Fructosamine

Fructosamine is basically a compound that is produced following glycation reactions taking place between any sugar (like glucose or fructose) and any primary amine and subsequently isomerized through a process called Amadori rearrangement. In terms of biology, fructosamines are identified by fructomine-3-kinase, which may possibly activate the debasement of the end products of advanced glycation. However, the actual clinical implication of the above mentioned pathway is still not clear. In addition, fructosamine also denotes the specific compound called isoglucosamine (1-amino-2-deoxy-D-fructose). German chemist and Nobel laureate Hermann Emil Fisher was the first to synthesize this compound in 1886.

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In most cases, when we talk about fructosamine, we actually mean a laboratory examination undertaken for diabetes management, which is seldom utilized in chemical practice. Instead of fructosamine, most people prefer to undergo a simple blood glucose examination. Some even prefer hemoglobin A1c tests. There are several direct-to-direct laboratory examination companies that market fructosamine tests. However, such tests are no necessary and their value is also very limited.

As discussed earlier, fructosamine is among the several blood examinations that can be undertaken to gauge the levels of blood sugar in people suffering from diabetes. In fact, several people suffering from this condition monitor their blood glucose levels on a daily basis at home using a glucometer or blood sugar meter. Since the blood sugar levels of an individual usually fluctuates all through the day and, hence, doctors often want to know the average glucose levels in the blood stream. Normally, the blood glucose levels is checked by undertaking the hemoglobin A1c test, as this experiment helps to determine the levels of one's blood sugar over a period of three months. In contrast, the fructosamine test only verifies the levels of glucose in the blood for the past two to three weeks. Hence, fructosamine test is just an alternative means to monitor blood glucose levels.

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All types of diabetes have a common symptom and that is presence of too much sugar in the blood stream, in due course, such excessive glucose in the blood may severely harm several organs, including the kidneys, feet, eyes as well as the cardiovascular system. Hence, diabetes requires an aggressive and frequent treatment with apt medications. In order to find out if the treatment regimen is working effectively, usually diabetics monitor their sugar levels in the blood stream no less that once every day using a glucometer or blood sugar meter. Sometimes, it may seem that the blood sugar levels are ideal, but one must bear in mind that they may change drastically over the day.

In order to obtain a more precise quantity of the blood glucose levels over a period of time, most doctors perform blood examinations frequently to determine the overall glucose level over a specific period of time. Generally, two laboratory examinations are undertaken to determine the levels of blood glucose - the fructosamine test and the hemoglobin A1c examination. Both these gauge the quantity of glucose that has attached to proteins present in the blood. The proteins that have attached to glucose in the blood stream are called glycated proteins. In people whose diabetes is poorly controlled, the levels of such glycated proteins are much higher compared to those whose diabetes is under control. However, several aspects are responsible for alterations in the free glucose levels in the blood stream. However, changes in the glycated protein levels occur much more sluggishly and offer readings that are reproducible.

Blood sugar level measurement provided by fructosamine test helps to identify products caused following reactions with glucose and attached to amino group present on a protein like albumin, which, in turn, results in the formation of glycated albumin. The fructosamine test also helps to determine the blood sugar levels over a period of two to three weeks. Basically, it is an alternative to several other common blood glucose tests like the hemoglobin A1c test that sometimes offers false readings for people enduring blood-related problems like sickle cell anemia or hemolytic anemia.

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Aside the false readings given by hemoglobin A1c, there are a number of other reasons for undertaking the fructosamine test. This method also fulfils the need to determine the levels of blood sugar during pregnancy. This is because if a pregnant woman suffering from gestational diabetes may experience rapid hormonal changes, this may also result in frequent changes in the blood sugar levels. Doctors generally want to check such changes, if any, more frequently compared to the three month readings offered by the common blood sugar tests. Undertaking the fructosamine test helps to monitor the levels of glucose in the blood stream for the previous two to three weeks.

Many people with diabetes often need to change their medicines depending on their present level of blood glucose. Hence, they need to check their blood glucose levels more frequently to monitor such changes. In such instances, the fructosamine test offers better readings compared to glycated hemoglobin test, especially when it is important to monitor the rapidly altering levels of glucose in the blood stream of such patients.

While appraising the levels of fructosamine in blood it is more imperative to observe the trends that analyzing the total percentage of glucose present in the blood stream. If the levels of blood sugar show a decreasing trend, it means that the medicines taken by the patient are effective and the levels are gradually coming under control. On the other hand, increasing levels of blood sugar suggest the contrary. In fact, the fructosamine test is not useful for screening diabetics. The lower limit of the test does not clarify whether or not a patient's diabetes is being controlled effectively or confirm if the patient does not suffer from diabetes.

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Like undertaking the hemoglobin A1c test that helps to determine the amount of glycation of hemoglobin, the fructosamine test also helps to measure the part of absolute serum proteins, which have already been transformed into glycated serum proteins. The protein that is found in most abundant levels in blood is albumin and this is the reason why the fructosamine levels usually reveal the amount of albumin glycation in the blood. However, a number of fructosamine examinations particularly show the amount of albumin glycation or the quantity of glycated serum albumin rather than reflecting the entire protein present in the blood. This is mainly owing to the fact that the half-life of albumin is roughly 20 days, while the concentration of plasma fructosamine shows rather recent (anything between the past one or two weeks) alterations in the blood glucose level.

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Undertaking a hemoglobin-based A1c examination for people suffering from ailments that decrease the life span of red blood cells (erythrocytes), such as hemoglobinopathies like sickle-cell disease or even anemia, can produce very misleading readings. Even in the case of hemoglobinopathies, the results of A1c tests may be very incorrectly low or high since anomalous hemoglobin variations can meddle the analysis. Therefore, fructosamine tests can be more effective for measuring the levels of blood sugar in such cases since the measurements of fructosamine are founded on albumin and not on hemoglobin. Nevertheless, any health condition that alters serum albumin, for instance the nephrotic syndrome, will also influence the results of fructosamine tests.

Actually, even in clinical trials, fructosamine is seldom measured. This holds true even for people enduring hemoglobinopathies or any other disorder related to red blood cells mainly because of some practical concerns. Firstly, it has been found that diabetes care seldom changes in brief intervals (for instance one to four weeks). This is because it may take several months for diabetic medication to arrive at a stable state. However, there is an exception and that is during pregnancy when there may be a need to change medication more frequently. In such instances, fructosamine may prove to be effective in providing more accurate short-term diabetes screening. The second aspect is that the variability of fructosamine tests is higher compared to A1c tests.

There is a third issue also. A great majority of scientific studies undertaken on diabetes cure are founded on the results of A1c tests. This can actually make it quite difficult to interpret the results of fructosamine tests. Fourthly, the results of A1c tests are extremely consistent and they are also trusted because of their almost widespread use. In fact, there are various other further advanced varieties of A1c tests, such as immunoassay, some forms of HPLC as well as capillary electrophoresis, that can evaluate the A1c levels more accurately, especially during complicated hemoglobinopathies and some other conditions. However, this does not mean that it overcome the result of the reduced life span of red blood cells on the results of A1c tests.

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