Increased 1,5-Anhydroglucitol Predicts Glycemic Remission in Patients with Newly Diagnosed Type 2 Diabetes Treated with Short-Term Intensive Insulin Therapy

Abstract

Short-term intensive insulin therapy has been shown to induce long-term glycemic remission in patients with newly diagnosed type 2 diabetes. However, predictors of remission are still uncertain. This study was conducted to evaluate whether changes of 1,5-anhydroglucitol (1,5AG) and fructosamine (FA) could be a predictor of remission. Newly diagnosed drug-naive patients with type 2 diabetes (n = 64) were enrolled. After baseline assessments, continuous subcutaneous insulin infusion (CSII) was administered in all patients until euglycemia was achieved and maintained for another 2 weeks. Patients were subsequently followed monthly for 3 months. 1,5AG and FA were measured before and after therapy and at 1-month follow-up. After CSII, A1C and FA decreased from baseline, whereas 1,5AG increased. 1,5AG was higher at 1-month follow-up (11.5 ± 4.1 vs. 6.7 ± 2.8 mg/L, P<0.001), whereas FA was lower (273.1 ± 56.1 vs. 316.2 ± 39.3 μmol/L, P = 0.021) in the remission group. Stepwise logistic regression analysis showed that 1,5AG at 1-month follow-up rather than FA was an independent predictor of remission after adjusting for other confounders (odds ratio 1.56, 95% confidence interval [CI] 1.15-2.12, P = 0.004). The area under the curve of the receiver operating characteristic curve analysis was 0.85 (95% CI 0.75-0.96, P<0.001). The optimal cutoff point for 1,5AG at 1-month follow-up was 8.9 mg/L (specificity, 83.3%; sensitivity, 78.6%). Improvement of 1,5AG predicts maintenance of glycemic remission after intensive insulin therapy in patients with newly diagnosed type 2 diabetes.