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Screening for Diabetes: Does Measurement of Serum Fructosamine Help?
Author(s) -
Swai A. B. M.,
Harrison K.,
Chuwa L. M.,
Makene W.,
McLarty D.,
Alberti K. G. M. M.
Publication year - 1988
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.1988.tb01073.x
Subject(s) - fructosamine , medicine , diabetes mellitus , impaired glucose tolerance , endocrinology , glucose tolerance test , type 2 diabetes , insulin resistance
The diagnostic sensitivity and specificity for diabetes of serum fructosamine levels and fasting venous blood glucose concentrations were compared in 613 subjects during a diabetes community screening programme of 1049 adult Muslim Asians in Dar es Salaam, Tanzania. Using WHO (1985) criteria 228 had impaired glucose tolerance (IGT), 41 had previously been diagnosed as having diabetes while 32 had newly recognized diabetes. The mean (± SD) serum fructosamine levels were 20.9 ± 3.2, 21.6 ± 3.2, 23.9 ± 4.9, and 30.1 ± 7.9 (μmol g −1 albumin) in subjects with normal glucose tolerance, IGT, newly diagnosed diabetes, and previously diagnosed diabetes, respectively ( p < 0.001 for differences between groups). The specificity of values above the mean + 2SD normal was 99% for abnormal glucose tolerance with a sensitivity of only 22% for diabetes. The predictive values were 44% and 97% for positive and negative results, respectively. Very little difference from normal was found for IGT subjects. Expressing fructosamine values in absolute terms or per gram albumin made little difference to sensitivity and specificity. The sensitivity was only 32% for fasting blood glucose ≥ 6.7 mmol l −1 , 73% for values ≥ 5.5 mmol l −1 and 100% for fasting blood glucose ≥ 4.5 mmol l −1 . It is concluded that both serum fructosamine and fasting blood glucose are poor screening and diagnostic tests for diabetes and for IGT, and that glucose loading is required.