Effect of renal function on serum concentration of 1,5‐anhydroglucitol in type 2 diabetic patients in chronic kidney disease stages I–III: A comparative study with HbA1c and glycated albumin 在合并I‐III期慢性肾脏疾病的2型糖尿病患者中肾功能对血清1,5‐脱水葡萄糖醇浓度的影响:一项HbA1c与糖化白蛋白的对比研究

• Published in: Journal of diabetes Vol. 8; no. 5; pp. 712 - 719
• Main Authors: Hasslacher, Christoph, Kulozik, Felix
• Format: Journal Article
• Language: English
• Published: 01.09.2016
• ISSN: 1753-0393; 1753-0407
• DOI: 10.1111/1753-0407.12354

Abstract Background 1,5‐Anhydroglucitol (1,5‐AG) is a new blood glucose control marker reflecting temporary glucose elevations. However, 1,5‐AG is of limited value in patients with advanced renal insufficiency. The aim of the present study was to assess the correlation between 1,5‐AG levels and renal function in patients with earlier stages of nephropathy compared with another two markers of diabetes control, namely HbA1c and glycated albumin (GA). Methods The following parameters were measured in 377 patients with type 2 diabetes: HbA1c, serum concentrations of 1,5‐AG, GA and creatinine, hemoglobin, urinary albumin/creatinine ratio, and urinary excretion of α 1 ‐microglobulin (A1M). Estimated glomerular filtration rate (eGFR) was calculated according to the Cockgroft–Gault formula. Results There was a negative correlation between 1,5‐AG and renal function (r = −0.18; P < 0.001). Concentrations of 1,5‐AG were, on average, 27.2% lower in patients with glomerular hyperfiltration (eGFR >120 mL/min) compared with patients with moderate renal impairment (eGFR 30–59 mL/min; P = 0.016). In contrast, HbA1c, GA levels and urinary A1M excretion did not differ between the two patient groups. The mean age of patients with eGFR 30–59 mL/min was substantially higher than that of patients with glomerular hyperfiltration (P < 0.001). Thus, an age‐related change in the renal glucose threshold could be the reason for the observed correlation between 1,5‐AG and renal function. Conclusions In clinical practice, age and renal function must be taken into consideration when interpreting 1,5‐AG levels, even in the absence of advanced renal impairment. 背景: 1,5‐脱水葡萄糖醇(1,5‐Anhydroglucitol,1,5‐AG)是一种新的血糖控制标志物,它反映了暂时性的血糖升高。然而,对于晚期肾功能不全患者来说1,5‐AG的价值有限。当前这项研究的目的是在处于早期肾病阶段的患者中评估1,5‐AG水平与肾功能之间的关系,并且将1,5‐AG与另外两个糖尿病控制情况标志物亦即HbA1c与糖化白蛋白进行了对比。 方法: 下列参数是在377名2型糖尿病患者中测量后得出的:HbA1c、血清1,5‐AG浓度、糖化白蛋白与肌酐、血红蛋白、尿白蛋白/肌酐比值以及尿α1‐微球蛋白(α1‐microglobulin,A1M)排泄率。根据Cockgroft–Gault公式计算后得出估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)。 结果: 1,5‐AG与肾功能之间的相关性是阴性的(r = ‐0.18; P < 0.001)。肾小球高滤过的患者(eGFR > 120 mL/min)与中度肾功能损害的患者(eGFR为30‐59 mL/min; P = 0.016)相比平均1,5‐AG浓度低27.2%。相反,这两组患者之间的HbA1c、糖化白蛋白水平以及尿A1M排泄率都没有差异。eGFR为30‐59 mL/min的患者平均年龄要远大于肾小球高滤过的患者( P < 0.001)。因此,年龄相关的肾脏葡萄糖阈值变化可能是观察到的1,5‐AG与肾功能之间具有相关性的原因。 结论: 在临床实践中,在解释1,5‐AG水平时必须要考虑到患者的年龄与肾功能情况,即使患者没有晚期肾功能损害。