Serum fructosamine could serve as an alternative to hemoglobin A1C (HbA1C) as a predictor of adverse surgical outcome in patients with diabetes or hyperglycemia, according to a new study.
Researchers at Thomas Jefferson University (TJU; Philadelphia, PA, USA) and Tel Aviv University (Israel) conducted a study that screened 829 patients undergoing primary total joint arthroplasty using serum HbA1c, fructosamine, and blood glucose levels. All patients were followed, and total joint arthroplasty complications were evaluated, in particular surgical-site infection (SSI). Based on recommendations of the American Diabetes Association, an HbA1c level of 7% was chosen as indicative of poor glycemic control, which correlated with a fructosamine level of 292 μmol/L.
The results of the study revealed that high HbA1c levels did not predict increased risk of complications; high fructosamine levels, on the other hand, were associated with a greater risk for deep SSI infection, readmission, and reoperation. In addition, 35% of patients with fructosamine levels higher than the cut-off level of 292 μmol/L had no history of diabetes, indicating an increased risk in patients who might not otherwise have been identified. The study was published on November 15, 2017, in The Journal of Bone & Joint Surgery.
“This study gives us a better method for identifying patients who need intervention prior to surgery. It could be immensely useful in preventing life-threatening post-surgery complications,” said senior author Professor Javad Parvizi, MD, of TJU. “Because of its promising role in determining poorly controlled glucose levels, we have already begun to use the fructosamine test at our institution to determine who is at high risk of complications, and allocate resources to optimizing the glycemic control in these patients.”
“The fact that we can use this test to detect poor glucose control in non-diabetic patients may be significant, and could help us improve outcomes for non-diabetic patients as well,” said lead author Noam Shohat, MD, of TAU. “Clinical and preclinical studies have shown that even short-term spikes in blood sugar can impair the immune system, specifically innate immunity, and the body's ability to fight infection.”
Fructosamines result from glycation reactions between a sugar--fructose or glucose--and a primary amine, followed by isomerization. In a similar way to HbA1c, fructosamine tests determines the fraction of total serum proteins that have undergone glycation; since albumin is the most abundant protein in blood, fructosamine levels typically reflect albumin glycation. As albumin has a half-life of approximately 20 days, plasma fructosamine concentration reflects relatively recent (one to two week) changes in blood glucose, in comparison to HbA1c, which is an average of three months of change.
Thomas Jefferson University
Tel Aviv University