Fructosamine and glycated albumin for risk stratification and prediction of incident diabetes and microvascular complications: a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study
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Background HbA1c is the standard measure by which to monitor long-term (2-3 months) glucose control in people with diabetes and is now used for diagnosis of diabetes. Fructosamine and glycated albumin are markers of short-term (2-4 weeks) glycaemic control that might add complementary prognostic information to HbA1c. Our aim was to clarify the performance of fructosamine and glycated albumin measurements for identifying people at risk of incident diabetes or diabetic complications.Methods We measured glycated albumin and fructosamine in blood samples from 11 348 adults without diabetes and 958 adults diagnosed with diabetes mellitus (both type 1 and 2) who attended the second examination of the Atherosclerosis Risk in Communities (ARIC) study in 1990-92 (baseline). We assessed the associations of fructosamine and glycated albumin with risk of incident diabetes, retinopathy, and risk of incident chronic kidney disease (CKD), during two decades of follow-up. We compared these associations with those of HbA1c with incident diabetes, retinopathy, and CKD. For analyses of associations with incident diabetes and CKD, adjusted hazard ratios (HRs) and their corresponding 95% CIs were estimated using Cox proportional hazards models. Model discrimination was assessed using Harrell's C statistic.Findings The HRs for incident diabetes were 4·96 (4·36-5·64) for fructosamine above the 95th percentile and 6·17 (5·45-6·99) for glycated albumin above the 95th percentile. Associations were attenuated but persisted after adjustment for HbA1c. Fructosamine and glycated albumin were strongly associated with retinopathy (p<0·0001 for trend). The multivariable-adjusted HRs for CKD for people with fructosamine and glycated albumin above the 95th percentile were 1·50 (95% CI 1·22-1·85) and 1·48 (1·20-1·83), respectively, when compared with people with no diabetes and fructosamine or glycated albumin below the 75th percentile. Prediction of incident CKD by fructosamine (C statistic 0·717) and glycated albumin (0·717) were nearly as strong as by HbA1c (0·726), but HbA1c outperformed fructosamine and glycated albumin for prediction of incident diabetes with C statistics of 0·760, 0·706, and 0·703, respectively.Interpretation Fructosamine and glycated albumin were strongly associated with incident diabetes and its microvascular complications, with prognostic value comparable to HbA1c.Funding National Heart, Lung, and Blood Institute.
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Fructosamine and glycated albumin have been linked to long-term complications in epidemiologic cohort studies.
“Fructosamine and glycated albumin have been linked to long-term complications in epidemiologic cohort studies (14)(15)(16)(17)(18).”
From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [16]
Serum glycated protein assays (fructosamine and glycated albumin) may also be useful for glycemic monitoring in conjunction with other measures.
“Serum gly- cated protein assays (fructosamine and glycated albumin) may also be useful for glycemic monitoring in conjunction with other measures (see Section 6, “Glycemic Goals and Hypoglycemia”) (56)(57)(58)(59)(60).”
From 13. Older Adults: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [57]
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Self-citation
- Authors
- Selvin, E., Rawlings, A. M., Grams, M., Klein, R., Sharrett, A. R., Steffes, M., & Coresh, J.
- Affiliations
- Johns Hopkins University (US)
- University of Wisconsin–Madison (US)
- University of Minnesota (US)
- Corresponding author
- Selvin, Elizabeth
- Venue
- The Lancet Diabetes & Endocrinology
- Publisher
- Elsevier BV
- Published
- 2014-04
- Volume
- 2
- Issue
- 4
- Pages
- 279-288
- ISSN
- 2213-8587 (ISSN-L)
- PMC
- PMC4212648
- OpenAlex
- W2109819974
- Cited by
- 262
- References
- 42
- Citations by year
- 2026: 11 · 2025: 21 · 2024: 20 · 2023: 22 · 2022: 17 · 2021: 23 · 2020: 27 · 2019: 20 · 2018: 18 · 2017: 21 · 2016: 26 · 2015: 21 · 2014: 15
- FWCI
- 22.25
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Lancet Diabetes & Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HHSN268201100007C, HHSN268201100011C, HHSN268201100005C, HHSN268201100008C, HHSN268201100006C, HHSN268201100009C, HHSN268201100010C, HHSN268201100012C)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Advanced Glycation End Products research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- fructosamine, glycated albumin, HbA1c, new-onset diabetes, diabetic retinopathy, chronic kidney disease, microvascular complications, risk stratification, type 1 diabetes, type 2 diabetes, diabetes prediction, Atherosclerosis Risk in Communities Study, model discrimination, risk prediction model
- MeSH terms
- Glycated Serum Albumin, Aged, Diabetes Mellitus, Diabetic Angiopathies, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Serum Albumin, Cohort Studies, Glycation End Products, Advanced, Risk Assessment, Fructosamine, Diabetes Complications, Atherosclerosis
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