Correlation between 1,5-anhydroglucitol and glycemic excursions in type 2 diabetic patients

Background 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. Methods 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 Alc （HbAlc） 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. Results 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 HbAlc levels. Multivariate stepwise regression analysis revealed a negative correlation between 1,5-AG and the above parameters, but not HbAlc and GA. Finally, HbAlc and GA were positively correlated with MBG and fasting blood glucose （FBG）. Conclusions 1,5-AG was much better than HbAlc 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 HbAlc and GA were superior to 1,5-AG for monitoring MBG and FBG.

Analysis on blood glucose excursions in well-controlled patients with type 2 diabetes mellitus

Objective:To probe glycemic excursions in type 2 diabetic patients whose hemoglobin A1c(HbA1c) was kept ≤6.0%.Methods:Totally 36 cases with type 2 diabetes(T2DM) with HbA1c≤6.0% and 30 cases with normal glucose tolerance(NGT) from December 2005 to December 2007 in our department were subjected prospectively.Continuous glucose monitoring system(CGMS) was employed to record their continuous blood glucose level for 3 d.The blood glucose profiles including the mean blood glucose(MBG),standard differentiation(SD),mean amplitude of glycemic excursions(MAGE) and absolute means of daily differences(MODD) were analyzed.Results:T2DM group had obviously postprandial hyperglycemia,in about 2 h after meal,especially after breakfast.Fifty-two hypoglycemic episodes occurred during the monitoring period in T2DM groups,of which 73.1%(38 episodes) were absence of symptomatic hypoglycemia with the lowest value of blood glucose only 2.0 mmol/L.And 20 episodes took place during the day hours,while 32 episodes observed during the night hours.Compared with NGT groups,SD,MAGE and MODD were all significantly higher in T2DM groups.MBG was significantly correlated with HbA1c in T2DM groups,but SD,MAGE,NGE and MODD were all independent of HbA1c.MAGE was independent of MODD.Conclusion:The amplitude of glycemic excursions is higher in normol-controlled T2DM groups than the NGT groups.Thus ideally glycemic control is not only to make HbA1c reach standard,but also to lessen glycemic excursions and reduce hypoglycemia episodes.

Characteristics of blood glucose excursions in type 2 diabetes mellitus patients with three different Traditional Chinese Medicine syndromes

OBJECTIVE:To explore the characteristics of blood glucose excursions of type 2 diabetes mellitus patients with three different Traditional Chinese Medicine(TCM) syndromes.METHODS:One hundred and nine patients with type 2 diabetes mellitus were recruited from the Department of Endocrinology and the Department of TCM of the Sixth People's Hospital affiliated to Shanghai Jiao Tong University.Subjects were divided into three groups according to TCM syndrome:intrinsic Damp(n- 42),Yin deficiency and internal Heat(n = 25),and Qi and Yin deficiency(n- 42).Subcutaneous interstitial glucose was monitored with a continuous glucose monitoring system for 3consecutive days to investigate the glycemic profile in each group.Plasma C-peptide levels were measured,and an arginine test was taken in 10 patients randomly selected from each group.Glucose data and glycemic variability were analyzed to investigate the differences among the groups.The change in C-peptide levels and the results from arginine trial were used to evaluate β cell function.RESULTS:Indicators reflecting blood glucose level were the highest in subjects with Yin deficiency and internal Heat syndrome,and parameters reflecting glycemic variability were the lowest in those with Qi and Yin deficiency syndrome.The change in C-peptide levels showed that subjects with Qi and Yin deficiency syndrome had the best βcell function among the three groups;this was confirmed by the arginine trial.CONCLUSION:Patients with Qi and Yin deficiency syndrome had a more stable blood glucose profile,as glycemic variability was higher in those with intrinsic Damp syndrome and those with Yin deficiency and internal Heat syndrome.