Evaluation of serum 1,5 anhydroglucitol levels as a clinical test to differentiate subtypes of diabetes.
Evaluation of serum 1,5 anhydroglucitol levels as a clinical test to differentiate subtypes of diabetes.
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DOI：
10.2337/dc09-1246
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发表时间：
2010-02
期刊：
影响因子：
16.2
通讯作者：
Owen KR
中科院分区：
文献类型：
--
作者：
Pal A;Farmer AJ;Dudley C;Selwood MP;Barrow BA;Klyne R;Grew JP;McCarthy MI;Gloyn AL;Owen KR
在糖尿病中分配正确的分子诊断对于关于治疗和预后的明智决定是必要的。更好的临床标志物将有助于区分和优先考虑糖尿病亚型之间的基因检测。据报道，血清1，5脱水葡萄糖醇（1，5AG）水平可区分2型糖尿病与HNF 1A突变（HNF 1A-MODY）引起的年轻人成熟型糖尿病，但这需要进一步验证。我们评估了血清1，5AG在一系列糖尿病亚型作为一个辅助定义糖尿病病因。1，5 AG是在英国测量的。受试者：HNF 1A-MODY（n = 23）、葡萄糖激酶突变导致的MODY（GCK-MODY，n = 23）、1型糖尿病（n = 29）、成人隐匿性自身免疫性糖尿病（LADA，n = 42）和2型糖尿病（n = 206）。应用受试者工作特征曲线分析评价1，5 AG对糖尿病病因的判别准确性。平均（SD范围）1，5AG水平为：GCK-MODY 13.06 μg/ml（5.74-29.74）、HNF 1A-MODY 4.23 μg/ml（2.12-8.44）、1型糖尿病3.09 μg/ml（1.45-6.57）、LADA 3.46 μg/ml（1.42-8.45）和2型糖尿病5.43（2.12-13.23）。GCK-MODY组的水平高于其他组（P < 10−4 vs.每组）。HNF 1A-MODY受试者未校正的1，5AG水平与2型糖尿病、1型糖尿病和LADA无差异。校正A1 C后显示HNF 1A-MODY与2型糖尿病之间存在差异（P = 0.001）。GCK-MODY与2型糖尿病的未校正1，5AG水平的判别准确度为0.79，GCK-MODY与HNF 1A-MODY的判别准确度为0.86，但HNF 1A-MODY与2型糖尿病的判别准确度仅为0.60。在我们的数据集中，血清1，5AG在区分GCK-MODY与其他糖尿病亚型，特别是HNF 1A-MODY方面表现良好。测量1，5AG水平可以为有关MODY诊断测试的决策提供信息。
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. 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. Mean (SD range) 1,5AG levels were: GCK-MODY 13.06 μg/ml (5.74–29.74), HNF1A-MODY 4.23 μg/ml (2.12–8.44), type 1 diabetes 3.09 μg/ml (1.45–6.57), LADA 3.46 μg/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. 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.