Chromogranin A as a biochemical marker for neuroendocrine tumors: a single center experience at Royal hospital, Oman

Objectives: To evaluate the significance of serum chromogranin A [CgA] status in patients with and without different neuroendocrine tumors [NETs] by conducting a retrospective assessment of the diagnostic utility and limitations of CgA as a biomarker for NETs in a tertiary care hospital in Oman

Methods: We conducted a retrospective analysis of CgA requests referred to the Clinical Biochemistry Laboratory, Royal Hospital, Oman over a 24-month period [April 2012 to March 2014]. During this time, 302 CgA tests for 270 patients [119 males and 151 females; age range 11-86 years and mean+/-standard deviation [SD] 44.0+/-18.0 years], were requested. Of these CgA tests, 245 tests were performed for 245 patients investigated for the diagnosis of NETs, and 57 CgA tests were performed for 25 patients with diagnosed NETs who were undergoing follow-up. Serum CgA levels were analyzed using the enzyme-linked immunosorbent assay based on a cut-off value of 22 IU/L

Results: Of the 302 CgA tests reviewed, 197 [65.2%] were within the quoted normal range; however, 105 [34.8%] had CgA > 22 IU/L. Of the 245 patients with first-line CgA, 38 patients [15.5%] had NET that included carcinoid, pheochromocytoma, pancreatic NET, adrenal adenoma, prostatic adenocarcinoma, gastrointestinal NET, medullary thyroid carcinoma, Schwannoma, lung small cell carcinoma, parathyroid adenoma, and pituitary macroadenoma. The mean+/-SD of CgA in these patients with NETs was 205.0+/-172.0 IU/L. Meanwhile, there were 45 [18.3%] patients with CgA > 22 IU/L [83.0+/-116.0 IU/L] who did not have NETs. The conditions/diseases included: essential hypertension, chronic kidney disease, heart failure, peptic ulcer, chronic diarrhea, use of proton pump inhibitors, and other chronic diseases [hypothyroidism, asthma, diabetes mellitus]. Of the 25 patients with known NET who were followed-up, there were 57 CgA results [29 with CgA 22 IU/L]. The overall clinical sensitivity of CgA in the diagnosis of NETs was 84.2%, overall specificity was 78.2%, positive predictive value was 41.5%, negative predictive value was 96.4%, and overall efficiency was 79.2%. In patients with individual NET, a good reflection in CgA was noticed in the follow-up period following surgery or therapy

Conclusions: Serum CgA is a sensitive and effective noninvasive laboratory test for the clinical detection and management of NETs. Awareness of the pitfalls of the tests in patients with non-NET conditions, particularly chronic diseases and use of certain drugs, is important to be considered during the interpretation of the CgA levels

Validity of prostate health index and percentage of [-2] pro-prostate-specific antigen as novel biomarkers in the diagnosis of prostate cancer: omani tertiary hospitals experience

Objectives: Prostate cancer is the leading cancer in older men. The Ministry of Health Oman Cancer Incidence Registry 2013 lists cancer of the prostate as the first most common cancer in males. Therefore, early detection is important and prostate-specific antigen [PSA] is widely used as an established laboratory test. However, despite its wide use, its value in screening, particularly in asymptomatic males, is controversial when considering the risks and benefits of early detection

Methods-. This prospective, observational study included 136 males [67.0+/-8.9 years; range 45-90] who were scheduled for a prostate biopsy in two different tertiary care teaching hospitals in Oman: the Royal Hospital and Sultan Qaboos University Hospital. Blood specimens from these patients were collected at the same setting before obtaining a prostatic biopsy

Three PSA markers [total PSA [tPSA], free PSA [fPSA], and [-2]proPSA [p2PSA]] were measured and the Prostate Health Index [phi] calculated. The histopathological report of the prostatic biopsy for each patient was obtained from the histopathology laboratory of the concerned hospital along with clinical and laboratory data through the hospital information system. Results: Phi has the highest validity markers compared with other prostate markers, with a sensitivity of 82.1%, specificity of 80.6%, and area under the curve [AUC] value of 0.81 at a cutoff of 41.9. The other prostatic markers showed sensitivities and specificities of 78.6% and 25.9% for tPSA; 35.7% and 92.6% for%fPSA; and 64.3% and 82.4% for%p2PSA, respectively. The AUCs at the best cutoff values were 0.67 at 10.1 pg/L for tPSA; 0.70 at 11.6% for%fPSA; and 0.55 at 1.4% for%p2PSA. An association between phi values and aggressiveness of prostate malignancy was noted. Of the 28 patients with prostate cancer, 22 patients had tPS A > 4 [ig/L. However, no patient had phi in the low-risk category, and five, six, and 17 patients had phi in the moderate-, high-, and very high-risk categories, respectively. Conclusions: Phi outperforms tPSA and f PSA when used alone or in combination, and appears to be more accurate than both markers in excluding prostate cancer before biopsy. Use of this biomarker helps clinicians to avoid unnecessary biopsies, particularly in patients with gray-zone tPSA level. Phi is the strongest marker that correlates proportionally with Gleason Score; therefore, it is also useful in predicting the aggressiveness of the disease. This is the first reported experience for the use of p2PSA and phi in Oman, the Middle East, and North Africa

Congenital adrenal hyperplasia due to 17-alpha-hydoxylase/17, 20-lyase deficiency presenting with hypertension and pseudohermaphroditism: first case report from Oman

This is the first report of congenital adrenal hyperplasia [CAH] due to combined 17 alpha-hydroxylase/17, 20 lyase deficiency in an Omani patient who was initially treated for many years as a case of hypertension. CAH is an uncommon disorder that results from a defect in steroid hormones biosynthesis in the adrenal cortex. The clinical presentation depends on the site of enzymatic mutations and the types of accumulated steroid precursors. A 22-year-old woman who was diagnosed to have hypertension since the age of 10 years who was treated with anti-hypertensive therapy was referred to the National Diabetes and Endocrine Centre, Royal Hospital, Oman. The patient also had primary amenorrhea and features of sexual infantilism. Full laboratory and radio-imaging investigations were done. Adrenal steroids, pituitary function and karyotyping study were performed and the diagnosis was confirmed by molecular mutation study. Laboratory investigations revealed adrenal steroids and pituitary hormones profile in addition to 46XY karyotype that are consistent with the diagnosis of CAH due to 17 alpha-hydroxylase deficiency. Extensive laboratory workup revealed low levels of serum cortisol [and its precursors 17 alpha-hydroxyprogesterone and ll'deoxycortisol], adrenal androgens [dehydroepiandrosterone sulfate and androstenedione], and estrogen [estradiol]; and high levels of mineralocorticoids precursors [11-deoxycorticosterone and corticosterone] with high levels of ACTH, FSH and LH. Mutation analysis revealed CYP17Al-homozygous mutation [c.287G>A p.Arg96Gln] resulting in the complete absence of 17 alpha-hydroxylase/17, 20-lyase activity. The patient was treated with dexamethasone and ethinyl estradiol with cessation of anti-hypertensive therapy. A review of the literature was conducted to identify previous studies related to this subtype of CAH. This is the first biochemically and genetically proven case of CAH due to 17 alpha-hydroxylase/17, 20-lyase deficiency in Oman and in the Arab World described in the literature

Comparison between three different equations for the estimation of glomerular filtration rate in omani patients with type 2 diabetes mellitus

Estimated glomerular nitration rate [eGFR] is an important component of a patient's renal function profile. The Modification of Diet in Renal Disease [MDRD] equation and the Chronic Kidney Disease-Epidemiology Collaboration [CKD-EPI] equation are both commonly used. The aim of this study was to compare the performance of the original MDRD[186], revised MDRD[175] and CKD-EPI equations in calculating eGFR in type 2 diabetes mellitus [T2DM] patients in Oman. The study included 607 T2DM patients [275 males and 332 females, mean age +/- standard deviation 56 +/- 12 years] who visited primary health centres in Muscat, Oman, during 2011 and whose renal function was assessed based on serum creatinine measurements. The eGFR was calculated using the three equations and the patients were classified based on chronic kidney disease [CKD] stages according to the National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines. A performance comparison was undertaken using the weighted kappa test. The median eGFR [mL/min/1.73 m[2]] was 92.9 for MDRD[186], 87.4 for MDRD[175] and 93.7 for CKD-EPI. The prevalence of CKD stage 1 was 55.4%, 44.7% and 57% while for stages 2 and 3 it was 43.2%, 54% and 41.8%, based on MDRD[186], MDRD[175] and CKD-EPI, respectively. The agreement between MDRD[186] and CKD-EPI [K 0.868] was stronger than MDRD[186] and MDRD[175] [K 0.753] and MDRD[175] and CKD-EPI [K 0.730]. The performances of MDRD[186] and CKD-EPI were comparable. Considering that CKD-EPI-based eGFR is known to be close to isotopically measured GFR, the use of MDRD[186] rather than MDRD[175] may be recommended

Validity of serum testosterone, free androgen index, and calculated free testosterone in women with suspected hyperandrogenism

There are technical limitations for the currently available methods of measuring serum total and free testosterone in females. The study objectives were to evaluate the usefulness of serum total testosterone, sex hormone-binding globulin [SHBG], free androgen index [FAI], and calculated free testosterone [CFT] in the assessment of androgen status in women investigated for suspected hyperandrogenism. This is a case control study that was conducted during the period from 1[st] May 2011 to 31[st] October 2011 on 122 patients aged [18-45 years] whom were referred to the Clinical Biochemistry Laboratory from the Endocrinology and Gynecology Clinics, Royal Hospital, Oman. Women with no clinical feature or laboratory data indicative of hormonal dysfunction and with midluteal progesterone >30 nmol/L were selected as controls [group 1; n=18]. The patients were divided into subgroups based on the clinical/laboratory diagnosis of polycystic ovary syndrome [PCOS [group 2; n=19], hirsutism [group 3; n=18], menstrual disturbances [irregularities] or infertility [group 4; n=49], as well as combination of PCOS or hirsutism and menstrual disturbances or infertility [group 5;n=18]. Serum total testosterone and SHBG were measured, FAI was calculated as percentage ratio of total testosterone to SHBG values, and CFT was calculated according to Vermeulen equation. There was a statistically significant difference in the mean levels of testosterone, FAI and CFT in each patient group compared with the control group. For diagnosing hyperandrogenism, each indicator was selected at the recommended cut-off: testosterone >3.0 nmol/L, SHBG <30 nmol/L, FAI >5%, and CFT >32 pmol/L. In group 2, 89.5% and 94.7% of the patients had increased FAI and CFT, respectively; compared with 36.4% for increased testosterone. In group 3, 88.9% and 88.9% of the patients had similarly increased FAI and CFT, respectively; compared with 66.7% for testosterone. In group 4, patients had 63.3% and 73.5% elevated FAI and CFT, respectively; compared with 53.1% for testosterone, while in group 5, patients had 83.3% and 88.9% elevated FAI and CFT, respectively, compared with 61.1% for testosterone. The diagnosis of hyperandrogenism was most obvious when using CFT or FAI than testosterone alone. It is thus recommended to include these calculated parameters [CFT and/or FAI] in the routine investigation and assessment of women with disorders related to clinical or biochemical hyperandrogenism

Estimated glomerular filtration rate [eGFR]: a serum creatinine-based test for the detection of chronic kidney disease and its impact on clinical practice

Chronic kidney disease [CKD] is an important epidemic and public health problem that is associated with a significant risk for vascular disease and early cardiovascular mortality as well as progression of kidney disease. Currently it is classified into five stages based on the glomerular filtration rate [GFR] as recommended by many professional guidelines. Radiolabelled methods for measuring GFR are accurate but not practical and can be used only on a very limited scale while the traditional methods require timed urine collection with its drawback of inaccuracy, cumbersomeness and inconvenience for the patients. However, the development of formula- based calculation of estimated GFR [eGFR] has offered a very practical and easy approach for converting serum creatinine value into GFR result taking into consideration patient's age, sex, ethnicity and weight [depending on equation type]. The commonly used equations include Cockraft and Gault [1976], Modification of Diet in Renal Disease [MDRD] [1999] and Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] [2009]. It is the implementation of these equations particularly the MDRD that has raised the medical awareness in the diagnosis and management of CKD and its adoption by many guidelines in North America and Europe. The impact and pitfalls of each of these equations in the screening, diagnosis and management of patients with CKD are presented and discussed in this review

Indicators of renal glomerular and tubular functions in patients with beta-thalassaemia major

There are limited data concerning the assessment of renal function in beta-thalassaemia major, with no study of such involvement in Omani patients. The objective of this study was to establish the pattern of renal glomerular and tubular function using traditional and specific laboratory tests in patients with beta-thalassaemia major. This cross-sectional study, from January-July 2008, included 30 patients of the Thalassaemia Clinic at the Royal Hospital, Oman, with transfusion-dependent homozygous beta-thalassaemia major. They included 15 males and 15 females, aged 16-32 years with mean +/- standard deviation of 21.23 +/- 3.42 years. The medical records were reviewed and renal function states assessed as follows: serum creatinine, estimated glomerular filtration rate [eGFR]; urea; phosphate, fractional excretion of filtered sodium [FENa]; urine albumin: creatinine index; urine beta2-microglobulin:creatinine index; tubular reabsorption of phosphate [TRP], and tubular maximum phosphate reabsorption [TmP]/GFR. All patients had eGFR >90 ml/min/1.73m2; serum creatinine <90 micro mol/L; serum urea <6.0 mmol/L, and urine albumin: creatinine <2.5 mg/mmol. Only 2 [6.7%] patients had FENa >1% and 3 [10.0%] patients had urine s2-microglobulin: creatinine >22 micro g/mmol. All patients had TRP >0.85, of whom seven [23.3%] patients had values within the range of 0.85-0.95 and 23 [76.7%] had values >0.95. Also, all patients had TmP/GFR >1.0 mmol/L, of whom only one [3.3%] patient had TmP/GFR of 1.0-1.5, and 29 [96.7%] patients had TmP/GFR >1.5 mmol/L. Finally, 24 [80%] patients had serum phosphate >1.4 mmol/L. Linear regression revealed a highly significant correlation between serum phosphate and TmP/GFR [r = 0.904, P < 0.001]. Renal function, glomerular and tubular, appears to be well preserved in beta-thalassaemia major. Almost all renal function indicators were within the recommended ranges. Raised TmP/GFR and TRP were noted in the majority of patients, reflecting an up-trend in serum phosphate and therefore increasing renal phosphate reabsorption

Serum myoglobin in patients with thyroid dysfunction

To assess the pattern of change in serum myoglobin concentration in subjects with thyroid dysfunction. Serum samples were selected from 150 subjects with suspected thyroid disorder who were referred to the Royal Hospital, Muscat, Oman. The subjects were 35 males and 115 females, aged 14-56 years with mean +/- SD of 34.3 +/- 12.7 years. They were classified on the basis of thyroid stimulating hormone [TSH] and free thyroxine [FT4] into 3 groups, each consisting of 50 subjects: hypothyroid, hyperthyroid, and euthyroid subjects. The mean serum myoglobin concentration was higher in hypothyroid patients compared to hyperthyroid and euthyroid subjects [mean +/- SD was 38.5 +/- 23.1 micro g/L in hypothyroid; 18.1 +/- 7.0microg/L in hyperthyroid; 17.4 +/- 5.7microg/L in euthyroid]. There was a significant difference in myoglobin concentration between hypothyroid and euthyroid groups [F = 36.1, p< 0.001], however, there was no significant difference between the hyperthyroid and euthyroid groups. When the mean +/- 2SD for myoglobin in euthyroid subjects was calculated, the reference range was 6-29 micro g/L. Of the hypothyroid subjects, 29 [58%] had high myoglobin and 21 [42%] had normal myoglobin level. No significant correlation was noticed between TSH or FT4 and myoglobin in all studied subjects. Raised serum myoglobin may be observed in patients with hypothyroidism. Hence hypothyroidism should be considered in the differential diagnosis of patients with raised serum myoglobin concentration

Biological and analytical variation of serum lipid profile

Dyslipidaemia is a major risk factor for coronary heart disease which can be assessed by measuring serum lipid profile. Biological variation has an important effect on the interpretation of all laboratory investigations, including lipid profile. To define the biological and analytical components of variation for the different parameters of serum lipid profile. The present study was conducted in Mosul City in northern Iraq, from 1[st] February to 30[th] April 2004. Fasting venous blood was collected from each of 10 apparently healthy volunteers [6 men and 4 women, aged 22-40 years], at 8-10 am following an overnight fast, at intervals of one week for 10 weeks. Sera were separated and stored frozen, in duplicate. Measurement and calculation of the different components of serum lipid profile were made including: triglycerides [TG], total cholesterol, HDL-C, LDL-C and ratios of total cholesterol: HDL-C, LDL-C: HDL-C and TG: HDL-C. The intra-individual [CVI] and inter-individual [CV[G]] variation were 21% and 37% for TG, 7.5% and 16.7% for total cholesterol, 11.2% and 24.5% for HDL-C, 13.7% and 28.3% for LDL-C, 13.1% and 25.4% for total cholesterol: HDL-C, 25.9% and 34.7% for LDL-C: HDL-C, and 27.2% and 40.7% for TG: HDL-C respectively. The indices of individuality, as reflected by CVI/CVG, for these parameters were all <1.0 [0.57 for TG, 0.45 for total cholesterol, 0.46 for HDL-C, 0.48 for LDL-C, 0.52 for total cholesterol: HDL-C, 0.95 for LDL-C: HDL-C and 0.85 for TG: HDL-C]. The analytical goals for imprecision, as reflected by analytical variation [CVA], was 6.3% for TG, 4.0% for total cholesterol, 5.2% for HDL-C, 7.8% for LDL-C, 5.8% for total cholesterol: HDL-C, 5.7% for LDL-C: HDL-C and 5.9% for TG: HDL-C. The critical difference calculated as 2.77 [CVA[2]+ CVI[2]][1/2] was 60.7% for TG, 23.5% for total cholesterol, 34.2% for HDL-C, 43.6% for LDL-C, 39.7% for total cholesterol: HDL-C, 73.3% for LDL-C: HDL-C and 97.5% for TG: HDL-C. The biological and analytical components of variation showed marked individuality. This together with the index of individuality supports the limited usefulness of using the conventional population-based reference range for interpretive criteria. The critical differences also confirm that single determination of lipid profile may have limited value in screening purpose

Performance indicators and validity of serum fructosamine assay as a diagnostic test in a screening program for diabetes mellitus

To evaluate the performance indicators and validity of fructosamine assay as a diagnostic tool in screening for Diabetes mellitus [DM]. Fasting plasma glucose [FPG] and serum fructosamine [FA] were compared in 1015 subjects aged >= 25 years from different urban and rural areas in Mosul city, Northern Iraq. The subjects were classified into 5 groups: Group 1: Subjects with FPG < 6.1 mmol/L [n=883], Group 2: Subjects with impaired FPG 6.1-6.9 mmol/L [n=29], Group 3: New diabetics diagnosed solely by new 1997 American Diabetes Association [ADA] criteria with FPG 7.0-7.7 mmol/L [n=20], Group 4: New diabetics diagnosed according to old 1980-1985 World Health Organization [WHO] criteria with FPG >= 7.8 mmol/L [n=23], and Group 5: Known diabetics [n=60]. Subjects in groups 2 and 3 underwent a standard 75 gm oral glucose tolerance test [OGTT] as recommended by the WHO. Reclassification of subjects into 3 groups according to FPG or 2hPG, or both was carried out for all subjects. Group A [non-diabetics]: Subjects with FPG < 6.1 mmol/L or 2hPG < 7.8 mmol/L, or both [n=910]. Group B [Diabetics]: Subjects with FPG >= 7.8 mmol/L or 2hPG >= 11.1 mmol/L, or both [n=92] including 60 known diabetics in group 5 and 23 new diabetics in group 4 in addition to 2 subjects in group 2 and 7 subjects in group 3. Group C [impaired glucose tolerance, IGT]: Subjects with 2hPG between 7.8-11.1 mmol/L [n=13]. Having all subjects had their serum FA being measured; the Receiver Operator Characteristic [ROC] curve was constructed on the data to determine the trade off between sensitivity and specificity of the FA test in the diagnosis of DM. This construction decided that serum FA value of 2.65 mmol/L would be the cutoff point, or the positivity criterion in the calculation of the validity parameters of FA test. Of 910 non-diabetics, 886 subjects had measured FA values within the 95th percentile, while 24 had FA higher than the cutoff point. Consequently, FA in non-diabetics yielded 886 [true negatives] and 24 [false positives]. Of the 92 diabetics, 30 subjects had normal FA values, while 62 diabetics showed FA higher than the cutoff point. Consequently, FA in diabetics yielded 30 [false negatives] and 62 [true positives]. Accordingly, the sensitivity, specificity, positive predictive value, negative predictive value, accuracy rate, positive likelihood ratio and negative likelihood ratio were 67.3%, 97.3%, 72.3%, 96.7%, 94.6%, 26 and 2.99. A highly significant correlation was observed between FPG and measured FA in non-diabetics [r=0.85, p<0.0001] and diabetics [r=0.92, p<0.0001]. No significant correlation was observed between serum FA and albumin in non-diabetics [r= 0.14, p>0.05] and diabetics [r=0.08, p>0.05]. Fructosamine test shows a moderate sensitivity with a high specificity as a diagnostic test for diabetes mellitus. The considerable overlap between diabetics and non-diabetics limit its usefulness. It is recommended that fructosamine test is not a suitable screening test for the disease. Measurement of plasma glucose [fasting or post-OGTT] remains the corner stone as a diagnostic test

Assessment of quantitative proteinuria using random urine protein/creatinine index at different times of the day

To determine the usefulness of measuring protein/creatinene index [PCI] in random urine specimens as an alternative to 24 hour urine protein excretion. Design: Prospective study for 7 months commencing from August 1994. Setting: Measurement of PCI in 3 random urine specimens collected at 8.00, 12.00 and 16.00 hrs were compared with daily urine protein excretion. Participants: A total of 250 individuals including 125 healthy control subjects [100 aged >/= /15 years, 25 aged < 15 years], and 125 patients with proteinuria who were subdivided according to age [100 aged >15 years, 25 aged < 15 years], renal function [69 with normal renal function, 56 with impaired renal function] or protein excretion [61 with proteinuria < 1.0 g/day, 64 with proteinuria >/= /1.0 g/day]. Main outcome measures: Measures were 24 hour urine protein excretion [P24] including that corrected according to surface area [P24/1.73], protein/creatinine index in 24 hour specimen [24PC] and in random specimens of morning [PC8], midday [PC12] and afternoon [PC16]. Student's unpaired t-test, analysis of variance [F test] and linear regression analysis were used for data evaluation. Main Numerical similarity was noted in mean values of 24PC, PC8, 12, 16 with P24 and P24/ 1.73. Correlation studies involving all subjects [n = 250] revealed highly significant correlations [P < 0.001] between random PCI and each of 24 PC [r = 0.978], P24 [r = 0.889] and P24/1.73 [r = 0.912]. The correlations were higher in proteinuric patients, irrespective of age, renal function and degree of proteinuria, than in healthy subjects, and with indices of random specimens obtained at 12.00 and 16.00 that at 8.00 hrs. The PCI of random urine specimen is strongly related to timed protein excretion making its measurement a suitable and convenient alternative to timed collection particularly for follow up and screening purposes

Comparison of 2 hour plasma glucose and serum fructosamine concentrations as screening tests for diabetes mellitus

To evaluate the clinical usefulness of fructosamine as a mean for diagnosing Diabetes mellitus, serum fructosamine and plasma glucose levels 2 h following 75 g Oral glucose load were compared in 158 subjects participating in a community Health survey. The subjects were classified as having normal, impaired or diabetic responses using WHO criteria of 135 subjects with normal and 7 subjects with impaired glucose tolerance. 130 and 5 subjects respectively had fructosamine within the ninty-fifth percentile. Of 16 subjects with diabetic response, 13 presented with high fructosmine. Fructosmaine assay yielded 7 false positive and 3 false negative results. Consequently, the sensitivity, specificity, predictive value positive, predictive value negative and efficiency calculated were 81.3%, 95.0%, 65.0%, 97.8% and 94.0% respectively. A highly significant correlation was observed between 2 h plasma glucose and measured fructosamine [r= 0.76, P<0.001] and between 2 h plasma glucose and corrected fructosamine [r= 0.77, P<0.001] in the studied population. A significant correlation was also observed between serum albumin and measured fructosamine [r= 0.33. P<0.001] in the non-diabetic subjects, and between measured and corrected fructosamine [r= 0.92, P<0.001] in the studied population. The results suggest that serum fructosamine provides an additional useful screening method for diabetes mellitus that may complement glucose measurement and correction of its level for albumine concentration may be unnecessary in subjects with normal protein metabolism

Comparison of glycosylated hemoglobin and fructosamine assay as indices of glycaemic control in diabetic patients

A method for the measurement of serum fructosamine as an index of glycosylated proteins is presented. A reference range was derived from non-diabetic subjects. Fructosamine was measured in patients attending the diabetic out-patients clinic including those with nephropathy. A longitudinal study was also performed in group of pregnant diabetics. Fructosamine concentrations correlated significantly with HbA1 in diabetic patients [r=0.67, p<0.001]. A similar correlation was found for both insulin and non-insulin dependent diabetics. The correlation was also significant in the pregnant diabetic group [r=0.61, p<0.001]. The longitudinal study revealed that the measurement is a useful index for monitoring the glycaemic state during pregnancy. In the presence of pre-eclamptic toxaemia or nephropathy, with increased protein turnover and hypoalbuminaemia, lower results were obtained. The serum fructosamine assay is readily automated, rapid, cheap, and may complement that of HbA1 in the assessment of glycaemic control in diabetic patients