Article

Diabetologia

, Volume 56, Issue 4, pp 709-713

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

1,5-Anhydroglucitol as a marker of maternal glycaemic control and predictor of neonatal birthweight in pregnancies complicated by type 1 diabetes mellitus

  • N. NowakAffiliated withDepartment of Metabolic Diseases, Jagiellonian University Medical College
  • , J. SkupienAffiliated withDepartment of Metabolic Diseases, Jagiellonian University Medical CollegeSection on Genetics and Epidemiology, Joslin Diabetes Center
  • , K. CyganekAffiliated withDepartment of Metabolic Diseases, University Hospital
  • , B. MatejkoAffiliated withDepartment of Metabolic Diseases, Jagiellonian University Medical College
  • , M. T. MaleckiAffiliated withDepartment of Metabolic Diseases, Jagiellonian University Medical CollegeDepartment of Metabolic Diseases, University Hospital Email author 

Abstract

Aims/hypothesis

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/interpretation

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.

Keywords

1,5-Anhydroglucitol Birthweight Haemoglobin A1c HbA1c Pregnancy Type 1 diabetes mellitus