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

¹ Division of Endocrinology, University of North Carolina School of Medicine, Durham, North Carolina
² Divisions of Endocrinology and General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
³ Endocrine/Metabolism Unit, University of Rochester, Rochester, New York
⁴ BioEmerge Partners, Winston-Salem, North Carolina
⁵ Tomen America, New York, New York

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

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 ± 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.

Abbreviations: 1,5-AG, 1,5-anhydroglucitol • AUC-180, area under the curve for glucose above 180 mg/dl • CGMS, continuous glucose monitoring system • FA, fructosamine • MPMG, mean postmeal maximum glucose

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