Aim: To evaluate the value of serum fructosamine as a screening test for gestational diabetes mellitus (GDM). Methods: 849 pregnant women underwent the one-step 75 g oral glucose tolerance test (OGTT) for universal screening of GDM. The fasting serum fructosamine (cFruc) was assessed using the area under the receiver operating characteristic curve (AUC). The GDM diagnostic criteria used were those of the American Diabetes Association; however, the cFruc performance was also evaluated using criteria of the World Health Organization, Australian (ADIPS), European (EASD) and International Association of Diabetes and Pregnancy Study Groups (IADPSG). Results: 113 (13.3%) women had GDM. The AUC of the cFruc was 0.60 (95% CI 0.54–0.66). A cFruc threshold of 237 µmol/l achieved an acceptable sensitivity of 85.8% (95% CI 78.0–91.0%), but the associated specificity remained poor at 23.4% (95% CI 20.0–27.0%) with a positive predictive value of just 14.7%. Overall, over 4 out of 5 pregnant women, being over this cutoff, would need the confirmatory OGTT. No cFruc threshold reached acceptable likelihood ratios to rule-in or rule-out GDM. The AUC for cFruc remained unacceptable independent of the diagnostic criteria. Conclusions: Despite all the advances in technology, serum fructosamine is a poor test to screen for GDM.

Keywords:
Fructosamine, International Association of Diabetes and Pregnancy Study Groups, Gestational diabetes, Screening
1.
Gestational Diabetes Mellitus: Position statement American Diabetes Association. Diabetes Care 2004;27(suppl 1):S88–S90.
2.
World Health Organization: Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications. Part 1: Diagnosis and Classification of Diabetes Mellitus. Report of a WHO Consultation. Geneva, WHO, 1999.
3.
The Australasian Diabetes in Pregnancy Society: Gestational diabetes mellitus guidelines. Med J Aust 1998;169:93–97.
4.
Report of the Pregnancy and Neonatal Care Group of the European Association for the Study of Diabetes. Diabet Med 1996;13:S43–S53.
5.
Agarwal MM, Dhatt GS, Punnose J, Koster G: Gestational diabetes: dilemma caused by multiple international diagnostic criteria. Diabet Med 2005;22:1731–1736.
6.
International Association of Diabetes and Pregnancy Study Groups: International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:676–682.
7.
International Diabetes Federation: Diabetes e-Atlas, ed 4, Brussels 2009. Available at http://www.eatlas.idf.org (last accessed June 12, 2010).
8.
Agarwal MM, Dhatt GS, Punnose J: Gestational diabetes: utility of fasting plasma glucose as a screening test depends upon the diagnostic criteria. Diabet Med 2006;23:1319–1326.
9.
Agarwal MM, Dhatt GS, Othman Y, Gupta R: Gestational diabetes: fasting capillary glucose as a screening test in a multi-ethnic, high-risk population. Diabet Med 2009;26:760–765.
10.
Agarwal MM, Dhatt GS, Punnose J, Koster G: Gestational diabetes: a reappraisal of HbA1c as a screening test. Acta Obstet Gynecol Scand 2005;84:1159–1163.
11.
Hughes PF, Agarwal M, Newman P, Morrison J: An evaluation of fructosamine estimation in screening for gestational diabetes mellitus. Diabet Med 1995;12:708–712.
12.
Lin MJ, Hoke C, Ettinger B, Coyne RV: Technical performance evaluation of BM/Hitachi 747-200 serum fructosamine assay. Clin Chem 1996;42:244–248.
13.
Flahault A, Cadilhac M, Thomas G: Sample size calculation should be performed for design accuracy in diagnostic test studies. J Clin Epidemiol 2005;58:859–862.
14.
Schlebusch DH: Correction of fructosamine values for total protein during pregnancy. Ann Clin Biochem 1991;28:316–318.
15.
Jaeschke R, Guyatt G, Lijmer J: Diagnostic tests; in Guyatt G, Rennie D (eds): Users’ Guides to the Medical Literature. Chicago, AMA Press, 2002, pp 121–140.
16.
Roberts AB, Baker JR, Court DJ, James AG, Henley P, Ronayne ID: Fructosamine in diabetic pregnancy. Lancet 1983;2:998–1000.
17.
Roberts AB, Baker JR: Serum fructosamine: a screening test for diabetes in pregnancy. Am J Obstet Gynecol 1986;154:1027–1030.
18.
Salemans TH, van Dieijen-Visser MP, Brombacher PJ: The value of HbA1 and fructosamine in predicting impaired glucose tolerance – an alternative to OGTT to detect diabetes mellitus or gestational diabetes. Ann Clin Biochem 1987;24:447–452.
19.
Comtois R, Desjarlais F, Nguyen M, Beauregard H: Clinical usefulness of estimation of serum fructosamine concentration as screening test for gestational diabetes. Am J Obstet Gynecol 1989;160:651–654.
20.
Vermes I, Zeyen LJ, van Roon E, Brandts H: The role of serum fructosamine as a screening test for gestational diabetes mellitus. Horm Metab Res 1989;21:73–76.
21.
Roberts AB, Baker JR, Metcalf P, Mullard C: Fructosamine compared with a glucose load as a screening test for gestational diabetes. Obstet Gynecol 1990;76:773–775.
22.
Nasrat HA, Ajabnoor MA, Ardawi MS: Fructosamine as a screening test for gestational diabetes mellitus: a reappraisal. Int J Gynaecol Obstet 1991;34:27–33.
23.
Huter O, Drexel H, Brezinka C, Soelder E, Koelle D, Patsch JR: Low sensitivity of serum fructosamine as a screening parameter for gestational diabetes mellitus. Gynecol Obstet Invest 1992;34:20–23.
24.
Bor MV, Bor P, Cevik C: Serum fructosamine and fructosamine-albumin ratio as screening tests for gestational diabetes mellitus. Arch Gynecol Obstet 1999;262:105–111.
25.
Perea-Carrasco R, Pérez-Coronel R, Albusac-Aguilar R, Lombardo-Grifol M, Bassas-Baena de León E, Romero-Diaz C: A simple index for detection of gestational diabetes mellitus. J R Soc Med 2002;95:435–439.
26.
Agarwal MM, Hughes PF, Punnose J, Ezimokhai M, Thomas L: Gestational diabetes screening of a multiethnic, high-risk population using glycated proteins. Diabetes Res Clin Prac 2001;51:67–73.
27.
Li K, Yang HX: Value of fructosamine measurement in pregnant women with abnormal glucose tolerance. Chin Med J 2006;119:1861–1865.
28.
Brody SC, Harris R, Lohr K: Screening for gestational diabetes: a summary of the evidence for the US Preventive Services Task Force. Obstet Gynecol 2003;101:380–392.
© 2010 S. Karger AG, Basel
2010
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.