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

Jean de Dieu Gatete; Charlita C Worthy; Ram Jagannathan; Christopher W DuBose; David B Sacks; Anne E Sumner

doi:10.2147/DMSO.S426406

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

Diabetes Metab Syndr Obes. 2023 Sep 5:16:2689-2693. doi: 10.2147/DMSO.S426406. eCollection 2023.

Authors

Jean de Dieu Gatete^#^{1

2}, Charlita C Worthy^#¹, Ram Jagannathan³, Christopher W DuBose¹, David B Sacks⁴, Anne E Sumner^{1

5

6}

Affiliations

¹ Section on Ethnicity and Health, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
² Institute of Global Health Equity, University of Global Health Equity, Kigali, Rwanda.
³ Emory Global Diabetes Research Center of Woodruff Health Sciences Center and Emory University, Rollins School of Public Health of Emory University, Atlanta, GA, USA.
⁴ Clinical Center, National Institutes of Health, Bethesda, MD, USA.
⁵ Hypertension in Africa Research Team, North-West University, Potchefstroom, North-West, South Africa.
⁶ National Institute of Minority Health and Health Disparities, Bethesda, MD, USA.

^# Contributed equally.

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.

Keywords: average glycemia; kappa-statistic; non-fasting glycemic markers; sensitivity.

Grants and funding

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.