Serum fructosamine can be used in all except-
Correct Answer: Screening of diabetes
Description: Ans. is 'a' i.e., Screening of diabetes Fructosamine is the product of a reaction between fructose and protein. Fructosamine is a compound that is formed by the non enzymatic reaction between fructose and ammonia. When fructosamine are formed from blood proteins such as albumin, they are known as glycated serum protein or glycated albumin.Since albumin has much shorter half life than hemoglobin, serum fructosamine generally reflects the state of glycemic control for only the preceding 2 weeks.Fructosamine measurement has been present since long to monitor sugar control in diabetes. The test for fructosamine is simpler and less costly than for glycated hemoglobin. However, the trials have shown it to be too unspecific to replace the increasingly well established and generally recommended determination of HbAcGlucose control in diabetics is usually assessed with the help of glycosylated hemoglobin that indicates average glucose level over the preceding 12 weeks as reflected by the permanent glycosylation of a small fraction of the hemoglobin molecule in the blood. However, its measurement is not appropriate where there has been a recent change in the diet or treatment within 6 weeks of if there are abnormalities in red blood cell aging or mix of hemoglobin subtypes (predominantly HbA in normal adults). Hence people with recent blood loss or hemolytic anemia or hemoglobinopathy such as sickle cell disease are not suitable for glycosylated hemoglobin method that do not account for higher turnover of hemoglobin.Fructosamine is used in these circumstances. It is also used in conditions such as pregnancy in which hormonal changes cause greater short term fluctuation in glucose concentrations.The American diabetes Association says that fructosamine may be a better choice when glycosylated hemoglobin cannot be reliably measured:These situations include:The evaluation of changes in diabetic treatment Q, since the effects of adjustment can be evaluated after a couple of weeks rather than months.In pregnancy/1, since the glucose and insulin needs of the mother and fetus changes rapidly during gestation. Any condition that effects the average age of red blood cells Q such as hemolytic anemia, sickle cell anemia or blood loss. Fructosamine is not affected by such conditions and may be a better choice for monitoring glucose control.In monitoring short term and intermediate glycemic controlDisadvantages of fructosamine:- * Measured fructosamine may be falsely low in the setting of decreased protein levels such as nephrotic syndrome or hepatic disease. Further, because of lack of standardization and concern with reproducibility, fructosamine is not recommended for routine use or as a replacement or supplement for glycated hemoglobin in the assessment of glucose in diabetes.
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