What does a fructosamine level of 285 µmol/L indicate?

What Does a Fructosamine of 285 µmol/L Mean?

A fructosamine level of 285 µmol/L indicates suboptimal glycemic control over the past 2-4 weeks, falling just below the threshold (292 µmol/L) that correlates with an HbA1c of 7%, but still elevated above the normal reference range of 200-285 µmol/L. 1, 2, 3

Clinical Interpretation

Your fructosamine level sits at the upper limit of normal or just into the abnormal range, depending on the specific laboratory reference range used:

• Normal reference range: 200-285 µmol/L 4, 5
• Threshold for poor control: ≥292 µmol/L (correlates with HbA1c ≥7%) 2, 3
• Your value of 285 µmol/L: Borderline elevated, suggesting glycemic control that is not optimal but not severely impaired 5, 6

What This Reflects About Your Blood Sugar

Fructosamine measures glycated serum proteins (primarily albumin) and reflects your average blood glucose over the past 2-4 weeks, which is a shorter timeframe than HbA1c (which reflects 2-3 months) 1, 2, 5. This value suggests:

• Your average blood glucose has been mildly elevated over the past 2-4 weeks 5
• You may have prediabetes or early diabetes that requires further evaluation 1, 2
• If you have known diabetes, your current treatment regimen may need adjustment 2, 5

Required Next Steps

You need confirmatory testing with standard diabetes diagnostic tests, as fructosamine alone should not be used to diagnose diabetes 1, 2:

1. Fasting plasma glucose (FPG) after 8-hour overnight fast:

   • Diabetes: ≥126 mg/dL (7.0 mmol/L) 1
   • Prediabetes: 100-125 mg/dL 7

2. HbA1c testing using NGSP-certified laboratory method:

   • Diabetes: ≥6.5% 1
   • Prediabetes: 5.7-6.4% 7

3. If either test is abnormal, repeat testing is required to confirm diagnosis (unless you have clear symptoms of hyperglycemia) 1, 7

When Fructosamine Is Most Clinically Useful

Fructosamine should primarily be used in specific situations where HbA1c is unreliable 1, 2:

• Hemolytic anemias or hemoglobin variants (sickle cell disease, thalassemia) 2, 4, 8
• Recent blood transfusion 2, 8
• End-stage kidney disease 2
• Pregnancy (second and third trimesters) 1, 2
• Conditions with altered red blood cell turnover 1, 8

If you don't have any of these conditions, HbA1c is the preferred test for assessing glycemic control 1, 2.

Critical Limitations to Recognize

• Fructosamine is affected by serum protein and albumin levels, which can cause misclassification if you have liver disease, nephrotic syndrome, or malnutrition 2, 5
• It has not been validated to predict long-term diabetes complications like HbA1c has 2
• Assay reliability varies between laboratories, which can affect clinical utility 2
• It should not be considered equivalent to HbA1c for routine diabetes management 2

If You Have Known Diabetes

A fructosamine of 285 µmol/L suggests you are close to but not quite meeting optimal glycemic targets 2, 3:

• Target HbA1c for most adults with diabetes: <7.0% (correlates with fructosamine <292 µmol/L) 1, 2, 3
• Your borderline result warrants: Review of current medications, assessment of adherence, evaluation of diet and exercise patterns, and consideration of treatment intensification if repeat testing confirms suboptimal control 2

Prognostic Significance

Research shows that fructosamine levels ≥292 µmol/L are associated with significantly increased risk of surgical complications in patients undergoing joint replacement surgery, including deep infection (6.2-fold increased risk), readmission (3-fold increased risk), and reoperation (3.4-fold increased risk) 3. While your level of 285 µmol/L is below this threshold, it emphasizes the importance of achieving optimal glycemic control, particularly if any surgical procedures are planned 3.