Fructosamine Is a Useful Indicator of Hyperglycaemia and Glucose Control in Clinical and Epidemiological Studies – Cross-Sectional and Longitudinal Experience from the AMORIS Cohort

PLOS ONE, Dec 2019

Context Fructosamine is a glycemic biomarker which may be useful for indication and control of diabetes respectively. Objective The objective of the study was to evaluate fructosamine as an indicator of hyperglycaemia and glucose control in subjects with diabetes. Design, Setting & Patients From the AMORIS cohort, subjects with serum glucose, fructosamine and HbA1c from the same examination were studied cross-sectionally and longitudinally (n = 10,987; 5,590 overnight-fasting). The guidelines of the American Diabetes Association were followed for classification of prediabetes and diabetes. Separate analyses were performed in patients with a newly detected or a known diagnosis of type 1 or type 2 diabetes respectively. Results All three biomarkers were strongly correlated. With regard to the association between fructosamine and HbA1c Pearson linear correlation coefficients in the range of 0.67–0.75 were observed in fasting and non-fasting subjects with type 1 or type 2 diabetes. Analyses of glucose control in fasting patients with type 2 diabetes having all three biomarkers measured at three separate occasions within on average 290 days of the index examination showed similar trends over time for glucose, fructosamine and HbA1c. Discrimination of subjects with and without diabetes across the range of fructosamine levels was good (area under curve (AUC) 0.91–0.95) and a fructosamine level of 2.5 mmol/L classified subjects to diabetes with a sensitivity of 61% and a specificity of 97%. Conclusions Fructosamine is closely associated with HbA1c and glucose respectively and may be a useful biomarker of hyperglycaemia and glucose control in clinical and epidemiological studies.

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Fructosamine Is a Useful Indicator of Hyperglycaemia and Glucose Control in Clinical and Epidemiological Studies – Cross-Sectional and Longitudinal Experience from the AMORIS Cohort

et al. (2014) Fructosamine Is a Useful Indicator of Hyperglycaemia and Glucose Control in Clinical and Epidemiological Studies - Cross-Sectional and Longitudinal Experience from the AMORIS Cohort. PLoS ONE 9(10): e111463. doi:10.1371/journal.pone. 0111463 Fructosamine Is a Useful Indicator of Hyperglycaemia and Glucose Control in Clinical and Epidemiological Studies - Cross-Sectional and Longitudinal Experience from the AMORIS Cohort Ha kan Malmstro m 0 1 2 3 4 Go ran Walldius 0 1 2 3 4 Valdemar Grill 0 1 2 3 4 Ingmar Jungner 0 1 2 3 4 Soffia Gudbjo rnsdottir 0 1 2 3 4 Niklas Hammar 0 1 2 3 4 Marta L. Hribal, University of Catanzaro Magna Graecia, Italy 0 Trondheim, Norway, 4 Department of Endocrinology, Trondheim University Hospital , Trondheim, Norway, 5 CALAB Research, Stockholm, Sweden, 6 Department of 1 Medicine, Karolinska Institutet, Stockholm, Sweden, 3 Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology 2 1 Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden, 2 Unit of Cardiovascular Epidemiology, Institute of Environmental 3 Data Availability: The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings. This study is based on national registers in Sweden: the National Board of Health and Welfare, the National Cause-of-Death Register, and the National Patient Register. From Statistics Sweden: the LISA database, Surveys of living conditions (ULF). The Swede-Heart Register, the National Diabetic Register (NDR) and several research registers; WOLF , 60 years old men and women, COSM , SMC at Karolinska institutet (KI), Stockholm, Sweden. These datasets contain sensitive information. The database used in the present paper is located in a security server at the institution (IMM, KI) with restricted access. This dataset is available upon request to the 4 Medicine, Sahlgrenska University Hospital, University of Gothenburg , Gothenburg , Sweden , 7 Department of Epidemiology, AstraZeneca R&D , M o lndal , Sweden Context: Fructosamine is a glycemic biomarker which may be useful for indication and control of diabetes respectively. Objective: The objective of the study was to evaluate fructosamine as an indicator of hyperglycaemia and glucose control in subjects with diabetes. Design, Setting & Patients: From the AMORIS cohort, subjects with serum glucose, fructosamine and HbA1c from the same examination were studied cross-sectionally and longitudinally (n = 10,987; 5,590 overnight-fasting). The guidelines of the American Diabetes Association were followed for classification of prediabetes and diabetes. Separate analyses were performed in patients with a newly detected or a known diagnosis of type 1 or type 2 diabetes respectively. Results: All three biomarkers were strongly correlated. With regard to the association between fructosamine and HbA1c Pearson linear correlation coefficients in the range of 0.67-0.75 were observed in fasting and non-fasting subjects with type 1 or type 2 diabetes. Analyses of glucose control in fasting patients with type 2 diabetes having all three biomarkers measured at three separate occasions within on average 290 days of the index examination showed similar trends over time for glucose, fructosamine and HbA1c. Discrimination of subjects with and without diabetes across the range of fructosamine levels was good (area under curve (AUC) 0.91-0.95) and a fructosamine level of 2.5 mmol/L classified subjects to diabetes with a sensitivity of 61% and a specificity of 97%. Conclusions: Fructosamine is closely associated with HbA1c and glucose respectively and may be a useful biomarker of hyperglycaemia and glucose control in clinical and epidemiological studies. - Funding: The study was funded by the Gunnar and Ingmar Jungner Foundation for Laboratory Medicine, Stockholm, Sweden. The funder had no role in study design and analysis, decision to publish, or preparation of the manuscript but was responsible for the laboratory data Collection in 1985-1996 via the CALAB laboratory. Competing Interests: Niklas Hammar is an adjunct professor of epidemiology at the Institute of Environmental Medicine, Karolinska Institutet (KI) and also employee of AstraZeneca Research & Development, Mo lndal, Sweden. The research of the current study has no relation to the drug development or other activities performed by AstraZeneca and AstraZeneca had no influence on the initiation, conduct or interpretation of the study. The CALAB laboratory was overtaken by another company in 1997 but the laboratory database containing data from 1985 to 1996 was still owned and managed by Ingmar Jungner. Jungner donated the database to the Institute of Environmental Medicine in 2012. Ingmar Jungner is retired since many years and is not active in any business activities. He still is a member of the AMORIS Steering Committee. This does not alter the authors adherence (...truncated)


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Håkan Malmström, Göran Walldius, Valdemar Grill, Ingmar Jungner, Soffia Gudbjörnsdottir, Niklas Hammar. Fructosamine Is a Useful Indicator of Hyperglycaemia and Glucose Control in Clinical and Epidemiological Studies – Cross-Sectional and Longitudinal Experience from the AMORIS Cohort, PLOS ONE, 2014, Volume 9, Issue 10, DOI: 10.1371/journal.pone.0111463