Abstract
Fructosamine is an alternative method to hemoglobin A1c (HbA1c) for determining average glycemia. However, its use has not been extensively evaluated in persons living with HIV (PLWH). We examined the relationship between HbA1c and fructosamine values, specifically focusing on anemia (which can affect HbA1c) and albumin as a marker of liver disease. We included 345 PLWH from two sites. We examined Spearman rank correlations between fructosamine and HbA1c and performed linear test for trends to compare fructosamine and HbA1c correlations by hemoglobin and albumin quartiles. We examined discrepant individuals with values elevated only on one test. We found a correlation of 0.70 between fructosamine and HbA1c levels. Trend tests for correlations between fructosamine and HbA1c were significant for both albumin (p = 0.05) and hemoglobin (p = 0.01) with the lowest correlations in the lowest hemoglobin quartile. We identified participants with unremarkable HbA1c values but elevated fructosamine values. These discrepant individuals had lower mean hemoglobin levels than those elevated by both tests. We demonstrated a large correlation between HbA1c and fructosamine across a range of hemoglobin and albumin levels. There were discrepant cases particularly among those with lower hemoglobin levels. Future studies are needed to clarify the use of fructosamine for diabetes management in PWLH.
Highlights
The dramatic decline in HIV-related mortality since the introduction of potent antiretroviral therapy (ART) [1,2,3] has been accompanied by an increase in metabolic derangements including abnormalities in glucose metabolism such as type 2 diabetes mellitus [4,5,6]
Low Hemoglobin A1c (HbA1c) values may be an artifact related to factors that shorten the lifespan of erythrocytes [9, 10] and studies suggest that HbA1c can underestimate average glucose measures in persons living with HIV (PLWH) due to subclinical hemolysis associated with medications including dapsone, ribavirin, and trimethoprimsulfamethoxazole and other conditions that shorten the lifespan of red blood cells such as chronic renal disease [11,12,13]
While more information is needed to further identify exactly which PLWH would be most likely to benefit from fructosamine versus HbA1c testing in clinical care, this study suggests that those with low hemoglobin values might benefit from fructosamine rather than HbA1c values
Summary
The dramatic decline in HIV-related mortality since the introduction of potent antiretroviral therapy (ART) [1,2,3] has been accompanied by an increase in metabolic derangements including abnormalities in glucose metabolism such as type 2 diabetes mellitus [4,5,6]. The pathogenesis of these conditions is likely multifactorial and includes the direct effects of HIV itself [7] and metabolic complications associated with antiretroviral therapy (ART) [4, 5]. Many studies evaluating HbA1c among PLWH considered small numbers of participants [11, 14], were conducted early in the ART treatment era when regimens were different [11], and targeted PLWH with diabetes [11, 13, 14] limiting their generalizability to the current treatment era and across the full spectrum of HbA1c values.
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