Monitoring glucose levels is imperative for diabetes patients, but for some the standard hemoglobin A1c (HbA1c) test is not valid. Researchers from Johns Hopkins University, the University of Wisconsin, and the University of Minnesota have determined that fructosamine tests and a novel assay for glycated albumin may be useful for predicting complications related to diabetes.

Funded by the US National Heart, Lung, and Blood Institute, the study was published online first in Lancet Diabetes & Endocrinology.

HbA1c, which is also used to diagnose diabetes, reflects exposure to glucose in the blood over the previous 2 to 3 months. However, this test will not work in patients with anemia, kidney disease, hemoglobinopathies, HIV, and other conditions.

The study measured HbA1c, fructosamine, and glycated albumin in blood samples from more than 12,000 participants in the Atherosclerosis Risk in Communities (ARIC) study. The ARIC study is a community-based cohort of persons from Washington County, Md; Jackson, Miss; Forsyth County, NC; and suburban Minneapolis, Minn, who have been followed for clinical outcomes since 1987.

Fructosamine is approved for clinical use in the United States but rarely used. The glycated albumin test is widely used in Japan but not approved for use in the United States. A major barrier to using these nontraditional markers is that they have not been related to the clinical outcomes of diabetes or compared to HbA1c.


Elizabeth Selvin, PhD, MPH

“We compared the associations of HbA1c, fructosamine, and glycated albumin with two of the most important clinical outcomes related to diabetes: retinopathy (eye disease) and kidney disease,” said lead author Elizabeth Selvin, PhD, MPH, associate professor at the Johns Hopkins Bloomberg School of Public Health. “We found that fructosamine and glycated albumin were strongly associated with retinopathy and kidney disease. These associations were similar to those observed for HbA1c with these outcomes.”

The results of the study suggest that fructosamine and glycated albumin may be useful substitutes for monitoring glucose control in patients with diabetes when HbA1c is not available or not valid. Because fructosamine and glycated albumin are measures of short-term (2–4 week) glucose control and change more rapidly than HbA1c, they could also be useful for monitoring changes in diabetes treatments.

“Further studies are needed to understand the value of these tests in the clinic,” Selvin added.