Low serum 1,5‐anhydroglucitol is associated with increased risk of all‐cause and cardiovascular mortality in type 2 diabetes: A real‐world cohort study

Abstract Aims Serum 1,5‐anhydroglucitol (1,5‐AG) indicates glycemic control over 1–2 weeks and is particularly useful for monitoring postprandial hyperglycemia. However, its predictive value for long‐term outcomes in type 2 diabetes has not been fully established. Therefore, our study intends to examine the correlation between 1,5‐AG and risk of all‐cause and cardiovascular mortality. Methods In this real‐world cohort study, 3721 patients with type 2 diabetes were classified by 1,5‐AG levels (<6.0 and ≥6.0 μg/mL). Cox proportional hazards regression models served to analyse the link between 1,5‐AG levels and risk of all‐cause and cardiovascular mortality, while restricted cubic splines were employed to investigate linearity of this association. Results Across a median 7.4‐year follow‐up duration, 528 death events were recorded, with 183 due to cardiovascular mortality. Restricted cubic spline analysis showed significant linear inverse relationships between 1,5‐AG levels and risk of all‐cause and cardiovascular mortality. In a fully adjusted Cox regression model including fasting plasma glucose, patients with lower 1,5‐AG levels (<6.0 μg/mL) had a 43% increased risk of all‐cause mortality (95% confidence interval CI 1.16–1.76), in contrast to individuals with higher 1,5‐AG levels (≥6.0 μg/mL). For cardiovascular mortality, while categorical 1,5‐AG showed an attenuated and null association (Hazard ratio 1.36, 95% CI 0.96–1.91), continuous 1,5‐AG maintained a significant association. Conclusions Lower serum 1,5‐AG levels were significantly linked to an elevated risk of all‐cause and cardiovascular mortality in type 2 diabetes.