Evaluation of serum 1,5 anhydroglucitol levels as a clinical test to differentiate subtypes of diabetes
- Aparna Pal, BM BCh1,2,
- Andrew J Farmer, DM1,2,3,
- Christina Dudley, RGN1,2,
- Mary P Selwood, MSc3,
- Beryl A Barrow, RGN1,2,
- Rhiannon Klyne2,4,
- Jilly P Grew, SRN1,2,
- Mark I McCarthy, MD1,2,5,
- Anna L Gloyn, DPhil1,2 and
- Katharine R Owen, MD (katharine.owen{at}drl.ox.ac.uk)1,2
- 1. Diabetes Research Laboratories, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), University of Oxford, UK
- 2. Oxford NIHR Biomedical Research Centre, Churchill Hospital, Oxford, UK
- 3. Department of Primary Care Medicine, University of Oxford, UK
- 4. Diabetes Trials Unit, OCDEM, University of Oxford, UK
- 5. Wellcome Trust Centre for Human Genetics, University of Oxford, UK
Abstract
Objective: Assigning the correct molecular diagnosis in diabetes informs treatment and prognosis. Better clinical markers would facilitate discrimination and prioritisation for genetic testing between diabetes subtypes. Serum 1,5 Anhydroglucitol (1,5AG) levels were reported to differentiate Maturity-onset diabetes of the young due to HNF1A mutations (HNF1A-MODY) from type 2 diabetes, but this requires further validation. We evaluated serum 1,5AG in a range of diabetes subtypes as an adjunct for defining diabetes aetiology.
Research Design and Methods: 1,5AG was measured in UK subjects with: HNF1A-MODY (n=23), MODY due to glucokinase mutations (GCK-MODY, n=23), type 1 diabetes (n=29), latent autoimmune diabetes of adults (LADA, n=42) and type 2 diabetes (n=206). ROC curve analysis was performed to assess discriminative accuracy of 1,5AG for diabetes aetiology.
Results: Mean [SD range] 1,5AG levels (μg/ml) were: GCK-MODY 13.06 [5.74-29.74]; HNF1A-MODY 4.23 [2.12-8.44]; type 1 diabetes 3.09 [1.45-6.57]; LADA 3.46 [1.42-8.45] and type 2 diabetes 5.43 [2.12-13.23]. Levels in GCK-MODY were higher than other groups [p<10−4 vs. each group]. HNF1A-MODY subjects showed no difference in unadjusted 1,5AG levels from type 2 diabetes, type 1 diabetes or LADA. Adjusting for HbA1c revealed a difference between HNF1A-MODY and type 2 diabetes [p=0.001]. The discriminative accuracy of unadjusted 1,5AG levels were 0.79 for GCK-MODY vs. type 2 diabetes, 0.86 for GCK-MODY vs. HNF1A-MODY, but only 0.60 for HNF1A-MODY vs. type 2 diabetes.
Conclusions: In our dataset serum 1,5AG performed well in discriminating GCK-MODY from other diabetes subtypes, particularly HNF1A-MODY. Measurement of 1,5AG levels could inform decisions regarding MODY diagnostic testing.
Footnotes
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- Received July 8, 2009.
- Accepted November 13, 2009.
- Copyright © American Diabetes Association
