Background: Microvascular complications such as retinopathy, nephropathy, and neuropathy are major causes of morbidity in type 2 diabetes mellitus (T2DM). Glycated hemoglobin (HbA1c) is the standard marker for long-term glycemic control, whereas serum fructosamine reflects short-term fluctuations. Their comparative predictive value for complications remains under evaluation. Objective: To assess and compare the prognostic value of fructosamine and HbA1c in detecting microvascular complications among T2DM patients. Methods: This multicenter cross-sectional study was conducted from February 2024 to February 2025 in tertiary care hospitals across Pakistan. One hundred patients with ≥5 years of T2DM were enrolled. HbA1c was measured by high-performance liquid chromatography and fructosamine by nitroblue tetrazolium assay. Neuropathy was assessed clinically and with nerve conduction studies where indicated; retinopathy by dilated fundus examination; and nephropathy by urine albumin-to-creatinine ratio and eGFR. ROC curve analysis, logistic regression, and correlation were performed. Results: Mean age was 55.2 ± 8.6 years; mean diabetes duration 10.1 ± 4.3 years. Retinopathy, nephropathy, and neuropathy were present in 42%, 36%, and 49% of patients, respectively. Fructosamine was significantly associated with neuropathy (348.7 vs 294.3 µmol/L, p < 0.01), while HbA1c was higher in retinopathy (9.1% vs 7.5%, p < 0.001) and nephropathy (8.9% vs 7.7%, p < 0.01). ROC analysis showed fructosamine better predicted neuropathy (AUC 0.76), HbA1c predicted retinopathy (AUC 0.83) and nephropathy (AUC 0.80). Combined use improved diagnostic accuracy (AUC 0.87). Conclusion: Fructosamine adds predictive value for neuropathy, while HbA1c remains superior for retinopathy and nephropathy. Their combined assessment enhances identification of T2DM patients at risk of microvascular complications.
Haq et al. (2025) studied this question.