Dear Collegues,
We have recently published recommendations to primary care doctors concerning optimal use of laboratory tests .http://www.spri.se/frlag/rap-info/Rap476.htm
For several reasons we do not recommend fructosamine test:
Background
Fructosamine is a color reaction to glucosulated serum proteins.
Analysis of fructosamine has been presented as an inexpensive
alternative to hemoglobin A1c determination. However, the
reaction has been shown to be too unspecific to replace the
increasingly well-established and generally recommended
determination of hemoglobin A1c.
References
142. Furuseth, K. et. al. - Fructosamine cannot replace
HbA1c in the management of type2 diabetes (NIDDM).
Scand.J.Prim.Health Care 1994;12:19-24.
The study shows that serum fructosamine does not correspond
well to blood hemoglobin A1c and cannot replace it.
141. Jerntorp, P. et. al. - Clinical utility of serum
fructosamine in diabetes mellitus compared with
hemoglobin A1c. Clinica Chimica Acta
1988;175:135-142.
The fructosamine test is not an alternative to hemoglobin A1c.
With kind regards
Nils Tryding
Box 57, S-296 21 Åhus, Sweden
> Tel: +46 44 241260
> Fax: +46 44 240007
> E-mail: [log in to unmask]
URL: http://home1.swipnet.se/~w-12360
>
"McNeely, Michael" wrote:
> Of interest, this test is being pushed by commercial interests in the USA. I enclose below some material from a product advertisement (not my composition).
>
> Michael McNeely MD FRCPC
>
> -----------------------------------------------------------------------------------
>
> A fructosamine test has been available through laboratories since the early 1980s. The main advantage of the test is that it can detect overall changes in blood glucose control within a few weeks, rather than months. Fructosamine levels indicate the level of blood glucose control over the past two or three weeks. So, when changes are being made in a diabetes treatment plan, this test can indicate in a more timely fashion than an A1c test how well the changes are working and whether other changes should be considered.
> In late 1997, the Food and Drug Administration approved the Duet Glucose Control Monitoring System marketed by LXN Corporation in San Diego California for home use in adults (excluding children and pregnant women). This testing system includes a blood glucose test and the first home fructosamine test in one hand-held meter. The meter and a starter pack of test strips cost about $300, and strips can be reordered at a cost of about $64 for eight strips.
> According to the manufacture, a reading below 310 micromoles per liter in this home fructosamine test is considered acceptable and a reading over 380 is very high and requires a change in treatment plan.
> The new home test can be potentially helpful for people making changes in their diabetes treatment plan. It can also be helpful to people with diabetes who do not closely monitor their blood sugar levels with multiple daily home tests. But, a once-a-week fructosamine test should not be considered a substitute for daily monitoring, and should not take the place of regular visits to your doctor and regular hemoglobin A1c tests. Also, a normal fructosamine test doesn't mean that your blood sugars have been normal for the past 2-3 weeks. Someone with wide swings in blood sugar levels - lots of highs and lows - would also have a normal fructosamine test, but would really have serious problems with their overall treatment plan that require adjustment. This would be uncovered by frequent daily home blood sugar monitoring Also, people should not be tempted to shoot for too low of a fructosamine level, as this might result in dangerous low blood sugars.
> This relatively new home test offers new information and more information than home blood sugar monitoring and hemoglobin A1c provide. For people who are changing a treatment program it may be particularly useful. For those who currently are not doing frequent blood sugar tests at home, it may provide a first step towards getting oriented more towards home testing and taking action in your overall diabetes management.
>
> -----Original Message-----
> From: [log in to unmask] [mailto:[log in to unmask]]
> Sent: Friday, March 19, 1999 8:26 AM
> To: [log in to unmask]
> Subject: Fructosamine
>
> I have had an esquire from somebody who would like to have fructosamine
> measured on a few samples.
> Does anyone still do this?
> It is not listed on the assay finder.
>
> Gerald A Maguire
> Dept of Clinical Biochemistry and Clinical Immunology
> Addenbrooke's Hospital
> Cambridge
> UK
> CB2 2QR
> UK
> Tel 44 (0) 1223 217159
> fax 44 (0) 1223 216862
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