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Fructosamine 3-kinase, an enzyme involved in protein deglycation.

The in vivo formation of fructosamines following non-enzymatic reaction of proteins with glucose (i.e. glycation) was first described almost 30 years ago. Until recently, the only known fate of fructosamines in mammalian cells was their spontaneous conversion into advanced glycation end products. The identification in human erythrocytes of a new enzyme, fructosamine 3-kinase, disclosed the existence of a so-far unsuspected intracellular metabolism of these compounds. Fructosamine 3-kinase phosphorylates with high affinity both low-molecular-mass and protein-bound fructosamines on the third carbon of their deoxyfructose moiety, leading to the formation of fructosamine 3-phosphates. The latter are unstable and spontaneously decompose into inorganic phosphate and 3-deoxyglucosone, with concomitant regeneration of the unglycated amine. The presence of proteins related to fructosamine 3-kinase in many prokaryotic and eukaryotic genomes suggests that this 'deglycation' process is not restricted to mammals.

Amino Acid Sequence↗

[Critical evaluation of fructosamine as a control parameter in the assessment of diabetic metabolic regulation].

For some years the glycosylated plasma proteins, the so-called fructosamines, have been used for the evaluation of metabolic control in diabetic patients. We studied the usefulness of fructosamine as an intermediate parameter in the control of diabetes and we also corrected fructosamine for serum protein. Furthermore, the dependence on daily times and amounts of food intake were examined for fructosamine alone as well as for protein-corrected fructosamine. Both parameters showed a statistically significant correlation with HbA1C (r = 0.7; P less than 0.001). Changes in the metabolic state of the diabetic patients were reflected more rapidly by both these parameters than by HbA1C. While the correction of fructosamine for serum protein eliminated its postprandial increase in the diabetic patients, circadian variation remained unchanged.

Adolescent↗

Glycated serum protein determination: comparison between thiobarbituric acid and fructosamine assays.

Glycated serum proteins were evaluated with fructosamine (GSP-fructosamine) and thiobarbituric acid (GSP) assays in 60 normal and 60 diabetic subjects. Higher levels of GSP-fructosamine and GSP were found in diabetics in comparison to controls. GSP-fructosamine levels were positively related to GSP values and the other metabolic control parameters. Moreover, the fructosamine assay is sensitive, reproducible, rapid and easy to perform. Thus, fructosamine assay could be a useful method for glycated serum protein evaluation in diabetic patients.

Adult↗

Comparison of serum fructosamine vs glycohemoglobin as measures of glycemic control in a large diabetic population.

In diabetic patients, measurement of glycohemoglobin (HbA1C) is widely accepted as the standard method for determining long-term glycemic control. Another test, the serum fructosamine test, has been suggested as a less costly alternative. To compare these two tests, we evaluated how well each correlated with fasting blood glucose and how well each could predict the degree of glycemic control perceived by treating physicians. Among 222 diabetic subjects, fructosamine (r=0.74) and fructosamine corrected for serum albumin (c-fructosamine) (r=0.79) correlated better with fasting blood glucose than did HbA1C (r=0.68) (P<0.05). Among 450 diabetic subjects, fructosamine, c-fructosamine, and HbA1C showed similar error rates (23%-26%) when discriminating between subjects who had either poor vs not-poor control or poor-to-fair versus good-to-excellent control. However, receiver operating characteristic curves for these tests indicated that HbA1C was the best discriminator because it showed a 9% to 10% greater area under the curve (P<0.05).

Adolescent↗

Diagnostic value of fasting capillary glucose, fructosamine and glycosylated haemoglobin in detecting diabetes and other glucose tolerance abnormalities compared to oral glucose tolerance test.

New diagnostic criteria for diabetes mellitus recommend lowering of the fasting plasma glucose to 7.0 mmol/l. In contrast to recommendations of the American Diabetes Association (ADA), WHO recommends using the oral glucose tolerance test (OGTT) in clinical practice. In this study. based on OGTT results and WHO 1998 criteria, we determined if measuring fasting capillary glycaemia (FCG) along with fructosamine and/or glycosylated haemoglobin allows the detection of glucose tolerance abnormalities better than FCG alone. OGTT was performed in 538 patients. Serum fructosamine was determined in 480 of the patients, and glycosylated haemoglobin in 234 of the patients. According to WHO 1998 criteria, the patients were divided into groups due to glucose tolerance abnormalities. Fructosamine correlated stronger with 2-h post-load glucose concentrations than with FCG. HbAlc correlated stronger with FCG than with 2-h post-load glucose. Combined use of fructosamine and FCG predicted 2-h post-load glucose better than combined use of FCG and HbA1c. Receiver operating characteristic curve analyses showed that FCG was the best criterion in discriminating diabetes. Combined use of FCG and fructosamine slightly improved the ability to discriminate glucose tolerance abnormalities from normal glucose tolerance. FCG is the most effective predictor of 2-h post-load glucose and the best criterion for discriminating diabetes and other glucose tolerance abnormalities from normal glucose tolerance. Fructosamine is a potentially useful post-load glycaemia index. OGTT is irreplaceable in identification of patients with high post-load glycaemia.

Biomarkers↗

Plasma fructosamine assay in children with insulin-dependent diabetes mellitus.

Plasma concentrations of fructosamine, an indicator of glycated plasma proteins, were measured in non-diabetic children and children with insulin-dependent diabetes mellitus (IDDM) to see if they also correlate with glycemic control in children as well as in adults. Non-diabetic children aged less than 4 yr had significantly lower plasma fructosamine than non-diabetic children aged 4 or more. Total plasma protein in these children was slightly lower or close to that of older children. There was no difference in fructosamine between non-diabetic children aged 4 or more and healthy adult subjects. Plasma fructosamine in children with IDDM was twofold that of age-matched controls. In children with IDDM, correlations between fructosamine and HbAI (r = 0.799) or HbAIc (r = 0.841) were high. The measurement of plasma fructosamine, which is practical in children because of the small sample volume needed and no influence of HbF, is useful in the management of children with IDDM.

Adolescent↗

Fructosamine as a screening-test for gestational diabetes mellitus: a reappraisal.

Fructosamine, glycosylated hemoglobin (HbA1c) and serum total proteins were measured in normal nondiabetic pregnant women (n = 170) at three stages of pregnancy (14-18, 24-28, and 32-40 weeks of gestation). No significant correlation was found between fructosamine and either HbA1c or total plasma proteins. Only early in pregnancy (less than 20 weeks of gestation) was a correlation found between fructosamine and fasting blood glucose (r = 0.40, P less than 0.05). There was also no correlation between either tests (i.e. fructosamine and HbA1c) and fetal birthweight. The value of fructosamine measurement in the detection of diabetes in pregnancy was further tested in a group of high-risk patients (n = 98) for developing carbohydrate intolerance. It is concluded that fructosamine has limited value as a screening test for gestational diabetes mellitus, particularly for the mild form of the glucose intolerance.

Biomarkers↗

Fructosamine assay: an index of medium-term metabolic control parameters in diabetic disease.

The fructosamine levels and some metabolic control parameters were evaluated in 120 diabetics and in 60 controls. Higher levels of fructosamine were found in diabetics compared to normals (3.22 +/- 0.06 vs. 1.82 +/- 0.05 mmol/l; P less than 0.001). Positive correlations were found between fructosamine and metabolic control parameters in diabetic subjects. Moreover, non-insulin-dependent diabetic subjects had better correlations. The study of fructosamine variation in relation to plasma glucose change showed that fructosamine levels were modified after at least 2 weeks of good metabolic control. In conclusion, the fructosamine assay could be a useful method for medium-term metabolic control evaluation.

Adolescent↗

An evaluation of serum fructosamine as a marker of the duration of hypoproteinaemic conditions in dogs.

Serum samples were collected from 153 normoglycaemic, hypoproteinaemic dogs of known case histories, and assayed for fructosamine, glucose, total protein and albumin concentrations. This study was conducted to evaluate the relationship between serum fructosamine and total serum proteins, or more specifically serum albumin. Serum fructosamine was positively correlated with both total serum protein (r = 0.47, p < 0.00001) and serum albumin (r = 0.77, p < 0.00001). Mean serum albumin concentrations were significantly different when the data were grouped as dogs with normal versus subnormal serum fructosamine concentrations. The data indicate the value of the serum fructosamine assay in estimating the duration of hypoalbuminaemia. Concurrent hypoalbuminaemia and normal serum fructosamine indicate hypoalbuminaemia of less than one week. Concurrent hypoalbuminaemia and hypofructosaminaemia indicate persistent hypoalbuminaemia of more than one week, and concurrent normal albumin and hypofructosaminaemia indicate recovery from a condition including hypoalbuminaemia or hypoglycaemia.

Animals↗

The long-term biological variability of fasting plasma glucose and serum fructosamine in healthy Beagle dogs.

The aim of this study was to estimate the long-term (month-to-month) between-dog, within-dog and analytical components of variance for fasting plasma glucose and serum fructosamine in healthy dogs to assess the usefulness of a single measurement of these analytes in a single dog. Fasting plasma glucose and serum fructosamine were measured in blood samples collected every month for 9 months from 23 clinically healthy dogs, and the results were subjected to nested analysis of variance. The between-dog variation, the within-dog variation, and the analytical variation were 3.8%, 9.5% and 3.7%, respectively, for plasma glucose and 4.2%, 11.1% and 2.8%, respectively, for serum fructosamine. The maximum allowable analytical imprecision, analytical inaccuracy and difference between analytical methods were 4.8%, 2.6% and 3.2%, respectively, for plasma glucose and 5.6%, 3.0% and 3.7%, respectively, for serum fructosamine. The index of individuality, 2.7 for both analytes, indicated that the test results from single dogs can be compared usefully to the corresponding population-based reference intervals. The number of samples required to estimate the true individual mean value +/-5% for a single dog was 16 for fasting plasma glucose and 20 for serum fructosamine. The one- and two-sided critical differences expressing the difference needed for two serial results from the same dog to be significantly different at a 5% level was 24% and 28%, respectively, for plasma glucose and 27% and 32%, respectively, for serum fructosamine.

Animals↗

Serum fructosamine measurement: a new diagnostic approach to renal glucosuria in dogs.

Measurement of serum fructosamine, 1-amino-1-deoxyfructose, is commonly used in diagnosing and monitoring hyperglycaemic disorders, such as diabetes mellitus in dogs. Serum fructosamine indicates long-term serum glucose concentrations and replaces serial serum glucose measurements. This study investigates the clinical usefulness of serum fructosamine in differentiating conditions other than diabetes mellitus characterised by glucosuria. Four dogs presented with glucosuria all had serum fructosamine concentrations within or close to the reference range (313 micromol 1(-1), 291 micromol 1(-1), 348 micromol 1(-1), 262 micromol 1(-1) reference range: 250 to 320 micromol 1(-1) indicating that a single serum fructosamine measurement is a simple and efficient way of verifying concurrent persistent normoglycaemia. Therefore, serum fructosamine is a useful parameter not only in diabetic patients, bu also in differentiating conditions in dogs characterised by glucosuria without hyperglycaemia, such as primary renal glucosuria and the Fanconi syndrome. To distinguish between primary renal glucosuria and the Fanconi syndrome, measurement of the amino acid concentration in urine was performed.

Amino Acids↗

Evaluation of metabolic control in type 1 (insulin-dependent) diabetic patients by estimation of serum fructosamine.

The method of Johnson et al. (1982) for the estimation of non-enzymatically glycated serum proteins (fructosamine test) was critically evaluated and modified with respect to photometric readings, incubation conditions, and standardization of the procedure. With this modified method, serum fructosamine concentrations were estimated in type 1 (insulin-dependent) diabetic patients whose glycemic control ranged from strictly to poorly controlled and in normoglycemic healthy control subjects. The mean fructosamine concentrations were for the control group (n = 52) 2.17 mmol/l (range 1.73-2.61 mmol/l) and for the diabetic patients (n = 432) 2.87 +/- 0.60 mmol/l (range 2.27-3.25 mmol/l). There were significant differences in fructosamine concentrations among the diabetic patients, corresponding to the degree of metabolic control. Serum fructosamine levels were closely correlated to the HbA1 levels. Compared with HbA1, fructosamine reflects short-term metabolic changes and appears to be an useful index of short-term glycemia.

Diabetes Mellitus, Type 1↗

Value of maternal fructosamine in the screening of an unselected population for hyperglycemia-related complications in the newborn.

The relationship between the maternal serum fructosamine concentration and pregnancy outcome was studied in 765 consecutive subjects of an obstetric community hospital population. The neonatal outcome of patients with a fructosamine concentration in pregnancy below and above 2.30 mmol/L were compared. Patients with a fructosamine concentration above 2.30 mmol/L did not show an increased incidence of neonatal hypoglycemia, hyperbilirubinemia, or respiratory distress syndrome. On the other hand, they did give birth to infants with a higher birthweight ratio, a variable defined as newborn weight corrected for sex, gestational age, and parity. However, the predictive value with respect to birthweight ratio was modest: Fructosamine accounted for only 1.4% of the variation in birthweight ratio, much less than other well-known contributors to this variation, such as smoking (10%) and prepregnancy maternal (6.5%) or paternal weight (2.8%). The screening value of fructosamine to identify patients who would give birth to a macrosomic infant was limited irrespective the gestational age at measurement. It is concluded that fructosamine determined during pregnancy in an unselected obstetric population is an unsuitable screening method to trace patients with an increased risk to deliver of an infant with neonatal complications of maternal hyperglycemia.

Adult↗

Association between serum fructosamine and mortality in elderly women: the study of osteoporotic fractures.

Serum fructosamine levels can be used to estimate long-term serum glucose values and can be measured in frozen serum. The authors examined whether fructosamine levels were associated with mortality in a cohort of 9,704 white women (> or = 65 years of age) recruited from September 1986 to October 1988 at four clinical centers in the United States. A random sample of women who had died during a mean of 6 years of follow-up (n = 55) was compared with randomly selected controls (n = 276, 54 of whom had died). Fructosamine assays were performed blinded to vital status. Hazard ratios with 95% confidence intervals were adjusted for age, clinical center, smoking, hypertension, and serum albumin and cholesterol levels. Each standard deviation (46 micromol) increase in fructosamine level was associated with a 1.3-fold (95% confidence interval (CI) 1.0-1.6, p = 0.04) increased rate of all-cause mortality, including a 1.5-fold (95% CI 1.0-2.1, p = 0.03) increase in cardiovascular disease mortality. Elevated fructosamine levels (>285 micromol/liter) were associated with a 4.3-fold (95% CI 1.6-12, p = 0.004) increased rate of cardiovascular mortality; in women without a history of diabetes, the hazard ratio was 4.6 (95% CI 1.3-16, p = 0.02). Fructosamine level, or another indicator of glycemia, should be included when the risk of cardiovascular disease among older patients is evaluated.

Aged↗

Serum fructosamine concentrations in 59 dogs naturally Infected with Angiostrongylus vasorum.

Retrospectively, 89 cases of dogs infected with Angiostrongylus vasorum were examined. Fifty-nine of these 89 dogs fulfilled the criteria of not being dually infected with Crenosoma vulpis as well as having a full biochemistry profile including serum fructosamine available. The mean serum fructosamine value of the 59 dogs was 236 micromol/l (reference value 258-348 micromol/l) and significantly lower than the serum fructosamine level of 314 micromol/l in a control group of 42 clinically healthy dogs. Eleven dogs were available for follow up after successful treatment of angiostrongylosis. In this group, the serum fructosamine value rose from a mean of 244 micromol/l to a mean of 320 micromol/l following treatment. Serum glucose, albumin and protein were all within the respective reference ranges at all sampling points. The results indicate that serum fructosamine could be affected by infection with A. vasorum. Furthermore, this change cannot be explained by measurable changes in the level of glucose, albumin or protein. The clinical impact of this study is that a low fructosamine value may indicate infection with A. vasorum thereby suggesting a Baermann test to be performed.

Angiostrongylus↗

Comparison of serum fructosamine with glycosylated serum protein (determined by affinity chromatography) for the assessment of diabetic control.

Glycosylated total protein (GTP) and glycosylated albumin (GALb) were measured in serum using aminophenylboronic acid affinity chromatography and the results were compared with those found using the fructosamine assay. The percentage GTP and GALb found by affinity chromatography correlated well with fructosamine values in the sera of a group of non-diabetic and diabetic patients (fructosamine vs GTP, r = 0.91, p less than 0.001; fructosamine vs GALb, r = 0.91, p less than 0.001). Results of each method gave similar correlations when compared with the degree of diabetic control assessed by glycosylated haemoglobin (GHb) and fasting plasma glucose (FPG) (fructosamine vs FPG, r = 0.74, p less than 0.001; GTP vs FPG, r = 0.75, p less than 0.001; GALb vs FPG, r = 0.79, p less than 0.001; fructosamine vs GHb, r = 0.79, p less than 0.001; GTP vs GHb, r = 0.81, p less than 0.001; GALb vs GHb, r = 0.84, p less than 0.001). Both methods could equally discriminate between groups of non-diabetics and diabetic patients (p less than 0.001) and showed similar temporal changes after starting insulin therapy.

Adolescent↗

Fructosamine in obese normal subjects and type 2 diabetes.

The effect of various grades of obesity on serum fructosamine concentrations was studied in Type 2 diabetic (n = 105) and non-diabetic (n = 128) subjects. In obese diabetic and non-diabetic subjects (body mass index > or = 30 kg m-2), the concentration of fructosamine was markedly lower than that obtained for lean diabetic and non-diabetic subjects with similar glycaemic control. Stepwise multiple-regression analysis showed that fructosamine was associated with glycaemic control (as indicated by fasting plasma glucose and glycated haemoglobin), fasting triglycerides, and body mass index in both diabetic and non-diabetic subjects. In vitro studies showed marked decreases in both the extent of [14C]-glucose incorporation into plasma proteins and fructosamine production by incubated sera of obese patients whether diabetic or non-diabetic, with obese subjects with body mass index > 40 kg m-2 exhibiting the greatest decrease. In conclusion, serum fructosamine concentrations are shown to decrease in obese diabetic and non-diabetic subjects with body mass index > or = 30 kg m-2 giving rise to the underestimation of glycaemic control as indicated by fructosamine measurement. A change in the glycation reaction itself may be partly responsible for such decrease.

Adult↗

Clinical usefulness of fructosamine measurements in diagnosing and monitoring feline diabetes mellitus.

Fructosamines are glycated serum proteins that reflect long-term serum glucose concentrations in humans and several animal species. In the present study, blood samples were drawn from three populations of diabetic cats: untreated diabetic cats with clinical symptoms prevailing only a few days (n = 1), untreated diabetic cats with symptoms lasting more than two weeks (n = 6) and clinically well stabilised diabetic cats receiving insulin twice daily which showed no signs of disease (n = 4). All untreated diabetic cats showed elevated fructosamine measurements. Based on fructosamine measurements, clinically well stabilised diabetic cats could be subdivided further according to the degree of glycaemic control. Diabetic cats with satisfactory glycaemic control revealed fructosamine concentrations within or close to the reference range (146 to 271 mumol/liter), whereas fructosamine concentrations above 400 mumol/liter indicated insufficient glycaemic control. This study suggests that the fructosamine assay reflects persistently elevated serum glucose concentrations in cats and is a useful parameter for diagnosing and monitoring diabetes mellitus in cats.

Animals↗