Department of Endocrinology, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Chin Med J (Engl). 2011 Nov;124(22):3641-5.
The accurate and comprehensive assessment of glycemic control in patients with diabetes is important for optimizing glycemic management and for formulating personalized diabetic treatment schemes. This study aimed to analyze the correlation between 1,5-anhydroglucitol (1,5-AG) and glycemic excursions in type 2 diabetic patients.
Seventy-one outpatients with type 2 diabetes mellitus were randomly recruited from Chinese People's Liberation Army General Hospital. Using a continuous glucose monitoring system (CGMS), these patients' blood glucose levels were monitored for three consecutive days to obtain mean blood glucose (MBG) data. Intraday glycemic excursions were evaluated using the mean amplitude of glycemic excursions (MAGE), the largest amplitude of glycemic excursions (LAGE), standard deviation of blood glucose (SDBG) and the M-value. Interday glycemic excursion was assessed by absolute mean of daily difference (MODD). Postprandial glycemic fluctuations were evaluated using postprandial glucose excursions (PPGE) and postprandial incremental area under the curve (iAUC). Fasting venous blood samples were collected to measure serum 1,5-AG, whole-blood hemoglobin A1c (HbA1c) and serum glycated albumin (GA). Clinical markers of glycemia and parameters of glycemic excursions from CGMS were analyzed using the Pearson correlation coefficient and multivariate stepwise regression.
Pearson correlation analysis revealed that 1,5-AG was significantly correlated with MAGE, SDBG, M-value, LAGE, PPGE and iAUC (r values were -0.509, -0.430, -0.530, -0.462, -0.416 and -0.435, respectively, P < 0.01), especially in moderately and well-controlled patients, based on defined HbA1c levels. Multivariate stepwise regression analysis revealed a negative correlation between 1,5-AG and the above parameters, but not HbA1c and GA. Finally, HbA1c and GA were positively correlated with MBG and fasting blood glucose (FBG).
1,5-AG was much better than HbA1c and GA as a marker of glycemic excursions in type 2 diabetic patients. Based on these results 1,5-AG is the best metric for assessing postprandial glucose levels in moderately and well-controlled patients, while HbA1c and GA were superior to 1,5-AG for monitoring MBG and FBG.
准确全面地评估糖尿病患者的血糖控制情况对于优化血糖管理和制定个体化糖尿病治疗方案非常重要。本研究旨在分析 1,5-脱水葡萄糖醇（1,5-AG）与 2 型糖尿病患者血糖波动的相关性。
本研究从中国人民解放军总医院招募了 71 名 2 型糖尿病门诊患者。使用连续血糖监测系统（CGMS）连续监测 3 天，获得平均血糖（MBG）数据。采用日内血糖波动幅度（MAGE）、最大血糖波动幅度（LAGE）、血糖标准差（SDBG）和 M 值评估日内血糖波动，采用日间平均血糖绝对差（MODD）评估日间血糖波动。采用餐后血糖波动幅度（PPGE）和餐后血糖曲线下面积增量（iAUC）评估餐后血糖波动。采集空腹静脉血样，检测血清 1,5-AG、全血糖化血红蛋白（HbA1c）和血清糖化白蛋白（GA）。采用 Pearson 相关系数和多元逐步回归分析 CGMS 临床血糖指标和血糖波动参数。
Pearson 相关分析显示，1,5-AG 与 MAGE、SDBG、M 值、LAGE、PPGE 和 iAUC 显著相关（r 值分别为-0.509、-0.430、-0.530、-0.462、-0.416 和-0.435，P＜0.01），在根据 HbA1c 水平定义的血糖控制较好和一般的患者中相关性更为显著。多元逐步回归分析显示，1,5-AG 与上述参数呈负相关，而与 HbA1c 和 GA 无相关性。最后，HbA1c 和 GA 与 MBG 和空腹血糖（FBG）呈正相关。
1,5-AG 作为 2 型糖尿病患者血糖波动的标志物优于 HbA1c 和 GA。基于这些结果，1,5-AG 是评估血糖控制较好和一般患者餐后血糖水平的最佳指标，而 HbA1c 和 GA 则优于 1,5-AG 监测 MBG 和 FBG。
