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BACKGROUND:Low 1,5-anhydroglucitol (1,5-AG) is a marker of glycosuric hyperglycemia. We evaluated 1,5-AG with clinical outcomes and assessed the effects of glucose- and blood pressure-lowering interventions on change in 1,5-AG in type 2 diabetes. METHODS:We measured 1,5-AG in 6,826 stored samples at baseline and a random subsample of 684 participants at the 1-year follow-up visit in the ADVANCE trial. We examined baseline 1,5-AG (<6, 6-10, ≥10 ug/mL) with microvascular and macrovascular events and mortality using Cox regression models during 5 years of follow-up. Using an intention-to-treat approach, we examined 1-year change in 1,5-AG (mean and percent) in response to the glucose- and blood pressure-lowering interventions in the subsample. RESULTS:Low 1,5-AG (<6 ug/mL vs ≥10 ug/mL) was associated with microvascular events (HR 1.28, 95%CI 1.03-1.60) after adjustment for risk factors and baseline HbA1c. However, the associations for macrovascular events and mortality were not independent of HbA1c. The glucose-lowering intervention was associated with a significant 1-year increase in 1,5-AG (vs standard control) of 1.01 ug/mL (SE, 0.38), corresponding to an 8.26% (SE, 0.10) increase from baseline. We also observed an increase in 1,5-AG of similar magnitude in response to the blood pressure intervention independent of the glucose-lowering effect. CONCLUSIONS:Our results suggest that 1,5-AG is a marker of risk in adults with type 2 diabetes, but only for microvascular events independently of HbA1c. We found that 1,5-AG was improved (increased) in response to an intensive glucose-lowering intervention, although the independent effect of the blood pressure-lowering intervention on 1,5-AG suggests potential non-glycemic influences. This article is protected by copyright. All rights reserved.

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Journal article


Diabetes, obesity & metabolism

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Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland.