Could fructosamine be used in the glycemic monitoring of individuals with a history of gestational diabetes mellitus?

Abstract

Aims

To evaluate the association of fructosamine with multiple glycemic control indices in individuals with previous gestational diabetes mellitus(GDM), with or without prediabetes or type 2 diabetes(T2D).

Materials

Individuals with prior GDM were studied 5–9 months postpartum. Data included demographics, medical history, clinical measures, HbA1c, oral glucose tolerance test(OGTT), fructosamine, and blinded continuous glucose monitoring(CGM). Associations between fructosamine and glycemic indices were assessed using regression models with interaction terms for dysglycemia; standardized models and partial R² enabled head-to-head comparison with HbA1c.

Results

Among 844 participants, 407(48.2%) had prediabetes and 47(5.5%) T2D. Mean fructosamine was higher in T2D(255.6 ± 4.0 μmol/L) than in normoglycemic (235.7 ± 22.0 μmol/L) and prediabetes groups(238.3 ± 21.4; p < 0.001). Fructosamine correlated with 2-h post-load glucose(β = 0.018,p < 0.001) and HbA1c(β = 0.054,p < 0.001), but not fasting glucose; it was inversely related to CGM time-in-range and positively to time-above-range, time-below-range, glucose management indicator, glycemic variability, and coefficient of variation. Associations were strongest in T2D. Compared directly, HbA1c related more to time-in-range, whereas fructosamine more strongly reflected glycemic variability. Combined models improved fit.

Conclusions

In individuals with prior GDM, fructosamine captured adverse glycemic patterns, especially variability and provided information complementary to HbA1c, supporting its use as a practical adjunct where CGM is unavailable.