| Glucose monitoring plays a key role in comprehensive management of diabetes. Glycated hemoglobin A1c(Hb A1c), which can reflect the mean blood glucose levels over the previous 2 to 3 months, attaches great importance to the glucose monitoring system. Some new indicators, such as glycated albumin(GA) with ability to reflect the blood glucose levels during the previous 2 to 3 weeks, and 1,5-anhydroglucitol(1,5-AG) with ability to reflect the blood glucose levels during the previous 1 to 2 weeks, have been gradually put into clinical application and provided Hb A1 c with complementary information in recent years. This study aimed to investigate the correlations of glycemic markers with atherosclerosis and pathophysiology of diabetes in three parts as follows:1. Associations of glycated hemoglobin A1 c, glycated albumin, and 1,5-anhydroglucitol with coronary artery diseaseObjective The goal of this study was to investigate the associations of HbA1 c, GA, and 1,5-AG with coronary artery disease(CAD).Methods A total of 272 subjects(178 men and 94 postmenopausal women; age range, 38 to 86 years old) were selected for this study. All of them underwent coronary angiography which was used for diagnosis of CAD. The severity of coronary artery stenosis was evaluated by the coronary stenosis index(CSI). Hb A1 c was determined by high-performance liquid chromatography. Serum GA and 1,5-AG were assayed using the enzymatic method.Results In 272 study subjects, 194(71.32%) were diagnosed with CAD. The Hb A1 c andGA levels were significantly higher in patients with CAD than those without CAD(both P < 0.01). The 1,5-AG level was significantly lower in patients with CAD than those without CAD(P < 0.05). When traditional risk factors of CAD, Hb A1 c, GA, and 1,5-AG were set as independent variables, multivariate logistic regression analysis showed that GA was independently correlated with CAD [odds ratio(OR) = 1.143, 95% confidence interval(CI): 1.048-1.247; P = 0.002]. In order to analyze the relationship between each glycemic marker and the severity of coronary artery stenosis, defining CSI as the dependent variable, multiple stepwise regression analysis demonstrated that GA, but not Hb A1 c and 1,5-AG, was independently and positively correlated with CSI(standardized β = 0.184, P = 0.003).Conclusions GA displayed a closer correlation with CAD than did HbA1 c and 1,5-AG in the population at high risk of CAD. Additionally, GA appeared to be independently associated with the severity of coronary artery stenosis.2. Associations of glycated hemoglobin A1 c and glycated albumin with subclinical atherosclerosis in population with impaired glucose regulationObjective The aim of this study was to investigate the associations of Hb A1 c and GA with subclinical atherosclerosis in middle-aged and elderly population with impaired glucose regulation.Methods A total of 640 subjects with impaired glucose regulation and without history of cardiovascular disease or carotid artery plaque in Shanghai community were recruited for this study(256 men and 384 women; age range, 40 to 70 years old). Carotid ultrasonography was used to measure the carotid intima-media thickness(C-IMT), which is an indicator of subclinical atherosclerosis. Increased C-IMT was defined as ≥ 0.70 mm(the upper quartile).Results The HbA1 c and GA levels were higher in subjects with increased C-IMT than those with normal C-IMT(both P < 0.01). Correlation analysis revealed that both Hb A1 c and GA were positively associated with C-IMT(r = 0.135 and 0.112, respectively; both P < 0.01). Logistic regression analysis showed that both Hb A1c(OR = 2.630, 95% CI = 1.401-4.935; P = 0.003) and GA(OR = 1.215, 95% CI = 1.008-1.466; P = 0.041) were independent factors associated with increased C-IMT.Conclusions In middle-aged and elderly population with impaired glucose regulation, both elevated levels of Hb A1 c and GA were associated with increased C-IMT, suggesting that Hb A1 c and GA might reflect the risk of subclinical atherosclerosis.3. Associations of glycated hemoglobin A1 c and 1,5-anhydroglucitol with insulin sensitivity and secretion in patients with newly diagnosed type 2 diabetes mellitusObjective The goal of this study was to probe into the relationships of Hb A1 c and l,5-AG with insulin sensitivity and secretion in patients who were newly diagnosed with type 2 diabetes mellitus.Methods A total of 302 patients with newly diagnosed type 2 diabetes mellitus(166 men and 136 women; age range, 27 to 79 years old) were enrolled in this study. The homeostasis model assessment of insulin resistance(HOMA-IR) and homeostasis model assessment of β cell function(HOMA-β) were calculated to evaluate the basal insulin sensitivity and secretory function, respectively. Insulinogenic index(IGI) was used for assessment of early-phase insulin secretion.Results When the subjects were stratified according to Hb A1 c quartiles, the trends analyses showed an upward trend for the HOMA-IR and downward trends for both the HOMA-β and IGI with increasing Hb A1 c quartiles(all P for trend < 0.001). Increased 1,5-AG quartiles were accompanied by a decreasing trend in HOMA-IR and increasing trends in HOMA-β and IGI(all P for trend < 0.001). Multiple stepwise regression analysis revealed that the independent correlations of HOMA-IR(standardized β = 0.525) and HOMA-b(standardized β =-0.673) with Hb A1 c were present(both P < 0.001) when Hb A1 c was defined as the dependent variable. Moreover, 1,5-AG was not only independently associated with HOMA-IR and HOMA-β(standardized β =-0.349 and 0.232, both P < 0.01), but also exhibited an independent and positive association with IGI(standardized β = 0.242, P < 0.001).Conclusions This study demonstrated significant correlations of lower basal insulin sensitivity and impaired basal insulin secretory function with the increasing Hb A1 c level, as well as the decreasing 1,5-AG level in patients with newly diagnosed type 2 diabetes mellitus. In addition, 1,5-AG level was closely associated with early-phase insulin secretion. |
PDF Full Text Request