Assessing fructosamine and fructosamine-albumin ratio in type 2 diabetic outpatients with chronic kidney disease

Abstract

Introduction

Haemoglobin A1c (HbA1c) levels might inaccurately represent long-term glycaemic control in type 2 diabetes mellitus (T2DM) patients with chronic kidney disease (CKD) owing to anaemia. Fructosamine, which reflects glycaemic control, remains unaffected by anaemia.

Material and methods

This study sought to assess whether fructosamine levels or fructosamine-albumin (FA) ratios could be biomarkers for glycaemic control in T2DM patients, with and without CKD. HbA1c and fructosamine levels were measured, and comparisons were made using the area under the curve and receiver operating characteristic curves. Youden's index was utilized to pinpoint the cut-off points. Predictive values for complications were also assessed.

Results

Our study underscores the close association between HbA1c and blood glucose concentrations among T2DM patients, regardless of kidney function status (r = 0.758). Conversely, fructosamine levels and FA ratios only displayed moderate correlations with FBG among those without CKD (r = 0.466 and r = 0.436, respectively). In a similar manner, the estimated blood glucose (eBG) levels derived from HbA1c were better than the ones from fructosamine levels and FA ratios in terms of comparation to actual fasting blood glucose (FBG) levels across various eGFR levels.

Conclusions

Our findings suggest that HbA1c remains a conventional gauge for glycaemic control among T2DM outpatients, regardless of CKD status. However, for short-term glycaemic monitoring in T2DM outpatients with CKD and low eGFR levels, fructosamine, and FA ratios emerge as potential biomarkers worthy of consideration.