Comparison of serum fructosamine and HbA1c as an index of postprandial glycaemic control in diabetic patients
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Date
2002
Authors
Mohamed, Mohd. Sapawi
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
Postprandial glycaemic control is important in avoiding microvascular and macrovascular
complications, lowering insulin resistance, restoring normal insulin secretion, and
avoiding complications in the offsprings of women with diabetes. It is recommended that
the treatment of diabetes include methods that lower both fasting and postprandial
glucose levels. Treatment aimed at controlling postprandial glucose levels is always
associated with better overall glucose control and thus may result in fewer chronic
complications in individuals with diabetes and impaired glucose tolerance. In order to
achieve good postprandial glycemic control, a proper monitoring tool that represents
postprandial glycaemia status should be used.
To evaluate the relationship between fructosamine and HbA1c in assessing postprandial
hyperglycaemia in diabetic subjects.
A total of 54 diabetic patients were included in this prospective, cross sectional study. All
subjects were given a standard diabetic hospital diet (breakfast and lunch). Glycaemic
profiles (fasting, 2-hours postbreakfast, prelunch and 2-hours postlunch plasma glucose)
over the same day were obtained. The different time points plasma glucose (PG) was
compared with measurement of HbA1c and fructosamine taken during fasting.
In multiple linear regression analysis with HbA1c as dependent variable and mean blood
glucose at each time points as independent variable, only FPG remained significantly
correlated with HbA1c (r=0.5I4; p=0.001). FPG was well correlated with HbA1c in
controlled glycemic group (HbAic S 7.0%) (r=0.459; p=0.007) but not in uncontrolled
(HbA1c > 7.0%) group (r=-0.19I; p=O.l75). Postprandial blood glucose was poorly
correlated with HbAlc [2-hours postbreakfast: r= 0.254 (p=0.032) and 2-hours postlunch:
r=0.045 (p=0.375)] and serum fructosamine [2-hours postbreakfast: r=0.245 (p=0.037)
and 2-hour postlunch: r=0.l46 (p=0.l46)]. The prevalence of isolated postchallenge
hyperglycaemia in the study population was 46%, with majority (77%) of them within the
controlled glycemic group. There was a strong correlation between 2-hours postbreakfast
PG and prelunch PG (r=0.891; p=0.001).
Both HbA I c and serum fructosamine did not reflect mean postprandial blood glucose in
our diabetic subjects. Fasting plasma glucose was significantly correlated with HbA I c
and thus remained a good predictor of overall glycaemic control. Since both HbA I c and
fructosamine did not correlate well with postprandial blood sugar, other markers of
postprandial glycaemia need to be found.
Description
Keywords
Diabetes