Work

Glycated albumin and fructosamine do not improve accuracy of glycaemic control assessment in patients with conditions reported to affect HbA 1c reliability

Year: 2025

Type: article

Abstract: Aims HbA 1c testing in African populations may be limited due to high prevalence of hemoglobinopathies, anaemia, malaria and renal impairment. We aimed to assess the performance of glycated albumin (GA) and fructosamine in comparison to HbA 1c for determining glycaemic control in Africans living with type 2 diabetes. Methods We compared the relationship between fructosamine, GA, and HbA 1c with mean continuous glucose monitoring (CGM) glucose and assessed the impact of sickle cell trait (SCT), anaemia and renal impairment on the relationship between each measure and CGM glucose. Results The overall association of HbA 1c , GA and fructosamine with CGM glucose was similar ( r = 0.88 [95%CI: 0.84, 0.91], 0.84 [0.79, 0.88] and 0.84 [0.79, 0.88]), respectively. For detecting those with mean CGM glucose >8 mmol/L HbA 1c had similar diagnostic accuracy to GA and fructosamine, even in those with conditions reported to affect HbA 1c performance ( n = 63). We found no evidence that SCT ( n = 43/192) altered the relationship between HbA 1c , fructosamine or GA with CGM glucose ( p > 0.3 for all). However, individuals with anaemia showed an underestimation of CGM glucose by HbA 1c and fructosamine compared to those without anaemia ( p for interaction <0.005 for both). In contrast, GA with average CGM glucose between those with anaemia and those without were not significantly different. Conclusions Switching to fructosamine or GA is unlikely to improve the accuracy of laboratory glycaemic monitoring beyond that of HbA 1c in a population with high prevalence of conditions reported to affect HbA 1c reliability.

Source: Diabetic Medicine

DOI: 10.1111/dme.70011