Can Plasma Fructosamine Substitute for Glycated Haemoglobin (HbA 1c ) Estimation in the Assessment of Diabetic Control?

Abstract

The ‘gold standard’ marker of overall glycaemic control in diabetes mellitus is the level of glycated haemoglobin (HbA_1c). It is, however, an expensive and technically difficult assay and is rarely appropriate to tropical laboratories. Plasma fructosamine measurement is cheaper and easier, though it reflects shorter-term glycaemia. We have measured both indices of control in a group of 154 diabetic patients. There was close correlation between the two measurements (=0.6506, P < 0.001), but many patients with abnormal HbA_1c levels had normal fructosamine levels. This resulted in an assay sensitivity (compared with HbA_1c as gold standard) of only 30%, though specificity was 98%. We conclude that fructosamine measurement cannot be regarded as a substitute for HbA_1c determination.