Fructosamine: structure, analysis, and clinical usefulness.

1987 ◽  
Vol 33 (12) ◽  
pp. 2153-2163 ◽  
Author(s):  
D A Armbruster
Keyword(s):  
Glycemic Control ◽  
Blood Sugar ◽  
Glycated Hemoglobin ◽  
Sugar Concentration ◽  
Diabetic Patients ◽  
High Concentration ◽  
Good Glycemic Control ◽  
The Past ◽  
Blood Sugar Concentration ◽  
Analytical Approaches

Abstract Glucose molecules are joined to protein molecules to form stable ketoamines, or fructosamines, through glycation, a nonenzymatic mechanism involving a labile Schiff base intermediate and the Amadori rearrangement. The amount of fructosamine in serum is increased in diabetes mellitus owing to the abnormally high concentration of sugar in blood. The concentration of fructosamine in serum thus reflects the degree of glycemic control attained by the diabetic patient and is useful in monitoring the effectiveness of therapy in diabetes over a period of several weeks, in a manner analogous to the determination of glycated hemoglobin. Of the analytical approaches used to measure fructosamine, affinity chromatography with m-aminophenylboronic acid and the nitroblue tetrazolium reduction method appear to be the most practical means for clinical chemists to assay fructosamine quickly, economically, and accurately. Fructosamine values can readily distinguish normal individuals and diabetic patients in good glycemic control from diabetics in poor control. Unlike glycated hemoglobin, which reflects the average blood sugar concentration over the past six to eight weeks, fructosamine reflects the average blood sugar concentration over the past two to three weeks. Thus a clinical advantage is that fructosamine responds more quickly to changes in therapy, thereby allowing for improved glycemic control. Used in conjunction with determinations of blood sugar and (or) of glycated hemoglobin, or by itself, the fructosamine assay can provide clinically useful information for the detection and control of diabetes.

scholarly journals Assessment of a glycated hemoglobin point-of-care analyzer (A1CNow+) in comparison with an immunoturbidimetric method: a diagnostic accuracy study

2015 ◽  
Vol 133 (6) ◽  
pp. 460-464 ◽  
Author(s):  
Aurélie Affret ◽  
Luiz Henrique Maciel Griz ◽  
Eduarda Ângela Pessoa Cesse ◽  
Yuri da Silva Specht ◽  
Eduardo Maia Freese de Carvalho ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Sensitivity And Specificity ◽  
Glycated Hemoglobin ◽  
Point Of Care ◽  
Venous Blood ◽  
Reference Method ◽  
University Hospital ◽  
Diabetic Patients ◽  
Good Glycemic Control ◽  
Accuracy Study

CONTEXT AND OBJECTIVE: To monitor glycemic control in diabetic patients, regular measurement of glycated hemoglobin (HbA1c) is recommended, but this can be difficult in remote places without access to laboratories. Portable point-of-care testing devices can prove a useful alternative. Our study aimed to assess the performance of one of them: A1CNow+, from Bayer. DESIGN AND SETTING: Cross-sectional accuracy study conducted at a university hospital in Brazil. METHODS: We made three successive measurements of capillary HbA1c using the A1CNow+ in 55 diabetic volunteers, while the same measurement was made on venous blood using the hospital reference method (Vitros 5,1 FS). We used the Bland-Altman graphical method to assess the A1CNow+ in relation to the Vitros 5,1 FS method. We also evaluated clinical usefulness by calculating the sensitivity and specificity of A1CNow+ for detecting patients with HbA1c lower than 7%, which is the usual limit for good glycemic control. RESULTS: The coefficient of variation between repeat testing for the A1CNow+ was 3.6%. The mean difference between A1CNow+ and Vitros 5,1 FS was +0.67% (95% confidence interval, CI: +0.52 to +0.81). The agreement limits of our Bland-Altman graph were -0.45 (95% CI: -0.71 to -0.19) and +1.82 (95% CI: +1.52 to +2.05). The sensitivity and specificity in relation to the 7% limit were respectively 100% and 67.7%. CONCLUSIONS: Although the A1CNow+ had good sensitivity, its accuracy was insufficient for use as a replacement for laboratory measurements of HbA1c, for glycemic control monitoring in diabetic patients.

scholarly journals Glycemic control, medication adherence, and injection practices among diabetic patients treated in the 3 tertiary referral hospitals in Bhutan: a call for more action

2018 ◽  
Vol 12 (1) ◽  
pp. 27-33
Author(s):  
Thinley Dorji ◽  
Pempa Lhamo ◽  
Tshering Tshering ◽  
Lungten Zangmo ◽  
Kencho Choden ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Glycemic Control ◽  
Blood Sugar ◽  
Injection Technique ◽  
Diabetic Patients ◽  
Tertiary Referral ◽  
Good Glycemic Control ◽  
Adherence To Medication ◽  
Referral Hospitals ◽  
Injection Practices

AbstractBackgroundThe burden of diabetes has increased rapidly with an increasing cost of treatment.ObjectivesTo describe the glycemic control, injection practices, and treatment adherence among diabetic patients treated with insulin.MethodsThis cross-sectional study was conducted using a convenience sampling method at the 3 tertiary referral hospitals in Bhutan. Sociodemographic, injection practices, and clinical details were collected. Good glycemic control was defined as glycated hemoglobin A (HbA1c) <7% if available or fasting blood sugar 70–130 mg/dL and 2 h postprandial blood sugar <180 mg/dL if HbA1c values were unavailable. Medication adherence was assessed using the Morisky, Green and Levine (MGL) scale. The injection technique was assessed using a 10-item checklist.ResultsWe studied 207 patients. Good glycemic control was achieved by only 58 (28.0%) of patients. Using the MGL scale score, the objective adherence with insulin therapy was mostly low to medium and a gross discordance was with self-declared adherence (P < 0.001). The injection technique was fair to poor in half of the participants. Those with good injection techniques also had good adherence to medication (P = 0.025, adjusted odds ratio = 4.4, 95% confidence interval 1.2–16.4). The majority (154, 74.4%) had self-injected insulin, while the remaining were dependent on their home caregivers. Forty percent of the participants used storage practices that were not recommended. The disposal of the used insulin needles was generally unsafe.ConclusionsGlycemic control and adherence to insulin administration recommendations were poor. The injection technique needs to be improved and standardized, and methods of safe disposal of sharps need to be developed.

scholarly journals Effects of Non-Surgical Periodontal Treatment on Reactive Oxygen Metabolites and Glycemic Control in Diabetic Patients with Chronic Periodontitis

Antioxidants ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 1056
Author(s):  
Simone Marconcini ◽  
Enrica Giammarinaro ◽  
Saverio Cosola ◽  
Giacomo Oldoini ◽  
Annamaria Genovesi ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Glycemic Control ◽  
Systemic Inflammation ◽  
Glycated Hemoglobin ◽  
Reactive Oxygen ◽  
Periodontal Treatment ◽  
Diabetic Patients ◽  
Reactive Oxygen Metabolites ◽  
Periodontal Infection ◽  
Oxygen Metabolites

Background: Periodontal infection may contribute to poor glycemic control and systemic inflammation in diabetic patients. The aim of the present study is to evaluate the efficacy of non-surgical periodontal treatment in diabetic patients by measuring oxidative stress outcomes. Methods: Sixty diabetic patients with periodontitis were enrolled, treated with scaling and full-mouth disinfection, and randomly prescribed chlorhexidine mouthwash, antioxidant mouthwash, or ozone therapy. Reactive oxygen metabolites (ROMs), periodontal parameters, and glycated hemoglobin were measured at baseline and then at 1, 3, and 6 months after. Results: At baseline, all patients presented with pathologic levels of plasmatic ROM (388 ± 21.36 U CARR), higher than the normal population. Probing depth, plaque index, and bleeding on probing values showed significant clinical improvements after treatment, accompanied by significant reductions of plasma ROM levels (p < 0.05). At the 6-month evaluation, the mean ROM relapsed to 332 ± 31.76 U CARR. Glycated hemoglobin decreased significantly (∆ = −0.52 units) after treatment. Both the test groups showed longer-lasting improvements of periodontal parameters. Conclusion: In diabetic patients, periodontal treatment was effective at reducing plasma ROM, which is an indicator of systemic oxidative stress and inflammation. The treatment of periodontal infection might facilitate glycemic control and decrease systemic inflammation.

scholarly journals Study the incidence of Candida infection in Diabetic patients submitted to the Balad Town Hospital in Salah –Eldeen, Province

2010 ◽  
Vol 7 (4) ◽  
pp. 1410-1415
Author(s):  
Baghdad Science Journal
Keyword(s):  
Blood Sugar ◽  
Candida Infection ◽  
Fasting Blood Sugar ◽  
Diabetic Patients ◽  
City Hospital ◽  
High Concentration ◽  
Town Hospital

This study was done at Al-Balad City Hospital on 60 diabetic patients (25 male and 35 female). The study included Fasting Blood Sugar and fungal diagnosis (systemic and superficial fungus). The results showed that the high concentration of blood sugar belonged to the group > 70 years among the diabetic patients with high significant differences in comparison with other groups P

Should the quality of glycemic control guide dental implant therapy in patients with diabetes? Focus on implant survival

2021 ◽  
Vol 17 ◽  
Author(s):  
Dalia Nourah ◽  
Salwa Aldahlawi ◽  
Sebastiano Andreana
Keyword(s):  
Risk Factors ◽  
Glycemic Control ◽  
Dental Implant ◽  
Failure Rate ◽  
Implant Failure ◽  
Diabetic Patients ◽  
Marginal Bone Loss ◽  
Good Glycemic Control ◽  
Implant Therapy

Introduction: Optimal glycemic control is crucial to dental implant long-term functional and esthetic success. Despite HbA1c levels of 7% or lower used as an indicator for good glycemic control, however, this level may not be attainable for all diabetic patients. Most dentists do not consider patients with poor glycemic control candidates for implant therapy due to higher implant failure, infection or other complications. Aim: This review challenges the concept of one size fits all and aims to critically appraise the evidence for the success or failure rate of dental implants and peri-implant health outcomes in patients with less-than-optimal glycemic control. Discussion: Evidence suggests that estimating glycemic control from HbA1c measurement alone is misleading. Moreover, elevated preoperative HbA1c was not associated with increased mortality and morbidity after major surgical procedures. Literature for the survival or success of implants in diabetic patients is inconsistent due to a lack of standardized reporting of clinical data collection and outcomes. While a number of studies report that implant treatment in patients with well-controlled diabetes has a similar success rate to healthy individuals, other studies suggest that the quality of glycemic control in diabetic patients does not make a difference in the implant failure rate or marginal bone loss. This discrepancy could indicate that risk factors other than hyperglycemia may contribute to the survival of implants in diabetic patients. Conclusion: In the era of personalized medicine, the clinician should utilize individualized information and analyze all risk factors to provide the patient with evidence-based treatment options.

Pre-Dialysis Glycemic Control is An Independent Predictor of Mortality Intype Ii Diabetic Patients on Continuous Ambulatory Peritoneal Dialysis

1999 ◽  
Vol 19 (2_suppl) ◽  
pp. 179-183 ◽  
Author(s):  
Mai-Szu Wu ◽  
Chun-Chen Yu ◽  
Ching-Herng Wu ◽  
Jeng Yi Haung ◽  
Mei-Lin Leu ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Glycemic Control ◽  
Serum Albumin ◽  
Poor Glycemic Control ◽  
Control Group ◽  
Diabetic Patients ◽  
Type Ii ◽  
Good Glycemic Control ◽  
Cholesterol Levels ◽  
Significant Difference

Objective To evaluate the impact of pre-dialysis glycemic control on clinical outcomes for type II diabetic patients on continuous ambulatory peritoneal dialysis (CAPO). Materials and Methods One hundred and one type II diabetic patients receiving CAPO for at least 3 months were enrolled in a single institute. The patients were classified into two groups according to status of glycemic control. In the good glycemic control group, more than 50% of blood glucose determinations were within 3.3 11.0 mmol/L and glycosylated hemoglobin (HbA 1 C) levels were within 5% -10% at all times. In the poor glycemic control group, less than 50% of blood glucose determinations were within 3.3 -11.0 mmol/L, or HbA1C levels were above 10% at least 6 months before peritoneal dialysis was started. In addition to glycemic control status, pre-dialysis serum albumin, cholesterol levels, residual renal function, peritoneal membrane function, and modes of glycemic control were also recorded. Results The patients with good glycemic control had significantly better survival than those with poor glycemic control (p < 0.01). There was no significant difference in pre-dialysis morbidity between two groups. No significant differences were observed in patient survival between patients with serum albumin above 30 g/L and those with serum albumin under 30 g/L; between those with cholesterol levels above or below 5.2 mmol/L; and between those with different peritoneal membrane solute transport characteristics as evaluated by a peritoneal equilibration test (PET). Furthermore, there was no significant difference in survival between patients who controlled blood sugar by diet and those who controlled it by insulin. Cardiovascular disease and infection are the major causes of death in both groups. Although good glycemic control predicts better survival, it does not change the pattern of mortality in diabetic patients maintained on CAPO. Conclusions Glycemic control before starting dialysis is a predictor of survival for type II diabetic patients on CAPO. Patients with poor glycemic control predialysis are associated with increased morbidity and shortened survival.

scholarly journals Comparison of Effectiveness between DPP4 inhibitors combined with Versus Other Oral Hypoglycaemic Agent(s) in Diabetic patients

2019 ◽  
Vol 30 (2) ◽  
pp. 63-70
Author(s):  
Md Shameem Haidar
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Combination Group ◽  
Diabetic Patients ◽  
Glycemic Status ◽  
Good Glycemic Control ◽  
Dpp4 Inhibitor ◽  
Number Of Patients ◽  
Inhibitor Combination

Background: Diabetes is global health burden of disease that requires life-long pharmacological and non-pharmacological management to prevent complications such as cardiovascular disease, retinopathy, nephropathy, and neuropathy. Treatment of type 2 diabetes is based on an interplay of patient characteristics, severity of hyperglycemia and available therapeutic options. Metformin, sulfonylureas (SU) and DPP IV inhibitor are the most studied of the oral medications used worldwide. They play a prominent initial role in the type 2 diabetes treatment algorithm recommended by the several guideline. The growing evidence on new technologies and therapeutic interventions is rapidly expanding our knowledge and ability to manage diabetes and its complications; at the same time, however, it is challenge for physicians to select appropriate medication in appropriate dose for optimal patients care. Objectives: To compare the safety and efficacy of the dipeptidylpeptidase-4 (DPP-4) inhibitors combination with other oral hypoglycaemic agent(s) in patients with type 2 diabetes and inadequate glycemic control. Materials & method: Study was conducted among 600 patients over a period of 24 months. All the patients were adult male and female type 2 diabetic patients who received regular oral anti-diabetic drug(s) and duration of T2DM for one year or more were enrolled for study. Total 150 cases were selected. Patients with Type 1 DM, pregnant women with DM and who was receiving injectable antidiabetic medications were excluded from this study. Detail demographic data were collected from the informant and recorded in structured case report form. Clinical examination and relevant investigations were done. Main outcome variable was Glycemic status (HbA1C, FBG, 2HABF). Effectiveness of drugs was evaluated by glycaemic status of the patients. Result: Maximum number of patients (38.5%) was between 31-40 years age group with mean age 37.8±9.5 years. Present study shows that, for good glycemic control, all three results (FBS, 2H ABF and HbA1c) were within targeted level in majority patients of DPP4 Inhibitor combination group. Although FBS was best result in metformin group. About 51.9% of SUs group achieved the glycemic control targets level. In case of metformin group it was in 59.8% of patients, and in combined therapy 67.1% patients shows good glycemic target. So DPP4 Inhibitor combination is better medication than other to maintain good glycemic status in type 2 DM patient, due to maximum number of patients reached all three components of result within target range. Conclusion: Diabetes is chronic illness. Good glycemic control with choosing appropriate anti-diabetic medication is pivotal for DM management. In this study it is observed that DPP4 Inhibitor combination group of drug is better than other anti-diabetic medication to maintain good glycemic status in type 2 DM patients. Bangladesh J Medicine July 2019; 30(2) : 63-70

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