Diabetes Research Laboratories, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK.
Diabetes Care. 2010 Feb;33(2):252-7. doi: 10.2337/dc09-1246. Epub 2009 Nov 23.
Assignment of the correct molecular diagnosis in diabetes is necessary for informed decisions regarding treatment and prognosis. Better clinical markers would facilitate discrimination and prioritization 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 etiology.
1,5AG was measured in U.K. subjects with: HNF1A-MODY (n = 23), MODY due to glucokinase mutations (GCK-MODY, n = 23), type 1 diabetes (n = 29), latent autoimmune diabetes in adults (LADA, n = 42), and type 2 diabetes (n = 206). Receiver operating characteristic curve analysis was performed to assess discriminative accuracy of 1,5AG for diabetes etiology.
Mean (SD range) 1,5AG levels were: GCK-MODY 13.06 microg/ml (5.74-29.74), HNF1A-MODY 4.23 microg/ml (2.12-8.44), type 1 diabetes 3.09 microg/ml (1.45-6.57), LADA 3.46 microg/ml (1.42-8.45), and type 2 diabetes 5.43 (2.12-13.23). Levels in GCK-MODY were higher than in 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, and LADA. Adjusting for A1C revealed a difference between HNF1A-MODY and type 2 diabetes (P = 0.001). The discriminative accuracy of unadjusted 1,5AG levels was 0.79 for GCK-MODY versus type 2 diabetes and 0.86 for GCK-MODY versus HNF1A-MODY but was only 0.60 for HNF1A-MODY versus type 2 diabetes.
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.
在治疗和预后方面做出明智决策，必须对糖尿病进行正确的分子诊断。更好的临床标志物将有助于区分和优先考虑糖尿病亚型的基因检测。据报道，血清 1,5 脱水葡萄糖（1,5AG）水平可区分因 HNF1A 突变（HNF1A-MODY）引起的青年发病型糖尿病和 2 型糖尿病，但这需要进一步验证。我们评估了一系列糖尿病亚型中的血清 1,5AG，作为确定糖尿病病因的辅助手段。
在英国，我们测量了 HNF1A-MODY（n = 23）、葡萄糖激酶突变引起的 MODY（GCK-MODY，n = 23）、1 型糖尿病（n = 29）、成人隐匿性自身免疫性糖尿病（LADA，n = 42）和 2 型糖尿病（n = 206）患者的血清 1,5AG。进行受试者工作特征曲线分析，以评估 1,5AG 对糖尿病病因的鉴别准确性。
平均（SD 范围）1,5AG 水平为：GCK-MODY 13.06μg/ml（5.74-29.74）、HNF1A-MODY 4.23μg/ml（2.12-8.44）、1 型糖尿病 3.09μg/ml（1.45-6.57）、LADA 3.46μg/ml（1.42-8.45）和 2 型糖尿病 5.43μg/ml（2.12-13.23）。GCK-MODY 组的水平高于其他组（P<10(-4)，与每组相比）。未经校正的 1,5AG 水平在 HNF1A-MODY 患者与 2 型糖尿病、1 型糖尿病和 LADA 之间没有差异。调整 A1C 后，HNF1A-MODY 与 2 型糖尿病之间存在差异（P=0.001）。未经校正的 1,5AG 水平对 GCK-MODY 与 2 型糖尿病的鉴别准确率为 0.79，对 GCK-MODY 与 HNF1A-MODY 的鉴别准确率为 0.86，但对 HNF1A-MODY 与 2 型糖尿病的鉴别准确率仅为 0.60。
在我们的数据集，血清 1,5AG 能很好地区分 GCK-MODY 与其他糖尿病亚型，特别是 HNF1A-MODY。1,5AG 水平的测量可以为 MODY 诊断检测做出决策。
