Abstract P144: 1,5-Anhydroglucitol as a Marker of Hyperglycemic Excursions Defined by Continuous Glucose Monitoring in Older Adults

Background: Low levels (≤6 μg/mL) of serum 1,5-anhydroglucitol (1,5-AG) are thought to reflect periods of hyperglycemia. During periods of hyperglycemia, 1,5-AG competes with glucose for reabsorption in the kidney and is excreted in the urine, resulting in low serum concentrations of 1,5-AG. However, the performance of 1,5-AG to identify hyperglycemic excursions detected by continuous glucose monitoring (CGM) is unknown. Methods: We conducted a cross-sectional analysis of participants with diabetes in the Atherosclerosis Risk in Communities Study who wore a CGM sensor in 2021-2022 for up to 2 weeks. We evaluated the performance of 1,5-AG, modeled continuously and dichotomously (≤6 μg/mL, >6 μg/mL), to identify CGM derived metrics of hyperglycemia. Hyperglycemic excursions were defined as percent time spent with CGM glucose above 140 mg/dL, area under the curve (AUC) >140 mg/dL*minute, peak (maximum) CGM glucose, and the coefficient of variation (CV). Results: Among 322 participants with diabetes (mean age 83, 55% female), 22% had 1,5-AG≤6 μg/mL. The median CGM wear time was 13.9 days. The mean CGM glucose was 125 mg/dL (SD, 28) among those with 1,5-AG>6 μg/mL and 156 mg/dL (SD, 45) among those with 1,5-AG≤6 μg/mL. 1,5-AG was inversely associated with percent of time CGM glucose >140 mg/dL ( Figure ), AUC >140 mg/dL (Pearson correlation, r =-0.25), peak CGM glucose ( r =-0.41) and CV ( r =-0.25). Individuals with 1,5-AG≤6 μg/mL spent 5.5 hours more per day above 140 mg/dL compared to those with 1,5-AG>6 μg/mL. Conclusion: 1,5-AG is correlated with CGM-defined hyperglycemia. Low levels of 1,5-AG identify older adults with diabetes experiencing glycemic excursions.