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. 2010 Feb;33(2):252-7.
doi: 10.2337/dc09-1246. Epub 2009 Nov 23.

Evaluation of serum 1,5 anhydroglucitol levels as a clinical test to differentiate subtypes of diabetes

Aparna Pal  1 , Andrew J Farmer, Christina Dudley, Mary P Selwood, Beryl A Barrow, Rhiannon Klyne, Jilly P Grew, Mark I McCarthy, Anna L Gloyn, Katharine R Owen
Affiliations

Evaluation of serum 1,5 anhydroglucitol levels as a clinical test to differentiate subtypes of diabetes

Aparna Pal et al. Diabetes Care. 2010 Feb.

Abstract

Objective: Assignment of the correct molecular diagnosis in diabetes is necessary for informed decisions regarding treatment and prognosis. Better clinical markers would facilitate discrimination and prioritization for genetic testing between diabetes subtypes. Serum 1,5 anhydroglucitol (1,5AG) levels were reported to differentiate maturity-onset diabetes of the young due to HNF1A mutations (HNF1A-MODY) from type 2 diabetes, but this requires further validation. We evaluated serum 1,5AG in a range of diabetes subtypes as an adjunct for defining diabetes etiology.

Research design and methods: 1,5AG was measured in U.K. subjects with: HNF1A-MODY (n = 23), MODY due to glucokinase mutations (GCK-MODY, n = 23), type 1 diabetes (n = 29), latent autoimmune diabetes in adults (LADA, n = 42), and type 2 diabetes (n = 206). Receiver operating characteristic curve analysis was performed to assess discriminative accuracy of 1,5AG for diabetes etiology.

Results: Mean (SD range) 1,5AG levels were: GCK-MODY 13.06 microg/ml (5.74-29.74), HNF1A-MODY 4.23 microg/ml (2.12-8.44), type 1 diabetes 3.09 microg/ml (1.45-6.57), LADA 3.46 microg/ml (1.42-8.45), and type 2 diabetes 5.43 (2.12-13.23). Levels in GCK-MODY were higher than in other groups (P < 10(-4) vs. each group). HNF1A-MODY subjects showed no difference in unadjusted 1,5AG levels from type 2 diabetes, type 1 diabetes, and LADA. Adjusting for A1C revealed a difference between HNF1A-MODY and type 2 diabetes (P = 0.001). The discriminative accuracy of unadjusted 1,5AG levels was 0.79 for GCK-MODY versus type 2 diabetes and 0.86 for GCK-MODY versus HNF1A-MODY but was only 0.60 for HNF1A-MODY versus type 2 diabetes.

Conclusions: In our dataset, serum 1,5AG performed well in discriminating GCK-MODY from other diabetes subtypes, particularly HNF1A-MODY. Measurement of 1,5AG levels could inform decisions regarding MODY diagnostic testing.

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Figures

Figure 1
Figure 1
Scatter plots of serum 1,5AG levels (μg/ml) versus A1C (%) for the different subtypes of diabetes. For clarity the data points are plotted on three panels with a filled symbol to emphasize a different diabetic subtype in each panel: lilac diamonds, subjects with autoimmune diabetes (type 1 + LADA combined); blue circles, type 2 diabetes; orange squares, HNF1A-MODY; and green squares, GCK-MODY. A: Distribution of autoimmune diabetes. B: Type 2 diabetes. C: Both MODY subtypes. Three subjects with A1C >12.5% are not shown for increased clarity of the figure but were included in the analysis.
Figure 2
Figure 2
ROC curves illustrating discriminative capacity of unadjusted 1,5AG to distinguish between diabetes subgroups. A: GCK-MODY and type 2 diabetes. B: HNF1A-MODY and type 2 diabetes. C: GCK-MODY and HNF1A-MODY.
See this image and copyright information in PMC

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