The Relationship Between Serum 1,5-AG And EGFR In Type 2 Diabetic Patients

Objective:The study of the relationship between serum 1,5-AG and glomerular filtration rate(eGFR)in patients with type 2 diabetes mellitus complicated with diabetic nephropathy or renal dysfunction,and to assess its application as a blood glucose monitoring indicator in different renal function status.Method:This was a cross-sectional study with 140 inpatients with type 2 diabetes complicated with different degrees of diabetic nephropathy or renal dysfunction who were divided into four groups based on estimated glomerular filtration rate(eGFR)using Modification of Diet in Renal Disease(eGFR-MDRD)formula:32 in CKD stage 1,37 in stages 2,37 in stage 3,and 34 in stages 4–5.Compare the differences of serum 1,5-anhydroglucitol(1,5-AG),HbAlc,fasting plasma glucose(FPG),fructosamine(FA),age,sgender,body mass index,and urine microalbumin/creatinine,urinary microalbumin,urinaryα1 microglobulin(urineα1-MG),blood lipids,uric acid,and blood pressure in different renal insufficiency groups.Analysis the correlations between serum 1,5-AG and other blood glucose indicators(HbAlc,FA,FPG)in different groups,and analysis the correlations between serum 1,5-AG and eGFR、urineα1-MG in different groups.Result:1.In CKD stage 1-3,serum 1,5-AG was significantly negatively correlated with HbAlc and FPG;and negatively correlated with FA only in stage 1,with no correlation in stages 2-3;no correlation was found in serum 1,5-AG and eGFR,suggesting that serum1,5-AG can monitor blood glucose in type 2 diabetes with mild or moderate renal dysfunction.2.In stages 4-5,serum 1,5-AG was no correlation with other blood glucose indicators(HbA1c,FPG,FA),but it was positively correlated with eGFR,and the regression coefficients was 0.502,indicating that each increase of eGFR was 10 ml/(min·1.73m~2),serum 1,5-AG increased by 5.02umol/L.3.Between stages 1-2,Urinaryα1-MG,which was a marker of renal tubular injury,was no statistical difference.The urinaryα1-MG excretion in stage 3-5 was higher than in stages 1-2,suggesting that there is tubular damage in moderate renal dysfunction,which leads to a decrease in serum 1,5-AG.In CKD stages 1-3,serum 1,5-AG was not associated with urineα1-MG;in CKD stages 4-5,both were negatively correlated(P=0.019<0.05),and the correlation coefficient was-0.721.4.In stages 4-5,the correlation between serum 1,5-AG and FPG is stronger than that of serum 1,5-AG and HbA1c,FA.when CKD status is aggravated,hemoglobin and albumin are decreased and affect HbA1c and FA respectively in monitoring blood glucose,serum 1,5-AG is affected and reduced by kidney injury,renal glucose threshold,diabetes duration and even dialysis.At this time,serum 1,5-AG,HbA1c,and FA are limited in monitoring blood glucose.Conclusion:Serum 1,5-AG can be used to monitor blood glucose in patients with type 2 diabetes with mild to moderate renal insufficiency,but there are limitations in severe renal insufficiency.