Fructosamine as an Indicator for Glycemic Control in the Veteran Community
Authors: Young Wendy , Nunez Carlos , Fleischman Alex , Commodore Carole 
Published: December 2024

ABSTRACT

Objective
Glycemic monitoring via Hemoglobin A1(HbA1c) proves to be inaccurate when a patient is diagnosed with a hemoglobinopathy/erythrocyte disorder. Moreover, any acute changes of glycemic intake within 6 weeks of blood sampling have been noted to impart a greater effect on HbA1c than the remaining days of the supposed overall 3-to-4-month average of glycemic control. Fructosamine, an alternative to HbA1c, allows physicians to analyze glycemic control in the presence of an underlying hemoglobinopathy/erythrocyte disorder. Fructosamine analyzes glycemic control over a two-to-three week period, compared to a 3-to-4-month period with HbA1c. Studies indicate that fructosamine is significantly correlated with HbA1c in various population types. Given the increased likelihood of hemaglobinopathies/erythrocyte disorders in the veteran population accompanied by the the necessity for tighter glycemic evaluation, fructosamine offers an assay for physician when analyzing glycemic control in veterans. The aim of our study was to evaluate the correlation of HbA1c and fructosamine in the veteran community. We hypothesize that fructosamine is significantly correlated with HbA1c in the veteran community and therefore can be used as an alternative assay in the Veterans Affairs.

Materials and Methods
Following institutional review board review and exemption, a retrospective chart review was conducted at the Northport Veterans Affairs between the dates of December 2007 and December 2018. Inclusion criteria consisted of veterans above the age of 18 years with a HbA1c and fructosamine assay drawn from the same blood sample. Exclusion criteria consisted of veterans with an underlying hemoglobinopathy, erythrocyte disorder, or serum protein altering pathology. Linear regression analysis was conducted between HbA1c and fructosamine values. Linear regression equation, correlation coefficient, and coefficient of variance were reported. A paired t-test was conducted between assay HbA1c and predicted HbA1c from the determined regression equation.

Results
A total of 156 veterans were included in this study. A correlation coefficient and coefficient of variance of 0.75 and 0.56 were calculated from regression analysis (P &lt; 0.05). A regression equation of the following was determined: HbA1c{%} = 0.0154*Fructosamine (mmol/L)+ 3.121. Paired t-test of assay HbA1c (M = 8.17, standard deviation = 1.64) and predicted HbA1c (M = 8.21, standard deviation = 1.53) returned without significance for difference of paired values.

Conclusions
Given that both correlation coefficient and coefficient of variance were considered significantly strong and the paired t-test indicated no significant difference between assay HbA1c and predicted HbA1c, fructosamine can be considered as an alternative assessment of glycemic control compared to HbA1c in the veteran community. We advise physicians at the Veterans Affairs to use fructosamine as an assessment of glycemic control when a veteran is diagnosed with an underlying hemoglobinopathy/erythrocyte disorder or requires stringent analysis of glycemic control. Yet, at this point of time, fructosamine does not have the necessary data to indicate complete replacement of HbA1c with fructosamine.