9.Hypoglycemia and 1,5-AG

  1,5-AG cannot directly catch the incidence of hypoglycemia.

  Prolonged hypoglycemia reduces HbA1c level, but does not influence on 1,5-AG. Therefore, relatively low level of HbA1c compared to that estimated from 1,5-AG value suggests the high frequency of hypoglycemia.

  Generally, patient with HbA1c of less than 6.0% and 1,5-AG of less than 6.0μg/ml should be required extra attention to hypoglycemia.

  In patients with type 1 diabetes mellitus, sharp fluctuations of blood glucose often cause low 1,5-AG (even 1.0~2.0 μg/ml) despite of HbA1c level of 5%. However, intensive insulin therapy or continuous subcutaneous insulin infusion (CSII) therapy can make 1,5-AG value to 10.0μg/ml level if it goes well.

  A close correlation between the risk of severe hypoglycemia and glucose excursion as evaluated by 1,5-AG was shown (Diabetes Care 40, 1661, 2017).

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