@article {1443, title = {Serum fructosamine as a screening test for diabetes in the elderly: a pilot study.}, journal = {J Am Geriatr Soc}, volume = {41}, year = {1993}, month = {1993 Oct}, pages = {1090-4}, abstract = {

OBJECTIVE: To determine the value of serum glycated protein, measured as serum fructosamine, as a screening test for diabetes in the elderly.

DESIGN: Cross-sectional pilot study.

SETTING: Ambulatory research clinic in university setting.

PATIENTS: One hundred fifty-seven consecutive community-dwelling participants in the Cardiovascular Health Study, average age 71.8 + 5 (mean +/- SD, range 65-88 years).

MEASUREMENTS: Serum fructosamine levels (first and second generation assay) were obtained. All subjects who did not have a diagnosis of diabetes were given a 75-g glucose tolerance test (GTT).

RESULTS: Twenty-six subjects (17\%) (10 previously diagnosed, 16 undiagnosed and asymptomatic) had diabetes mellitus, and 38 subjects (24\%) had impaired glucose tolerance by history or by the GTT (WHO criteria). Only the 16 asymptomatic diabetics were included in the analysis for the pilot study. There was a significant difference in the fasting fructosamine level between non-diabetics and asymptomatic diabetics for the first generation (2.06 +/- .21 vs 2.53 +/- .49 mMol/L, P < 0.0015) and second generation assay (221 +/- 27 vs 269 +/- 48 mMol/L, P < 0.0012). Receiver operator curves were constructed to evaluate the test characteristics of serum fructosamine. Using a point of > or = 2.3 mMol/L for the first-generation assay, the sensitivity to detect asymptomatic diabetes was 75\%, specificity 83\%, and positive predictive value 35\%. To detect both diabetes and impaired glucose tolerance using a cutpoint of > or = 2.3 mMol/L, the sensitivity was 24\%, specificity 95\%, and positive predictive value 68\%. Employing a cut point of 250 muMol/L for the second generation assay, the sensitivity to detect diabetes was 81\%, specificity 87\%, and positive predictive value 43\%. However, to detect diabetes and glucose intolerance using the second generation assay, the sensitivity was 39\% and specificity was 86\%.

CONCLUSION: This study demonstrated that a single measurement of either first or second generation fructosamine showed promise as a screening test for diabetes, but not impaired glucose tolerance, in older people.

}, keywords = {Aged, Diabetes Mellitus, Female, Fructosamine, Glucose Tolerance Test, Hexosamines, Humans, Insulin, Male, Pilot Projects, Predictive Value of Tests, Sensitivity and Specificity}, issn = {0002-8614}, author = {Cefalu, W T and Ettinger, W H and Bell-Farrow, A D and Rushing, J T} }