Presentation is loading. Please wait.

Presentation is loading. Please wait.

1 GLYCOMARK GLYCOMARK A NEW BLOOD TEST FOR PPG A NEW BLOOD TEST FOR PPG.

Similar presentations


Presentation on theme: "1 GLYCOMARK GLYCOMARK A NEW BLOOD TEST FOR PPG A NEW BLOOD TEST FOR PPG."— Presentation transcript:

1 1 GLYCOMARK GLYCOMARK A NEW BLOOD TEST FOR PPG A NEW BLOOD TEST FOR PPG

2 2 Importance of Postprandial Glucose Control

3 The Glycemic Triad 3 HbA1c Long term average glucose level FPG Basal glucose level PPG Peak Glucose Level

4 4 Duration of daily metabolic conditions Breakfast Lunch Dinner0:00 am4:00 amBreakfast Postprandial PostabsorptiveFasting Monnier L. Eur J Clin Invest 2000;30(Suppl. 2):3–11

5 5 As Patients Get Closer to A1C Goal, the Need to Successfully Manage PPG Significantly Increases Adapted from Monnier L, Lapinski H, Collette C. Contributions of fasting and postprandial plasnma glucose increments to the overall diurnal hyper glycemia of Type 2 diabetic patients: variations with increasing levels of HBA(1c). Diabetes Care. 2003;26:

6 6 Moving from A1C 8.0% to 7.0% Difficult and Important!! Moving from A1C 8.0% to 7.0% Difficult and Important!! 20-25% of Patients Have A1Cs between 8.0% and 7.0% 20-25% of Patients Have A1Cs between 8.0% and 7.0% Moving from A1C 8.0% to 7.0% - Reduces Serious Complications Moving from A1C 8.0% to 7.0% - Reduces Serious Complications UKPDS Study Results Reduced microvascular complications (kidney, eye, etc.) by 17-33% Reduced microvascular complications (kidney, eye, etc.) by 17-33% Reduced risk of heart attack by 16% Reduced risk of heart attack by 16% Reduced diabetes-related deaths by 21% Reduced diabetes-related deaths by 21% Challenge: More difficult to make improvements as A1C gets closer to 7.0% Challenge: More difficult to make improvements as A1C gets closer to 7.0%

7 7 DCCT Research Group. N Engl J Med. 1993;329: Ohkubo Y, et al. Diabetes Res Clin Pract. 1995;28: UKPDS 33: Lancet 1998; 352, Slide modified from J. Buse HbA1c Retinopathy Nephropathy Neuropathy Cardiovascular disease DCCT 9  7.2% 63% 54% 60% 41% Kumamoto 9  7% 69% 70% Improved - UKPDS 8  7% 17-21% 24-33% - 16% Reducing A1C Levels: Reduces Incidence of Complications *NCS

8 Coronary Artery Disease and Postprandial Hyperglycemia Coronary Artery Disease and Postprandial Hyperglycemia Mellen PB et al. Arterioscler Thromb Vasc Biol. 2006;26:

9 9 Summary Postprandial glycemia plays a clinically important role in the complications of diabetes Postprandial glycemia plays a clinically important role in the complications of diabetes Postprandial glycemia is a major contributor to overall glycemic control ESPECIALLY in moderately-well to well controlled patients Postprandial glycemia is a major contributor to overall glycemic control ESPECIALLY in moderately-well to well controlled patients

10 10 A1C values can be “misleading”  Nearly 40% of diabetes patients in “good control” have persistently elevated glucose levels (Bonora et al. Diabetologia 2006)  These patients are at high risk of developing of developing serious complications!!!!

11 11 So How Can We Assess Post-Prandial Glucose Control Clinically ?? Frequent fingersticks Frequent fingersticks HbA1C HbA1C Fructosamine Fructosamine Continuous Glucose Monitoring Systems Continuous Glucose Monitoring Systems Sensor-Augmented Insulin Pumps Sensor-Augmented Insulin Pumps

12 12 A New Approach to Monitoring Postprandial Hyperglycemia 1,5-Anhydroglucitol (1,5-AG) GlycoMark

13 13 1,5-AG Physiology

14 14 The structure of 1,5-anhydroglucitol (1,5AG) O OH HO OH O HO D-glucose 1,5-anhydro-D-glucitol (1-deoxyglucose)

15 15 Oral Supply 1,5AG (5-10mg/day) Blood stream Tissues Internal Organs ( mg) Kidney Urinary excretion (5-10mg/day) Oral Supply 1,5AG (5-10mg/day) Blood Stream (1,5-AG Level Lower) Tissues Internal Organs ( mg) Kidney Urinary excretion (INCREASED) NormoglycemiaHyperglycemia Glucose Blocks Reabsorption Physiology of 1,5-AG

16 16 Relationship of Blood Glucose and 1,5-AG As postprandial glucose rises in blood over the renal threshold of 180 mg/dL glucosuria occurs. As postprandial glucose rises in blood over the renal threshold of 180 mg/dL glucosuria occurs. Excessive glucose in urine competitively inhibits the reabsorption of 1, 5–AG into the bloodstream at the proximal renal tubules. Excessive glucose in urine competitively inhibits the reabsorption of 1, 5–AG into the bloodstream at the proximal renal tubules. As glucose blood levels increase, 1,5–AG blood levels decrease. As glucose blood levels increase, 1,5–AG blood levels decrease. 1,5–AG blood levels less than 10 µg/ml are abnormal. 1,5–AG blood levels less than 10 µg/ml are abnormal. GLUCOSE >180 mg/dL GLYCOMARK

17 17 Glycemic control markers 1,5AG Fructosamine HbA 1C Blood glucose Weeks before measurement

18 18 GlycoMark Monitors Postprandial Hyperglycemia Dungan, K., Buse, J. et al. Diabetes Care (June 2006) Patients were sorted by glycemic excursions as measured by CGMS (AUC-180) and subdivided into two populations – bottom 50 th percentile (17 patients) and top 50 th percentile (17 patients). Authors’ Conclusions 1,5-AG (GlycoMark) assay reflects glycemic excursions, often in the postprandial state, more robustly than other established glycemic assays. 1,5-AG was reflective of varying postmeal glucose levels, despite similarities in A1Cs. In clinical practice, A1C and 1,5-AG may be used sequentially, first employing the A1C assay to identify patients who are moderately controlled and then using the 1,5-AG assay to determine the extent of postprandial glycemic excursions.

19 19 52 year old female with type 1 DM A1C 7.43% 1,5-AG 12.4mcg/dL PPG max 195 mg/dL 49 year old male with type 2 DM A1C 7.27% 1,5-AG 4.5mcg/dL PPG max 235 mg/dL GlycoMark Reveals Elevated PPG Levels in Patients with “Good” A1Cs

20 20 Relationship of 1,5-Anhydroglucitol (1,5-AG) to Baseline Characteristics in Insulin-naïve Type 2 Diabetes (T2DM) Patients in the DURABLE Trial Baseline Characteristic HbA1c ≤ 8.0% HbA1c 1,5-AG HbA1c >8.0% HbA1c 1,5-AG Mean Premeal Glucose n = * n = ** n = ** n = ** Mean Postprandial Glucose n = * n= ** n = ** n = ** Mean Glucose n= * n= ** n = ** n = ** All values are r correlations * p <0.05; ** p <0.001 Authors’ Conclusions:  1,5_AG had stronger correlation than HbA1c with all self-monitored plasma glucose (SMPG) parameters, particularly PPG.  Additionally, at HbA1c ≤ 8.0%, 1,5-AG has a stronger correlation with blood glucose values compared with HbA1c. As such, these data support the use of 1,5-AG in conjunction with HbA1c in moderately controlled patients with T2DM.

21 21 1,5-AG (ug/ml) Approximate Mean Postmeal Maximum Blood Glucose (mg/dl) > 12 < < 2 > 290 GlycoMark Values vs. PPG Levels GlycoMark Values vs. PPG Levels

22 22 Interpreting GlycoMark Results Interpreting GlycoMark Results GlycoMarkDiabetesA1C > 10 Well-Controlled – 10* Moderately Controlled Poor Control < 2 Very Poor Control > 10

23 23 Target Glycemic Goals GlycoMark > 10 ug/ml GlycoMark > 10 ug/ml A1C <7.0% (6.5% AACE Goal) A1C <7.0% (6.5% AACE Goal) GlycoMark may be tested monthly GlycoMark may be tested monthly

24 24 Clinical Study Revealing Underlying Treatment Effects Exenatide

25 25 Revealing Underlying Treatment Effects Exenatide Objective: To assess 1,5-AG as a marker of PPG control in Exenatide-treated patients with type 2 diabetes (T2DM) Objective: To assess 1,5-AG as a marker of PPG control in Exenatide-treated patients with type 2 diabetes (T2DM) 144 Patients 144 Patients Initial A1C levels: 8.2 +/-1% Initial A1C levels: 8.2 +/-1% Randomized to Exenatide (5 or 10 ug) or placebo Randomized to Exenatide (5 or 10 ug) or placebo Thirty week study Thirty week study Presented at ADA 2007 Annual Meeting

26 26 Revealing Underlying Treatment Effects Exenatide Revealing Underlying Treatment Effects Exenatide Comparison of Changes in Values from Baseline to Study End Exenatide (5 ug)Exenatide (10 ug) 1,5-AG /- 0.6 ug/ml* / % /- 0.6 ug/ml** / % A1C /- 0.1 %-0.9 +/- 0.1 %** * P < 0.05; ** P < 0.01 Correlations : Changes from baseline 1,5-AG vs. HbA1C: r = ; P < ,5-AG vs. fasting plasma glucose (FPG): r = -0.54; P <0.0001

27 27 THE USE OF 1,5 – ANHYDROGLUCITOL (GLYCOMARK) TO MONITOR NEW CLASSES OF THERAPIES FOR MANAGING POSTMEAL GLUCOSE IN PATIENTS WITH DIABETES 1,5-AG (Absolute % Change) A1C (Absolute % Change) Exenatide 5 ug (30 weeks) %-6.1% Pramlintide (29 weeks) +30.0%-2.4% Sitagliptin (12 weeks) +83.1%-8.6% BIAsp 70/30 (28 weeks) %-29.9% Comparison of % Changes in Values from Baseline to Study End – Treated Populations

28 28 Patient Cases Patient Cases PatientHbA1c (%) GlycoMark (µg/ml) Intrepretation Male – age Tests Consistent – Poor Control Female – age Tests Consistent – Good Control Female – age Tests Inconsistent – Poor PPG control indicated by GlycoMark Male – age Tests Consistent – Good Control Female – age Tests Inconsistent – Poor PPG control indicated by GlycoMark Female – age Tests Consistent – Good Control Female – age Tests Consistent – Poor Control GlycoMark values <10 µg/ml are abnormal

29 29 Moderately Controlled Patients (A1C <8.5%) GlycoMark (>10  g/ml) Normal PPG GlycoMark (<10  g/ml) Elevated PPG Target After-Meal Glucose Exenatide Sitagliptin Prandial Insulin Maintain Fasting Therapy Target Fasting Glucose Metformin Sulfonylurea Basal Insulin Utilizing GlycoMark to Reach Glycemic Goals

30 30 “A1C is currently the gold standard measure of the quality of glycemic control.” “Alchemy is a complex subject with many different facets – literature, chemistry, fraud; searching for a gold standard in diabetes care from among the currently available tools is perhaps as futile as the quest for the Philosophers' Stone to change base metals into gold. Each tool has its limitations and the most complete picture emerges from careful application of at least two.” John Buse “Alchemy is a complex subject with many different facets – literature, chemistry, fraud; searching for a gold standard in diabetes care from among the currently available tools is perhaps as futile as the quest for the Philosophers' Stone to change base metals into gold. Each tool has its limitations and the most complete picture emerges from careful application of at least two.” John Buse

31 The Glycemic Triad 31 HbA1c Long term average glucose level FPG Basal glucose level PPG GLYCOMARK

32 32 CME CREDITS FOR 1,5-ANHYDRO-D-GLUCITOL ARE NOW AVAILABLE FROM DiabetesWRAP Presented by Steven D. Wittlin, M.D., Associate Professor of Medicine, Clinical Director of the Endocrine-Metabolism Division, University of Rochester School of Medicine and Dentistry, Strong Memorial Medical Center, Rochester, NY. Enrollment for this HealthWRAP is complimentary. The University of Massachusetts Medical School designates this activity for a maximum of 2 AMA PRA Category 1 Credit(s). Focus on 1,5-anhydroglucitol for Monitoring and Clinical Management of Patients with Diabetes: Implications and Relationship to Other Critical Biomarkers of Diabetes Control This activity is supported by an Independent Educational Grant from Quest Diagnostics. Access at

33 33 GLYCOMARK GLYCOMARK Thank you for your interest in GlycoMark


Download ppt "1 GLYCOMARK GLYCOMARK A NEW BLOOD TEST FOR PPG A NEW BLOOD TEST FOR PPG."

Similar presentations


Ads by Google