have been shown to be a potential risk marker of stroke well-controlled DM [ 153 ].…”

Cardiovascular disease and 1,5-anhydro-d-glucitol

“…They suggested that 1,5-AG is associated with stiffness but not with morphological changes of carotid arteries (27). Shiga demonstrated that a low serum 1,5-AG value (1,5-AG < 14 μg/mL) is a marker for acute ischemic stroke or transient ischemic attacks in patients with wellcontrolled DM (HbA1c < 7%) (29).…”