What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Type 2 diabetes in older adults (n=2509). Intervention: 1,5-anhydroglucitol (1,5-AG) < 6.0 μg/mL vs. 1,5-AG ≥ 10.0 μg/mL. Primary outcome: Abnormal carotid intima-media thickness (CIMT ≥ 1.0 mm) (OR 1.25, 95% CI 1.00-1.55, p=<0.05).

November 21, 2025Cardiovascular Diabetology1 citationsOpen Access

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

Q: What are the key findings of this study?

In older adults with type 2 diabetes, serum 1,5-anhydroglucitol < 6.0 μg/mL was associated with a 25% higher odds of abnormal carotid intima-media thickness compared to levels ≥ 10.0 μg/mL (OR 1.25).

HSHang SuSichuan University JNJiaying NiShanghai Jiao Tong University JLJingyi LuShanghai Ninth People's Hospital

Key Result

In older adults with type 2 diabetes, serum 1,5-anhydroglucitol < 6.0 μg/mL was associated with a 25% higher odds of abnormal carotid intima-media thickness compared to levels ≥ 10.0 μg/mL (OR 1.25).

Study Design

Type

Cross-Sectional (n=2,509)

Multicenter

Structured PICO

Does 1,5-anhydroglucitol perform comparably to continuous glucose monitoring in detecting abnormal carotid intima-media thickness in elderly patients with type 2 diabetes?

Population

2,509 adults aged ≥ 60 years with type 2 diabetes on stable glucose-lowering therapy for the previous 3 months, without prior cardiovascular disease, severe renal dysfunction (eGFR < 30), or current use of SGLT2 inhibitors. Median age 66.0, 53.8% male, based in China.

Intervention

Serum 1,5-anhydroglucitol (1,5-AG) measurement and 72-hour continuous glucose monitoring (CGM)

Comparator

Higher levels of 1,5-AG (≥ 10.0 μg/mL) and different categories of CGM metrics

Outcome

Abnormal carotid intima-media thickness (CIMT), defined as a mean thickness of ≥ 1.0 mm measured by high-resolution ultrasonographysurrogate

In older adults with type 2 diabetes, serum 1,5-anhydroglucitol performs comparably to continuous glucose monitoring metrics for detecting subclinical atherosclerosis, offering a practical and lower-cost alternative biomarker.

Main Result

Effect estimate: OR 1.25 (95% CI 1.00-1.55)

p-value: p=<0.05

Limitations

Cross-sectional study design precludes causal inferences
CGM wear duration was 72 hours, which may introduce imprecision in capturing glycemic patterns
Use of two different CGM devices may have introduced heterogeneity in the derived indices
Measuring only the IMT of the bilateral common carotid arteries may have underestimated focal atherosclerotic changes
Definition of elderly as ≥ 60 years may limit generalizability to other age groups

Abstract

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. 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. 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 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). 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.

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