J Korean Diabetes.  2012 Mar;13(1):1-6. 10.4093/jkd.2012.13.1.1.

Review of the Potential Glycemic Markers Glycated Albumin and 1,5-anhydroglucitol

• Kim WJ
• Park CY

• KMID: 1436179
• DOI: http://doi.org/10.4093/jkd.2012.13.1.1

Abstract

The measure of HbA1c is the gold standard index of glycemic control in clinical practice for diabetes treatment and is well known as a risk marker for diabetes complications. However, HbA1C does not accurately reflect glucose fluctuations or the actual status of glycemic control for several days or weeks. HbA1c measurement can be confounded in the anemia, hemoglobinopathy, or renal impairment. In comparison, glycated albumin (GA), a ketoamine formed by binding of albumin and glucose, more accurately reflects short-term changes in plasma glucose and postprandial plasma hyperglycemia (PPH). GA is not affected by hemoglobin or dialysis. 1,5-Anhydroglucitol (1,5-AG), another glycemic marker, structurally resembles glucose and decreases with spikes of hyperglycemia exceeding the average renal threshold for glucose. Especially, 1,5-AG level is reflective of PPH or glycemic variability and becomes an increasingly important contributor in a moderately controlled glycemic state, even when HbA1c level is within the target range. Herein, the usefulness of and recent studies on GA and 1,5-AG are summarized. Further investigations about the associations between these glycemic markers and diabetes complications are needed.

Keyword

Glycosylated hemoglobin A; Glycosylated serum albumin; 1,5-anhydroglucitol; Diabetes mellitus

MeSH Terms

Anemia
Deoxyglucose
Diabetes Complications
Diabetes Mellitus
Dialysis
Glucose
Hemoglobin A, Glycosylated
Hemoglobinopathies
Hemoglobins
Hyperglycemia
Plasma
Serum Albumin
Deoxyglucose
Glucose
Hemoglobin A, Glycosylated
Hemoglobins
Serum Albumin

Figure

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  Fig. 1 Recommended algorithm of 1,5-anhydroglucitol (1,5-AG) in the decision of diabetes treatment. Adapted from Duncan. Expert Rev Mol Diagn 2008;8:9-19 [15].

Reference

1. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010. 33:Suppl 1. S62–S69.

2. Armbruster DA. Fructosamine: structure, analysis, and clinical usefulness. Clin Chem. 1987. 33:2153–2163.

3. Kohzuma T, Koga M. Lucica GA-L glycated albumin assay kit: a new diagnostic test for diabetes mellitus. Mol Diagn Ther. 2010. 14:49–51.

4. Imagawa A, Hanafusa T, Miyagawa J, Matsuzawa Y. Osaka IDDM Study Group. A novel subtype of type 1 diabetes mellitus characterized by a rapid onset and an absence of diabetes-related antibodies. N Engl J Med. 2000. 342:301–307.

5. The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology : Collaborative analysis Of Diagnostic criteria in Europe. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. Lancet. 1999. 354:617–621.

6. Tominaga M, Eguchi H, Manaka H, Igarashi K, Kato T, Sekikawa A. Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes Study. Diabetes Care. 1999. 22:920–924.

7. Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M. STOP-NIDDM Trial Research Group. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial. JAMA. 2003. 290:486–494.

8. Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M. STOP-NIDDM Trail Research Group. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet. 2002. 359:2072–2077.

9. Monnier L, Mas E, Ginet C, Michel F, Villon L, Cristol JP, Colette C. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA. 2006. 295:1681–1687.

10. Koga M, Murai J, Saito H, Kasayama S. Glycated albumin and glycated hemoglobin are influenced differently by endogenous insulin secretion in patients with type 2 diabetes. Diabetes Care. 2010. 33:270–272.

11. Suwa T, Ohta A, Matsui T, Koganei R, Kato H, Kawata T, Sada Y, Ishii S, Kondo A, Murakami K, Katabami T, Tanaka Y. Relationship between clinical markers of glycemia and glucose excursion evaluated by continuous glucose monitoring (CGM). Endocr J. 2010. 57:135–140.

12. Selvin E, Francis LM, Ballantyne CM, Hoogeveen RC, Coresh J, Brancati FL, Steffes MW. Nontraditional markers of glycemia: associations with microvascular conditions. Diabetes Care. 2011. 34:960–967.

13. Pu LJ, Lu L, Shen WF, Zhang Q, Zhang RY, Zhang JS, Hu J, Yang ZK, Ding FH, Chen QJ, Shen J, Fang DH, Lou S. Increased serum glycated albumin level is associated with the presence and severity of coronary artery disease in type 2 diabetic patients. Circ J. 2007. 71:1067–1073.

14. Koga M, Kasayama S. Clinical impact of glycated albumin as another glycemic control marker. Endocr J. 2010. 57:751–762.

15. Dungan KM. 1,5-anhydroglucitol (GlycoMark) as a marker of short-term glycemic control and glycemic excursions. Expert Rev Mol Diagn. 2008. 8:9–19.

16. McGill JB, Cole TG, Nowatzke W, Houghton S, Ammirati EB, Gautille T, Sarno MJ. U.S. trial of the GlycoMark assay. Circulating 1,5-anhydroglucitol levels in adult patients with diabetes reflect longitudinal changes of glycemia: a U.S. trial of the GlycoMark assay. Diabetes Care. 2004. 27:1859–1865.

17. Kishimoto M, Yamasaki Y, Kubota M, Arai K, Morishima T, Kawamori R, Kamada T. 1,5-Anhydro-D-glucitol evaluates daily glycemic excursions in well-controlled NIDDM. Diabetes Care. 1995. 18:1156–1159.

18. Dworacka M, Winiarska H. The application of plasma 1,5-anhydro-D-glucitol for monitoring type 2 diabetic patients. Dis Markers. 2005. 21:127–132.

19. Mehta SN, Schwartz N, Wood JR, Svoren BM, Laffel LM. Evaluation of 1,5-anhydroglucitol, hemoglobin A1c, and glucose levels in youth and young adults with type 1 diabetes and healthy controls. Pediatr Diabetes. 2011. 11. 08. [Epub]. http://dx.doi.org/10.1111/j.1399-5448.2011.00830.x.

20. Kim MJ, Jung HS, Hwang-Bo Y, Cho SW, Jang HC, Kim SY, Park KS. Evaluation of 1,5-anhydroglucitol as a marker for glycemic variability in patients with type 2 diabetes mellitus. Acta Diabetol. 2011. 06. 18. [Epub]. http://dx.doi.org/10.1007/s00592-011-0302-0.

21. Dungan KM, Buse JB, Largay J, Kelly MM, Button EA, Kato S, Wittlin S. 1,5-anhydroglucitol and postprandial hyperglycemia as measured by continuous glucose monitoring system in moderately controlled patients with diabetes. Diabetes Care. 2006. 29:1214–1219.

22. Won JC, Park CY, Park HS, Kim JH, Choi ES, Rhee EJ, Lee WY, Oh KW, Kim SW, Park SW. 1,5-Anhydroglucitol reflects postprandial hyperglycemia and a decreased insulinogenic index, even in subjects with prediabetes and well-controlled type 2 diabetes. Diabetes Res Clin Pract. 2009. 84:51–57.

23. Kim WJ, Park CY, Park SE, Rhee EJ, Lee WY, Oh KW, Park SW, Kim SW, Park HS, Kim YJ, Song SJ, Ahn HY. Serum 1,5-anhydroglucitol is associated with diabetic retinopathy in Type 2 diabetes. Diabet Med. 2012. 02. 14. [Epub]. http://dx.doi.org/10.1111/j.1464-5491.2012.03613.x.

24. Kim WJ, Park CY, Lee KB, Park SE, Rhee EJ, Lee WY, Oh KW, Park SW. Serum 1,5-anhydrogluc i tol concentrations are a reliable index of glycemic control in type 2 diabetes with mild or moderate renal dysfunction. Diabetes Care. 2012. 35:281–286.