Fructosamine is Not a Reliable Test for the Detection of Hyperglycemia: Insight from the Africans in America Study

• Type of Material: Article
• Authors: Jean de Dieu Gatete, University of Global Health Equity; Charlita C. Worthy, National Institute of Diabetes; Ram Jagannathan, Emory University; Christopher W. DuBose, National Institute of Diabetes; David B. Sacks, National Institutes of Health; Anne E. Sumner, North-West University
• Language: English
• Date: 2023-09-05
• Publisher: Dovepress
• Publication Version: Final Published Version
• Copyright Statement: © 2023 Gatete et al.
• License: Creative Commons Attribution-Noncommercial 3.0 Unported
• Final Published Version (URL): https://doi.org/10.2147%2FDMSO.S426406
• Title of Journal or Parent Work: Diabetes, Metabolic Syndrome and Obesity
• Volume: 16
• Start Page: 2689
• End Page: 2693
• Grant/Funding Information: JdDG, CCW and AES received supported from the intramural program of the National Institute of Minority Health and Health Disparities; JdDG received support from the Institute of Global Health Equity Research, University of Global Health Equity, Kigali, Rwanda, JdDG, CCW, CWD and AES received support from the intramural program of the National Institute of Diabetes and Digestive and Kidney Diseases; DBS received support from the Intramural Research Program of the Clinical Center, National Institutes of Health, Bethesda, Maryland, United States.; This NIH research was supported by intramural program of the Clinical Center and the intramural programs of the National Institute of Minority Health and Health Disparities and the National Institute of Diabetes and Digestive and Kidney Diseases.
• Keywords: non-fasting glycemic markers; kappa-statistic; sensitivity; average glycemia
• Research Categories: Health Sciences, Nutrition

Abstract

Objective To improve detection of abnormal glucose tolerance (Abnl-GT), attention has moved beyond the oral glucose tolerance test (OGTT), to non-fasting markers of glycemia, specifically, HbA1c, fructosamine (FA) and glycated albumin (GA). Emerging data suggest that in African descent populations, the combination of HbA1c and GA is superior to the combination of HbA1c and FA. However, the diagnosis of Abnl-GT is usually based on tests which are performed only once. As reproducibility of Abnl-GT diagnosis by HbA1c, fructosamine (FA) and glycated albumin (GA) is unknown, reproducibility of Abnl-GT diagnosis by HbA1c, FA and GA were assessed in 209 African-born Blacks living in America. Methods At Visits 1 and 2 (9 ± 4 days apart), samples were obtained for HbA1c, FA and GA levels. Glucose tolerance status was determined at Visit 1 by OGTT. Reproducibility was based on the К-statistic and paired t-tests. Thresholds for the diagnosis of Abnl-GT by FA and GA which corresponded to an HbA1c of 5.7% were 235umol/L and 14.6%, respectively. Results Abnl-GT occurred in 38% (80/209). Diagnostic reproducibility was excellent for HbA1c (К≥0.86) and GA (К≥0.89), but only moderate for FA (К=0.59). Neither HbA1c nor GA levels varied between visits (both P≥0.3). In contrast, FA was significantly lower at Visit 2 than Visit 1(P<0.01). Conclusion As HbA1c and GA provided similar diagnostic results on different days and FA did not, HbA1C and GA are superior to FA in both clinical care settings and epidemiologic studies.