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

  1. Kathleen M. Dungan, MD1,
  2. John B. Buse, MD, PHD2,
  3. Joseph Largay, PAC, CDE1,
  4. Mary M. Kelly, RN, CCRC3,
  5. Eric A. Button, MS, MBA4,
  6. Shuhei Kato, BS5 and
  7. Steven Wittlin, MD3
  1. 1Division of Endocrinology, University of North Carolina School of Medicine, Durham, North Carolina
  2. 2Divisions of Endocrinology and General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
  3. 3Endocrine/Metabolism Unit, University of Rochester, Rochester, New York
  4. 4BioEmerge Partners, Winston-Salem, North Carolina
  5. 5Tomen America, New York, New York
  1. Address correspondence and reprint requests to John Buse, MD, PhD, CB#7110, Old Clinic 5039, University of North Carolina, Chapel Hill, NC 27599-7110. E-mail: jbuse{at}med.unc.edu

Abstract

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 HbA1c (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 ± 3.2 μg/ml [means ± SD]) despite similar A1C (7.3 ± 0.5%). Mean 1,5-AG (r = −0.45, P = 0.006) correlated with AUC-180 more robustly than A1C (r = 0.33, P = 0.057) or FA (r = 0.38, P = 0.88). MPMG correlated more strongly with 1,5-AG (r = −0.54, P = 0.004) than with A1C (r = 0.40, P = 0.03) or FA (r = 0.32, P = 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.

Footnotes

  • J.L. holds stock in Medtronic MiniMed. E.A.B. is a paid consultant for Tomen America. S.W. has served on an advisory board for and has received honoraria and grant/research support from Medtronic MiniMed and has received honoraria from Tomen America.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted February 21, 2006.
    • Received October 7, 2005.
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