diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM10258diaendo-10258Research ArticleОбзорыReview1,5-ангидроглюцитол при сахарном диабете: роль в диагностике, скрининге, оценке гликемического статуса и прогнозе осложнений1,5-anhydroglucitol in diabetes: its role in diagnostics, screening, glycemic status assessment, and the prediction of complicationshttps://orcid.org/0000-0002-5407-8722КлимонтовВадим ВалерьевичKlimontovV. V.

д.м.н., профессор

MD, PhD, Professor

klimontov@mail.ruhttps://orcid.org/0000-0002-5099-5144ДашкинМаксим ВалерьевичDashkinM. V.mdashkin@invitro.ruНаучно-исследовательский институт клинической и экспериментальной лимфологии – филиал ФГБНУ «Федеральный исследовательский центр Институт цитологии и генетики Сибирского отделения Российской академии наук»РоссияResearch Institute of Clinical and Experimental Lymphology – Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of SciencesRussian Federation202010082020233250259Copyright © Климонтов В.В., Дашкин М.В., 20202020Климонтов В.В., Дашкин М.В.Klimontov V.V., Dashkin M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/10258

1,5-ангидроглюцитол (1,5-АГ) – среднесрочный индикатор гликемического статуса, отражающий колебания в диапазоне гипергликемии в течение 1–2 нед. При нормальном уровне глюкозы концентрация 1,5-АГ в плазме крови поддерживается за счет баланса между поступлением с пищей и выведением через почки. В условиях гипергликемии, когда превышен почечный порог для глюкозы, концентрация 1,5-АГ в плазме падает за счет конкурентного ингибирования его реабсорбции глюкозой. В клинической практике 1,5-АГ используется для ретроспективной оценки постпрандиальных колебаний глюкозы у больных сахарным диабетом (СД) с небольшим или умеренным повышением гликированного гемоглобина (HbA1c). Маркер также применяется в клинических исследованиях новых лекарственных препаратов, влияющих на постпрандиальную гликемию. Преимуществами 1,5-АГ как маркера гликемического статуса являются стабильность, отсутствие зависимости от физиологического состояния в момент забора крови, возможность использования у больных с гемоглобинопатиями и аномалиями скорости обмена пула эритроцитов. Вместе с тем информативность 1,5-АГ ограничена у больных с почечным канальцевым ацидозом, хронической болезнью почек 4–5 стадии, ренальной глюкозурией, у получающих акарбозу и ингибиторы SGLT2. Протестировано применение 1,5-АГ для диагностики и скрининга СД 2 типа, гестационного СД и предиабета. Показано, что чувствительность 1,5-АГ как инструмента скрининга СД может быть недостаточной у лиц с невысокими цифрами гликемии, особенно в случае преобладания гипергликемии натощак. В связи с этим для целей скрининга предложено сочетать исследование 1,5-АГ с определением уровня глюкозы натощак. У больных СД 2 типа низкий уровень 1,5-АГ в плазме является предиктором почечной недостаточности, сердечно-сосудистых событий, в том числе ишемической болезни сердца, сердечной недостаточности и инсульта. Низкий уровень 1,5-АГ у беременных женщин является фактором риска гестационного СД и макросомии. Для определения 1,5-АГ в крови, моче и других биологических жидкостях применяются хроматография и ферментативные методы. В настоящее время относительно высокая стоимость и недостаточная стандартизация определения ограничивают использование 1,5-АГ в клинической практике. Необходимы дальнейшие исследования для уточнения значимости 1,5-АГ как маркера гликемического статуса у больных СД 1 типа, у пациентов с различным уровнем HbA1c и различной вариабельностью гликемии, а также в ситуациях, когда клиническая ценность HbA1c ограничена.

1,5-anhydroglucitol (1,5-AG) is a short-term indicator of glycemic status, reflecting hyperglycemic glucose excursions over the prior 1–2 weeks. As glucose level remains in the normal range, plasma concentration of 1,5-AG is maintained stable due to the balance between intake with the food and renal excretion. Under hyperglycemic conditions, when the renal threshold for glucose is exceeded, concentration of 1,5-AG decreases due to competitive inhibition of 1,5-AG reabsorption by glucose. In clinical practice, plasma 1,5-AG is used for retrospective assessment of postprandial glucose fluctuations in diabetic subjects with mild or moderate elevation of HbA1c. The marker is also applied in clinical trials of new agents affecting postprandial glycemia. The advantages of 1,5-AG as a marker of glycemic status are stability, independence on the physiological state when sampling, applicability for patients with abnormalities of hemoglobin and lifespan of erythrocytes. Meantime, the value of this marker is limited in subjects with renal tubular acidosis, 4-5 stages of chronic kidney disease, renal glucosuria, in those receiving acarbose and SGLT2 inhibitors. Application of 1,5-AG for the diagnosis and screening of type 2 diabetes, gestational diabetes and prediabetes has been tested. It was revealed that sensitivity of 1,5-AG as screening tool may be insufficient in individuals with mild hyperglycemia, especially if fasting hyperglycemia prevails. Therefore, it has been proposed to combine 1,5-AG with assessment of fasting glucose for the screening purposes. In type 2 diabetic subjects low plasma 1,5-AG is a predictor of renal failure, cardiovascular events, including ischemic heart disease, heart failure and stroke. Decreased 1,5-AG concentration in pregnant women is a risk factor for gestational diabetes and macrosomia. Chromatography and enzymatic methods are used to determine 1,5-AG in blood, urine and other biological fluids. Currently, the relatively high cost and lack of standardization restrain the use of 1,5-AG in clinical practice. Further studies are needed for estimation of 1,5-AG value as a marker of glycemic status in type 1 diabetes, in patients with different levels of HbA1c and different magnitude of glucose variability, as well as in situations where the clinical value of HbA1c is limited.

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The authors declare that there are no conflicts of interest present.