title: 1,5-Anhydroglucitol as a marker of maternal glycaemic control and predictor of neonatal birthweight in pregnancies complicated by type 1 diabetes mellitus.
abstract: OBJECTIVE
  Most pregnant women with type 1 diabetes mellitus achieve HbA1c targets; however, macrosomia remains prevalent and better pregnancy glycaemic markers are therefore needed. 1,5-Anhydroglucitol (1,5-AG) is a short-term marker of glycaemia, reflecting a period of 1 to 2 weeks. Its excretion rate depends on the renal glucose threshold and thus it is unclear whether it may be used in pregnant type 1 diabetes women. We evaluated 1,5-AG as a glycaemic marker and birthweight predictor in pregnant women with type 1 diabetes, and compared its performance with HbA1c.
  
  
  METHODS
  1,5-AG and HbA1c were measured in 82 pregnant women with type 1 diabetes. In addition, 58 continuous glucose monitoring system (CGMS) records were available. Macrosomia was defined as birthweight >90th centile. The data were analysed with Pearson's correlations, and linear and logistic regression models. Receiver operating characteristic (ROC) analysis was used to evaluate third trimester 1,5-AG as a predictor of macrosomia.
  
  
  RESULTS
  Unlike HbA1c, 1,5-AG strongly correlated with CGMS indices: the AUC above 7.8 mmol/l (r = -0.66; p < 0.001), average maximum glucose (r = -0.58; p < 0.001) and mean glucose (r = -0.54; p < 0.001). In the third trimester, 1,5-AG was the strongest predictor of macrosomia, with ROC AUC 0.81 (95% CI 0.70, 0.89). In contrast, HbA1c in the third trimester had a ROC AUC of 0.69 (95% CI 0.58, 0.81). The best discrimination was achieved when both markers were used jointly, yielding a ROC AUC of 0.84 (95% CI 0.76, 0.93).
  
  
  CONCLUSIONS
  In pregnant women with type 1 diabetes, 1,5-AG is a better glycaemic marker than HbA1c, as assessed by CGMS. A decreased third trimester 1,5-AG level, either singly or with HbA1c, is a strong predictor of macrosomia.
authors: Department of Metabolic Diseases, Jagiellonian University Medical College, 15 Kopernika Street, 31-501 Krakow, Poland.
authors: N
authors: N
authors: Nowak
authors: J
authors: J
authors: Skupien
authors: K
authors: K
authors: Cyganek
authors: B
authors: B
authors: Matejko
authors: M T
authors: MT
authors: Malecki
mesh_terms: D000328:Adult; D001724:Birth Weight; D001786:Blood Glucose / Q000378:metabolism; D003847:Deoxyglucose / Q000097:blood*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D005260:Female; D005947:Glucose / Q000378:metabolism; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D008423:Maternal Age; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011254:Pregnancy in Diabetics / Q000097:blood*; D012372:ROC Curve; D012044:Regression Analysis
chemical_list: D001786:Blood Glucose; D003847:Deoxyglucose; D005947:Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human; C006584:1,5-anhydroglucitol
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