The effectiveness of glycosylated hemoglobin, fructosamine in the diagnosis of diabetes

ABSTRACT

BACKGROUND: With respect to the risk of developing diabetic vascular complications, the central purpose of most screening and detection program, is to identify people with diabetes at early stage so they might have advantages of early treatment to prevent complication of the disease. Oral glucose tolerence test(OGTT) is widely used for diagnosis of diabetes and impaired glucose tolerence, bit the performance of a complete OGTT is not only time consuming and expensive but physically demanding on the individual being tested. Determination of HbA1 and more recently of glycosylated total serum proteins(fructosamine) has been proposed as an alternative method of screening and diagnosis. The aim of our cross-sectional study is to compare the values of fructosamine and HbA1, for the ourpose of diabetes diagnosis with the OGTT as reference method. METHODS: In the study, from January 1996 to August 1996, we included 55 consecutive subjects in Kyeungssang Hospital. Blood samples for HbA1 and fructosamone determination were drawn at the same time as a fasting plasma glucose sample, and then all subjects underwent a standard 2-hour OGTT according to the World Health Organization recom-mandations, The subjects were classified according to the American Diabetes Association classification. RESULTS: In our study, we observed fasting plasma glucose of 145.32+/-75.00mg/deciliter, two-hour plasma glucose of 245.83+/-155.22mg/deciliter, HbA1 of 7.06+/-2.77%, and fructosamine of 308.77+/-128.23 micromol/liter. The correlation coefficient between FPG and HbA1 was 0.9098(p<.05), between FPG and fructosamine 0.7953(pplasma glucose and HbA1 0.7955-(p<.05), between 2h-PG and fructosamine 0.7770(p<.05), and between HbA1 and fructosamine with OGTT as a reference. After combination of FPG ir 2h-PG and HbA1 especially fructosamine, sensitivity was increased, Receiver operating characteristic curves showed the cutoff point of HbA1 7.0mg/deciliter, of fructosamine 290 micromol/liter. CONCLUSION: As observed in our study, HbA1 and fructosamine were highly correlated with FPG and 2h-PG. Combination of HbA1 or fructosamine and FPG or 2h-PG improve prediction over FPG or 2h-PG alone, especially fructosamine and FPG or 2h-PG combination. We conclude that measurement of HbA1 or fructosamine may be a useful diagnostic test for diabetes.