Comparable performance of 1,5-anhydroglucitol and continuous glucose monitoring in detecting subclinical atherosclerosis in elderly patients with type 2 diabetes.

BACKGROUND

The comparison between conventional glycemic markers and continuous glucose monitoring (CGM) in relation to adverse outcomes in the elderly with type 2 diabetes remains unclear. We aimed to assess associations of 1,5-anhydroglucitol (1,5-AG) and CGM metrics with carotid intima-media thickness (CIMT) as a surrogate of cardiovascular disease.

METHODS

The study included 2509 adults aged ≥ 60 years with type 2 diabetes. CIMT was measured by high-resolution ultrasonography, with abnormal CIMT defined as a mean thickness of ≥ 1.0 mm. Time in range (TIR), mean sensor glucose (MSG), time above range (TAR, > 10.0 mmol/L), standard deviation (SD), and coefficient of variation (CV) were calculated from CGM data.

RESULTS

The median serum 1,5-AG was 3.9 (2.0, 8.0) μg/mL, and the prevalence of abnormal CIMT was 44.2% (n = 1,109). The prevalence of abnormal CIMT decreased across ascending 1,5-AG categories (P for trend < 0.01). In the fully adjusted model, each 1-standard deviation decrease in 1,5-AG conferred 10% higher odds of abnormal CIMT. Compared with 1,5-AG ≥ 10.0 μg/mL, 1,5-AG < 6.0 μg/mL was associated with an odds ratio of 1.25 (95% CI 1.00-1.55) for abnormal CIMT. Among CGM metrics, TIR, MSG, and TAR > 10.0, but not CV or SD, were significantly associated with abnormal CIMT. The C-statistics for 1,5-AG in predicting abnormal CIMT were comparable to those for TIR, MSG, and TAR >10.0 (all P > 0.05).

CONCLUSIONS

In older adults with type 2 diabetes, 1,5-AG demonstrated a performance comparable to CGM for detecting abnormal CIMT, supporting its potential as a clinical biomarker for identifying subclinical atherosclerosis.