From the Guidelines
Fructosamine can be used as a reliable diagnostic tool for diabetes in patients with anemia of chronic disease, where hemoglobin A1c (HbA1c) levels may be falsely elevated, as it reflects glycated serum proteins over a shorter timeframe of 2-4 weeks, making it less affected by red blood cell lifespan abnormalities. According to the most recent and highest quality study 1, fructosamine and glycated albumin are alternative measures of glycemia that are approved for clinical use for monitoring glycemic status in people with diabetes. The study highlights that fructosamine reflects total glycated serum proteins (mostly albumin) and has been linked to long-term complications in epidemiologic cohort studies.
Key Considerations
- Fructosamine measures glycated serum proteins (primarily albumin) over the previous 2-4 weeks, rather than the 2-3 months reflected by HbA1c.
- Normal fructosamine levels typically range from 200-285 μmol/L, with values above 285 μmol/L suggesting hyperglycemia.
- When using fructosamine, it's essential to consider that low albumin levels (common in chronic disease) may lead to falsely low results, so albumin levels should be checked simultaneously.
- Other alternatives include glycated albumin testing or simply monitoring fasting and postprandial glucose levels over multiple visits.
Clinical Implications
- Fructosamine works well because it reflects protein glycation rather than hemoglobin glycation, bypassing the interference from altered red blood cell turnover that affects HbA1c measurements in anemic conditions.
- The use of fructosamine as a diagnostic tool can help improve the accuracy of diabetes diagnosis in patients with anemia of chronic disease, ultimately leading to better management and outcomes.
- As noted in the study 1, in people with diabetes who have conditions that interfere with the interpretation of A1C, alternative approaches to monitoring glycemic status should be used, including self-monitoring of blood glucose, CGM, and/or the use of glycated serum protein assays.
From the Research
Diagnostic Tools for Diabetes
- Fructosamine can be used as a diagnostic tool for diabetes, especially in patients with anemia of chronic disease, where hemoglobin A1c (HbA1c) levels may be falsely elevated 2, 3.
- HbA1c measures the blood glucose control over the lifespan of red blood cells, but it may not accurately portray glycemic control in patients with red blood cell disorders 2, 4.
- Fructosamine measurement is unaffected by disorders of red blood cells and can accurately reflect shorter-term changes in glycemia, corresponding to the half-life of albumin 2, 5.
Comparison with HbA1c
- Fructosamine and HbA1c evaluate different aspects of glycemic control, with fructosamine reflecting exposure to circulating glycaemia over a shorter period 3, 5.
- HbA1c is a reliable marker of glycemic control, but its measurement can be influenced by hemoglobin disorders or anemia, making fructosamine a useful alternative in these cases 2, 4.
- Fructosamine can be used to confirm poorly-controlled diabetes and assist in improving diabetes control, especially in patients with discrepancies between glucose measurements and HbA1c values 2.
Clinical Utility
- Fructosamine is an inexpensive assay that is currently underused in clinical practice, but it can provide additional information to HbA1c or serve as a reliable measure when HbA1c is not dependable 2, 3.
- Glycated albumin is another alternative marker of glycaemia that can be used in patients with anemia or hemoglobinopathies, and it reflects mean glycemia over two to three weeks 4, 6.
- Fructosamine and glycated albumin can be used to monitor rapid metabolic alterations or changes in diabetes treatment, and they may be beneficial in predicting complications risk 3, 6.