1,5-Anhydro-D-glucitol Evaluates Daily Glycemic Excursions in Well-Controlled NIDDM

Abstract

OBJECTIVE To evaluate the usefulness of plasma 1,5-anhydro-D-glucitol (1,5-AG) as a possible marker for daily glycemic excursion, we measured plasma 1,5-AG, HbA1c, fasting plasma glucose (FPG) level, and daily excursion of glycemia, from which the M-value (after Schlichtkrull) was calculated as an index of daily glycemic excursion. RESEARCH DESIGN AND METHODS The subjects were 76 patients with well-controlled non-insulin-dependent diabetes mellitus (NIDDM) treated with diet therapy only (diet, n = 17), oral hypoglycemic agents (OHA, n = 28), conventional insulin therapy (CIT, n = 16), or multiple insulin injection therapy (MIT, n = 15). RESULTS HbA1c values were similar among all the groups (diet, 6.9 ± 0.6; OHA, 7.2 ± 0.5; CIT, 7.1 ± 0.6; MIT, 7.2 ± 0.5%). The MIT group showed a significantly higher 1,5-AG concentration (11.5 ± 5.3 μg/ml), a significantly lower M-value (9.2 ± 5.2), and little risk of hypoglycemia (< 4 mmol/l) and hyperglycemia (> 10 mmol/l) (1.3 ± 1.1 times/24 h) compared with the CIT group (6.9 ± 3.3μg/ml, 15.7 ± 8.9, 2.2 ± 1.6 times/24 h, respectively). Insulin doses (22.4 ± 4.5 vs. 22.0 ± 8.9 U/day), FPG (6.6 ± 2.2 vs. 7.4 ± 2.4 mmol/l), and HbA1c concentrations were not significantly different between the CIT and MIT groups. M-values significantly correlated with 1,5-AG concentrations (r = 0.414, P < 0.05), but not with HbA1c concentrations. CONCLUSIONS The findings suggest that the plasma 1,5-AG concentration can be a useful index of the daily excursion of blood glucose, especially in patients with well-controlled NIDDM.