New research shows that fructosamine and glycated albumin not only are strongly associated with incident diabetes and diabetes-related microvascular disease, but also have prognostic value comparable to HbA1c (Lancet 2014; http://dx.doi.org/10.1016/S2213-8587(13)70199-2). The findings suggest that these two analytes might be useful complements to HbA1c in clinical practice, especially when HbA1c testing is not available, or when HbA1c results might be considered unreliable.
Fructosamine and glycated albumin are markers of short-term, 2–4 week glycemic control, but neither are used routinely in clinical practice. On the other hand, HbA1c, a measure of long-term glucose exposure in the blood, has been the primary test used to manage diabetes, and in 2010, also was recommended as a diagnostic test for the disease. However, HbA1c has some limitations, including assay interferences such as hemoglobin variants, and other conditions like hemolytic anemia and pregnancy that can affect validity of HbA1c results.
The authors measured fructosamine and glycated albumin from 11,348 non-diabetics and 958 diabetics, as part of the Atherosclerosis Risk in Communities (ARIC) studies. All ARIC participants included in the analysis had undergone ARIC’s second clinical examination between 1990 and 1992 as well as visit three, when retinal photographs were taken. The outcomes of interest were relationships between fructosamine and glycated albumin with risk of incident diabetes, retinopathy, and risk of incident chronic kidney disease (CKD) during 2 decades of follow up.
The researchers found that hazard ratios for incident diabetes were 4.96 and 6.17, respectively, for fructosamine and glycated albumin above the 95th percentile. Fructosamine and glycated albumin also were strongly associated with retinopathy. Fructosamine and glycated albumin predicted incident CKD almost as well as HbA1c, although the reverse was true when it came to predicting incident diabetes.
The authors used a standard commercial assay to measure fructosamine, but employed a novel enzymatic method for glycated albumin. Both showed “excellent” performance, with coefficients of variation ≤3%. However, they also have limitations, including being affected by alterations in serum protein turnover, and by certain conditions, including liver disease, hyperuricemia, and thyroid dysfunction.
Based on their findings, the authors suggested that fructosamine and glycated albumin testing might be particularly useful when short-term measurement of glycemic control is important, such as for monitoring changed treatment regimens.
Fructosamine and glycated albumin are markers of short-term, 2–4 week glycemic control, but neither are used routinely in clinical practice. On the other hand, HbA1c, a measure of long-term glucose exposure in the blood, has been the primary test used to manage diabetes, and in 2010, also was recommended as a diagnostic test for the disease. However, HbA1c has some limitations, including assay interferences such as hemoglobin variants, and other conditions like hemolytic anemia and pregnancy that can affect validity of HbA1c results.
The authors measured fructosamine and glycated albumin from 11,348 non-diabetics and 958 diabetics, as part of the Atherosclerosis Risk in Communities (ARIC) studies. All ARIC participants included in the analysis had undergone ARIC’s second clinical examination between 1990 and 1992 as well as visit three, when retinal photographs were taken. The outcomes of interest were relationships between fructosamine and glycated albumin with risk of incident diabetes, retinopathy, and risk of incident chronic kidney disease (CKD) during 2 decades of follow up.
The researchers found that hazard ratios for incident diabetes were 4.96 and 6.17, respectively, for fructosamine and glycated albumin above the 95th percentile. Fructosamine and glycated albumin also were strongly associated with retinopathy. Fructosamine and glycated albumin predicted incident CKD almost as well as HbA1c, although the reverse was true when it came to predicting incident diabetes.
The authors used a standard commercial assay to measure fructosamine, but employed a novel enzymatic method for glycated albumin. Both showed “excellent” performance, with coefficients of variation ≤3%. However, they also have limitations, including being affected by alterations in serum protein turnover, and by certain conditions, including liver disease, hyperuricemia, and thyroid dysfunction.
Based on their findings, the authors suggested that fructosamine and glycated albumin testing might be particularly useful when short-term measurement of glycemic control is important, such as for monitoring changed treatment regimens.
source: www.aacc.org
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