Context: During an asymptomatic pre-diabetic state, the functional ß-cell mass decreases up to a critical threshold triggering diabetes and related symptoms. To date, there are no reliable readouts able to capture in vivo a potential drop of the ß-cell mass.

Objective: Beside its use as a short-term marker of glycemic control, the deoxyhexose 1,5-anhydroglucitol was identified in rodents as a circulating biomarker of the functional ß-cell mass already in the asymptomatic prediabetic stage. The present study investigated the putative corresponding relevance of circulating 1,5-anhydroglucitol in different human cohorts.

Methods: We analyzed clinical and blood parameters in patients with established type 2 diabetes and subjects considered at high risk of developing diabetes, as well as patients with no history of diabetes scheduled for pancreaticoduodenectomy.

Results: Circulating 1,5-anhydroglucitol was reduced in type 2 diabetic patients, negatively correlating with fasting plasma glucose (p<0.0001) and HbA1c (p<0.0001). In healthy subjects, 1,5-AG levels positively correlated with body mass index (p=0.004) and HOMA%S (p<0.03) and was particularly high in nondiabetic obese individuals, potential accounting for compensatory ß-cell expansion. Patients with no history of diabetes undergoing pancreaticoduodenectomy exhibited a 50% reduction of circulating 1,5-anhydroglucitol levels following surgery leading to an acute loss of their ß-cell mass (p=0.002), regardless their glucose tolerance status.

Conclusion: In summary, plasma concentration of 1,5-anhydroglucitol follows the ß-cell mass and its non-invasive monitoring may alert about the loss of ß-cells in subjects at risk for diabetes, an event that cannot be captured by other clinical parameters of glycemic control.