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Serum fructosamine as a screening test for diabetes in the elderly: a pilot study.

TitleSerum fructosamine as a screening test for diabetes in the elderly: a pilot study.
Publication TypeJournal Article
Year of Publication1993
AuthorsCefalu, WT, Ettinger, WH, Bell-Farrow, AD, Rushing, JT
JournalJ Am Geriatr Soc
Date Published1993 Oct
KeywordsAged, Diabetes Mellitus, Female, Fructosamine, Glucose Tolerance Test, Hexosamines, Humans, Insulin, Male, Pilot Projects, Predictive Value of Tests, Sensitivity and Specificity
Abstract<p><b>OBJECTIVE: </b>To determine the value of serum glycated protein, measured as serum fructosamine, as a screening test for diabetes in the elderly.</p><p><b>DESIGN: </b>Cross-sectional pilot study.</p><p><b>SETTING: </b>Ambulatory research clinic in university setting.</p><p><b>PATIENTS: </b>One hundred fifty-seven consecutive community-dwelling participants in the Cardiovascular Health Study, average age 71.8 + 5 (mean +/- SD, range 65-88 years).</p><p><b>MEASUREMENTS: </b>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).</p><p><b>RESULTS: </b>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%.</p><p><b>CONCLUSION: </b>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.</p>
Alternate JournalJ Am Geriatr Soc
PubMed ID8409155
Grant ListAG00436 / AG / NIA NIH HHS / United States
N01-HC-85080 / HC / NHLBI NIH HHS / United States