Multisite evaluation of a new diabetes self-test for glucose and glycated protein (fructosamine)

Effect of a short-term exercise program on glycemic control measured by fructosamine test in type 2 diabetes patients

BACKGROUND

Glycated hemoglobin (A1C) and Fasting Plasma Glucose (FPG) are the two monitoring blood glucose tests most frequently used. However, both methods are shown to be insensitive to detect glycemic variations in short duration periods. Therefore, we aimed to assess the effect of a short-term exercise program on glycemic levels measured by fructosamine concentrations in type 2 diabetes patients.

METHODS

Eight volunteers (51.1 ± 8.2 years) underwent a supervised exercise program during eight weeks (3 d.wk-1, 50-60% of VO2 peak for 30-60 minutes). The body composition, VO2 peak, A1C, FPG, fructosamine and capillary blood glucose (CBG) were evaluated. We used ANOVA - One Way for repeated measures followed by Tukey post-hoc test and paired t test. P values <0.05 were considered significant.

RESULTS

We found statistical differences on the concentrations of fructosamine, VO2 peak and CBG. However, A1C and FPG showed no statistical difference. Fructosamine declined by 15% (57 μmol/L) between the beginning and the end of the study. Individually, 50% of the sample reached the reference values for the normality in fructosamine test. VO2 peak increased by 14.8% (3.8 ml.kg-1.min-1) and CBG decreased on an average of 34.4% (69.3 mg/dL).

CONCLUSIONS

Fructosamine test is effective in the evaluation of glucose with type 2 diabetes patients when undergoing a short exercise program, alternatively to the traditional A1C and FPG assessment. Our results are relevant in clinical practice, because the significant improvement in glycemic status can help to evaluate the inclusion of exercise as adjunct therapy to replace the prescription of additional drugs in poorly controlled patients.

A review of glycated albumin as an intermediate glycation index for controlling diabetes

INTRODUCTION

This article reviews glycated albumin (GA) as a potential intermediate-term glycation index to fill the gap between self-monitoring of blood glucose (SMBG) and hemoglobin A1c testing in diabetes management. The introduction gives an assessment of available short-, medium-, and long-term glycemic indicators. METHODOLOGIES AND UTILITY: Methods of GA measurement are summarized, and the variance of normal and diabetic GA values are discussed. Greatest uniformity in GA measurement is generally associated with immunoassay and the newer affinity chromatography methodologies utilized by reference laboratories. Utility of GA measurement includes its value as a marker for glycation, its substantial relationship to diabetes complications such as nephropathy and coronary artery disease, and as an unambiguous indicator of glycemic control in diabetes patients undergoing hemodialysis. Studies support the utility of GA in detecting short-term changes in glycemic control, and GA testing has been strongly recommended for gestational diabetes.

RESULTS AND DISCUSSION

The results of a survey with mailings to over 3500 diabetes care professionals primarily in the United States are outlined and analyzed (margin of error: +/-6.5%, 95% confidence). Respondents strongly supported the need for a test for intermediate glycemic control as well as the utility of a rapid GA test as a monthly glycemic indicator.

CONCLUSIONS

Such a test, as yet unavailable, could increase compliance and enhance empowerment among diabetes patients. It also has the potential to reduce the number of recommended SMBG tests, which may result in significant health care cost savings.

A prospective, randomized, multicentered controlled trial to compare the annual glycemic and quality outcomes of patients with diabetes mellitus monitored with weekly fructosamine testing versus usual care

Fructosamine is an indicator of overall glycemic control for a 10-14-day time frame, medium-term marker, versus the 90-day average indicated by the hemoglobin A1c (A1C) test. The utility of the home fructosamine test for management of persons with diabetes remains undefined. The primary objectives of this study were (1) to compare the annual A1C results of subjects monitoring weekly fructosamine with those receiving usual care, (2) to identify the number of subjects achieving goal A1C, and (3) to determine if the addition of a weekly fructosamine test changed a subject's quality of life. This was a prospective, randomized, multicenter, controlled trial. Subjects were recruited from three sites and randomly assigned to collect weekly fructosamine in addition to daily glucose (Group 1) or to receive usual care of daily glucose collection (Group 2). Follow-up occurred at 3-month intervals for a year. Baseline and quarterly A1C tests were collected. Quality of life assessment was conducted at baseline and at the final study visit. Seventy-two subjects were randomized. Demographic and whole blood assessments were similar between the two groups at baseline. The mean percent change of A1C from baseline to final study visit in Group 1 (-0.52 +/- 1.5) was not statistically different than Group 2 (-0.86 +/- 1.4) (P = 0.320). Seven subjects in each group achieved A1C of less than 7% (P = 0.532). No change in quality of life between or within the two groups was observed (P > 0.05) for each area of concern. Blood glucose monitoring alone was shown to be superior to the additional fructosamine testing after 1 year of treatment; however, weekly fructosamine testing demonstrated a decrease in A1C earlier and more consistently throughout the study. Despite glycemic improvement, the number of subjects attaining American Diabetes Association-defined A1C goals was not different between the treatment groups. Quality of life did not change with the addition of a weekly fructosamine test.

A prospective, randomized, multicentered controlled trial to compare the annual outcomes of patients with diabetes mellitus monitored with weekly fructosamine testing versus usual care: a 3-month interim analysis

The recent introduction of a home monitoring system that measures whole blood glucose and whole blood fructosamine values by fingerstick blood drop adds a previously unavailable estimate of overall glycemic control via the fructosamine component. Fructosamine serves as an indicator of overall glycemic control for a 10-14-day time frame versus the 90-day average indicated by the hemoglobin A1c (A1C) test. The utilization of the fructosamine test for management of patients with diabetes mellitus remains unclear. The primary objectives of this study are to compare the quarterly A1C results of subjects monitoring weekly fructosamine with those receiving usual care, to identify the number of patients achieving goal A1C, and to determine if the addition of a weekly fructosamine test changes a patient's quality of life. Secondary objectives include determining if specific patient demographics predict success or difficulty in achieving improved A1C. This is a prospective, randomized, multicenter controlled trial. Patients were randomly assigned to collect weekly fructosamine in addition to daily glucose (Group 1) or usual care of daily glucose (Group 2) and had study visits every 3 months. Baseline and quarterly A1C tests were collected. Quality of life assessment was conducted at baseline and will be evaluated at the final study visit. Sixty subjects have been randomized into the study since May 2001 with enrollment ongoing. Baseline demographics, glucose, fructosamine, and A1C were similar between the two groups. The 3-month interim analysis demonstrated no statistically significant difference in fructosamine (p = 0.265) between Group 1 (293.00 +/- 111.22 micromol/L) and Group 2 (336.69 +/- 111.12 micromol/L), respectively. No statistical difference at 3 months (p = 0.676) in A1C values for Group 1 (7.921 +/- 1.848% vs. 7.755 +/- 1.408%) and Group 2 (7.800 +/- 1.505% vs. 7.971 +/- 1.797%) were noted when compared with baseline. The interim data suggest that the fructosamine group has had a net decrease in A1C over the 3-month time frame, whereas the control group has had a net increase in A1C values. Ongoing follow-up will determine if this trend continues and becomes statistically and clinically significant.

Home testing of fructosamine improves glycemic control in patients with diabetes

OBJECTIVE

To determine whether weekly fructosamine testing at home by patients with type 2 diabetes, combined with therapeutic intervention when necessary on the basis of the results, would lead to improved glycemic control in comparison with usual care during a 3-month period.

METHODS

In a prospective study, 25 patients with glycosylated hemoglobin (HbA1c) values above 8.0% were randomized into 2 groups. Both groups, a glucose-only testing group (14 patients with an initial mean HbA1c of 9.4 +/- 0.9%) and a combined glucose plus fructosamine testing group (11 patients with an initial mean HbA1c of 9.2 +/- 0.7%), received therapeutic intervention at the time of randomization. Both groups were instructed to perform blood glucose testing up to four times per day. The combined glucose plus fructosamine testing group was also instructed to perform weekly fructosamine testing in addition to the glucose testing and to telephone the investigator if their home-testing fructosamine value exceeded 350 mmol/L (approximately equivalent to HbA1c of 7.8%), whereupon the investigator implemented further interventions. Both groups returned in 3 months, at which time HbA1c testing was repeated in order to determine whether glycemic control had changed.

RESULTS

The study results after 3 months showed that the HbA1c values in the combined glucose plus fructosamine testing group decreased from 9.2 +/- 0.7% to 8.0 +/- 0.5% (P<0.0001). In contrast, the HbA1c values in the glucose-only testing group declined from 9.4 +/- 0.9% to 9.1 +/- 1.3%, a difference that was not significant.

CONCLUSION

In the 3 months after a change in therapy for type 2 diabetes, weekly home testing of fructosamine, combined with therapeutic interventions based on the results, led to a more rapid and significant improvement in glycemic control than did the usual regimen of glucose-only testing.

Dual test diabetes screening project: screening for poor glycemic control in a large workplace population

The objective of this study was to assess the efficacy of a dual test blood glucose/fructosamine home monitoring system to screen individuals in the workplace for poor glycemic control. Screening values qualifying individuals for 90 days of additional monitoring were as follows: fasting blood glucose > or =126 mg/dL, casual blood glucose > or =140 mg/dL, and/or fructosamine <310 micromol/L. Subjects with positive values were provided access to classroom instruction by a Certified Diabetes Educator. The population consisted of 100 males and 177 females, ages 22-71 years, mean 49.7 years, with 12 males and 22 females reporting diabetes. Their ethnic backgrounds were 17.7% African American, 0.4% Asian, 1.8% Hispanic, 0.4% mixed, and 79.8% Caucasian reflecting the general United States population. A total of 26 males and 27 females had results indicating poor glycemic control. Of the known individuals with diabetes, seven of 12 males and 15 of 22 females had positive results. More males than females were unaware of their potential for diabetes but of those previously diagnosed with diabetes more females than males had poor glycemic control. A total of 31 subjects tested positive for blood glucose, 39 tested positive for fructosamine, indicating a 15.1% (p < 0.005) improvement in detection chances with fructosamine. Cost per subject including equipment, supplies, and labor was $18.13. Study results indicate that the addition of a fructosamine test improves screening accuracy for large groups of people while retaining ease of use and affordability.