Fructosamine
Fructosamine measures glycated blood proteins and reflects average glucose over the past 2 to 4 weeks. A US cohort put its reference interval at about 195 to 258 µmol/L. Higher levels go with more diabetes, kidney disease, heart disease and deaths. A US laboratory guideline states the test is not standardized and that no treatment goals have been set.
Checked 2026-11-13
- Status
- A blood test run by clinical laboratories, ordered by a clinician. FDA has cleared fructosamine assays, and in 2017 a glycated albumin assay, under its class II regulation for glycosylated hemoglobin assays [1]. A joint laboratory guideline of the American Association for Clinical Chemistry and American Diabetes Association states that the clinical utility of glycated proteins other than hemoglobin has not been clearly established, that neither fructosamine nor glycated albumin is standardized and that treatment goals have not been established. It allows their use where red blood cell turnover, hemoglobin variants or other factors compromise an HbA1c result [2].
- Measures
- The total of glycated proteins in serum or plasma, which reflects average blood glucose over the previous 15 to 30 days, the turnover time of albumin [2].
- Also called
- fructosamine, serum fructosamine, glycated serum protein, GSP, glycosylated serum protein, FRA, glycated albumin, GA, glycated protein, 2 to 3 week glucose test
- Tested for
- blood sugar control over recent weeks, diabetes monitoring when HbA1c is unreliable, anemia or hemoglobin variants, pregnancy, checking a recent change in diabetes treatment, diabetes screening
Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on
Linked in research3
- ModerateLinked to more new diabetes at higher levels, about 5 times the rate above the 95th percentile in a US cohort, a weaker predictor than HbA1c.
- ModerateLinked to more heart attacks and deaths at high levels in US and Swedish cohorts, and to slightly more deaths at the lowest levels.
- LimitedOne US cohort linked fructosamine above the 95th percentile to 50% more new chronic kidney disease, and higher levels to more retinopathy.
Reported risks0
No risks sourced yet.
Reference ranges
Each range is the one its source published, in µmol/L. Where sources differ, each is shown.
Reference interval in the Atherosclerosis Risk in Communities Study, United States, 2018
Adults, from a healthy reference group of US black and white adults with a mean age of 55 · [3]
| Range | What the source calls it |
|---|---|
| below 194.8 µmol/L | No name given |
| 194.8 to 258 µmol/L | "reference interval" |
| above 258 µmol/L | No name given |
A population reference interval, the 2.5th to 97.5th percentiles of 1,799 healthy people, so 1 in 20 healthy people falls outside it. It is not a diagnostic range, and a laboratory guideline states that fructosamine is not standardized and has no established treatment goals [2]. The authors also matched fructosamine to existing diabetes cut points by percentile: 270.2 µmol/L corresponded to an HbA1c of 6.5% and 261.7 µmol/L to a fasting glucose of 126 mg/dL. Distributions differed by race, sex and body mass index. For glycated albumin, a different quantity that is not placed on this scale, the same study gives a reference interval of 10.7% to 15.1% and 15.6% as the equivalent of an HbA1c of 6.5% [3].
Reference interval in the ELSA-Brasil cohort, Brazil, 2019, women
Women without diabetes and with normal glucose and kidney tests, in a Brazilian cohort of adults · [4]
| Range | What the source calls it |
|---|---|
| below 186 µmol/L | No name given |
| 186 to 248 µmol/L | "reference interval" |
| above 248 µmol/L | No name given |
A population reference interval from 466 men and women selected after excluding people with diabetes or altered glucose or kidney tests. It is not a diagnostic range [2]. Fructosamine was higher in men than in women and in the non-white population, and fell slightly with higher body mass index. The authors conclude that intervals stratified by sex are more adequate [4].
Reference interval in the ELSA-Brasil cohort, Brazil, 2019, men
Men without diabetes and with normal glucose and kidney tests, in a Brazilian cohort of adults · [4]
| Range | What the source calls it |
|---|---|
| below 196 µmol/L | No name given |
| 196 to 269 µmol/L | "reference interval" |
| above 269 µmol/L | No name given |
The same study's interval for men, whose upper limit sits 11 µmol/L above the US interval for both sexes [3][4]. It is not a diagnostic range [2].
How it compares with the reference method
Mixed results2
Agreement with HbA1c and blood glucose
Mixed results: fructosamine correlated with HbA1c at 0.67 to 0.75 in people with diabetes, and in one study 40% of paired results pointed to different risk.
The numbers and sources
- Compared with
- HbA1c and glucose measured on the same sample
- Effect
- In a Swedish cohort with all three tests from the same examination, fructosamine correlated with HbA1c at 0.67 to 0.75 in people with type 1 or type 2 diabetes, fasting or not. It separated people with and without diabetes with an area under the curve of 0.91 to 0.95, and the cohort's chosen cut point had a sensitivity of 61% and a specificity of 97% [10]. In 153 people with both tests on the same sample, the gap between measured HbA1c and the HbA1c predicted from fructosamine ranged from -3.2 to 5.5 percentage points, and 40% of samples differed enough to change the predicted risk of complications. The gap was stable in people retested about 23 weeks later (correlation 0.81) [11]. A laboratory guideline notes that fructosamine reflects 15 to 30 days of glucose, against 60 to 90 days for HbA1c [2].
- Population
- 10,987 people, 5,590 of them fasting [10]. 153 people, with repeat measurements in 65 [11].
- Sources
- [10], [11], [2]
- Caveats
- The sources state no single threshold for agreement. The two tests cover different lengths of time, so a difference between them need not be an error in either. The Swedish cut point, 2.5 mmol/L, is on that cohort's scale, about ten times this page's, and is not placed here [10].
Variation from one test to the next
One small study found fructosamine varied 2.3% within a healthy person over two months, with a 10% change needed to exceed expected variation.
The numbers and sources
- Compared with
- The same person's results on 5 draws, one every two weeks
- Effect
- Within-person variation was 2.3% for fructosamine, 2.1% for glycated albumin and 2.3% for albumin. Variation between people was 6.3%, 10.6% and 2.9%, and analytical variation 2.8%, 1.7% and 2.3%. The authors calculated that two results in one person need to differ by 10% for fructosamine and 7.5% for glycated albumin to exceed expected variation [13].
- Population
- 18 apparently healthy adults aged 26 to 52, 9 men and 9 women [13].
- Sources
- [13]
- Caveats
- Eighteen healthy people and one laboratory, so the figures may not hold in people with diabetes. The study states no threshold for agreement, so the result is given as numbers only [13].
Did not match the reference method1
Calibration and standardization of the assay
Limited evidence: results from older and newer fructosamine calibrations differ about tenfold, and a 2023 guideline states the test is still not standardized.
The numbers and sources
- Compared with
- An earlier fructosamine assay calibrated with a different standard
- Effect
- A 1990 standardization paper calibrated the assay with glycated protein standards and obtained an average of 247 µmol/L in people without diabetes, about a tenth of the value given by the earlier assay calibrated with a synthetic standard [12]. A Swedish cohort reports fructosamine in mmol/L, with 2.5 mmol/L as its cut point for diabetes and 2.30 mmol/L as the level above which heart attacks and deaths rose [10][8]. A 2023 laboratory guideline states that neither fructosamine nor glycated albumin is standardized, and that efforts toward a reference method for glycated albumin are under way [2].
- Population
- A laboratory standardization study and a guideline, not studies of patients [12][2].
- Sources
- [12], [10], [8], [2]
- Caveats
- A laboratory report does not always say how the assay was calibrated. A result is comparable with a reference interval only when both come from the same kind of assay.
What studies tie it to
Linked in research3
Developing diabetes
Linked to more new diabetes at higher levels, about 5 times the rate above the 95th percentile in a US cohort, a weaker predictor than HbA1c.
The numbers and sources
- Effect
- Among US adults without diabetes followed for two decades, the hazard ratio for developing diabetes was 4.96 (95% CI 4.36 to 5.64) for fructosamine above the 95th percentile and 6.17 (5.45 to 6.99) for glycated albumin above the 95th percentile. The associations weakened and persisted after adjustment for HbA1c. HbA1c predicted new diabetes more accurately, with C statistics of 0.760 for HbA1c, 0.706 for fructosamine and 0.703 for glycated albumin [5]. In a later sample of the same cohort, the top against the bottom quarter of fructosamine had a hazard ratio of 3.99 (95% CI 1.93 to 8.28), which remained significant after adjustment for HbA1c or fasting glucose [6].
- Population
- 11,348 adults without diabetes in the Atherosclerosis Risk in Communities Study, examined in 1990 to 1992 [5]. 1,299 participants of the same study without diagnosed diabetes, 119 new cases over a median 3.3 years [6].
- Sources
- [5], [6]
- Caveats
- Observational, and both analyses come from one US cohort. In the smaller analysis new diabetes was self-reported [6].
Eye and kidney complications
One US cohort linked fructosamine above the 95th percentile to 50% more new chronic kidney disease, and higher levels to more retinopathy.
The numbers and sources
- Effect
- Fructosamine and glycated albumin were strongly associated with retinopathy (P below 0.0001 for trend). The adjusted hazard ratio for chronic kidney disease was 1.50 (95% CI 1.22 to 1.85) for fructosamine above the 95th percentile and 1.48 (1.20 to 1.83) for glycated albumin, compared with people without diabetes below the 75th percentile. Prediction of chronic kidney disease was nearly as strong as with HbA1c, with C statistics of 0.717, 0.717 and 0.726 [5].
- Population
- 11,348 adults without diabetes and 958 with diagnosed diabetes, followed for two decades [5].
- Sources
- [5]
- Caveats
- Observational, from one cohort. A laboratory guideline states that few published studies have convincingly shown a relationship between glycated protein levels and the chronic complications of diabetes [2].
Heart attack, stroke and death from any cause
Linked to more heart attacks and deaths at high levels in US and Swedish cohorts, and to slightly more deaths at the lowest levels.
The numbers and sources
- Effect
- In a US cohort followed for two decades, elevated fructosamine and glycated albumin were each significantly associated with coronary heart disease, ischemic stroke, heart failure and death after adjustment for cardiovascular risk factors. The associations were similar in size to those for HbA1c and tended to be J-shaped, with raised risk at the lowest levels as well [7]. In a Swedish cohort, the hazard ratio in people above 2.70 mmol/L on that cohort's scale, against its reference range, was 2.88 (95% CI 2.70 to 3.07) for heart attack and 2.31 (2.21 to 2.41) for death from any cause, and the associations weakened but remained after adjustment for glucose [8]. Among Swedish adults without diabetes, the lowest tenth of fructosamine had a hazard ratio for death of 1.20 against the middle eight tenths, falling to 1.11 (95% CI 1.07 to 1.15) after adjustment for six other blood markers [9].
- Population
- 11,104 adults with and without diabetes, with 1,096 new cases of coronary heart disease, 605 ischemic strokes, 1,432 cases of heart failure and 2,860 deaths [7]. 338,443 people followed 19 years on average, with 21,526 heart attacks and 73,458 deaths [8]. 215,011 people without diabetes, 41,388 deaths over 25 years [9].
- Sources
- [7], [8], [9]
- Caveats
- Observational. The Swedish cohort reported fructosamine in mmol/L on a scale about ten times this page's, so its cut points are not placed here. Its authors found that smoking and chronic inflammation at least partly explained the higher mortality at low fructosamine [9]. No source here tested whether lowering fructosamine changes these outcomes, and a laboratory guideline states that treatment goals have not been established [2].
Sources
- US Food and Drug Administration. 510(k) premarket notification records for fructosamine assays (for example K131307, cleared January 24, 2014) and for the Lucica Glycated Albumin-L assay (K170147, cleared October 12, 2017), product code LCP, read through the openFDA device API, with 21 CFR 864.7470, Glycosylated hemoglobin assay. Electronic Code of Federal Regulations. https://www.ecfr.gov/current/title-21/section-864.7470
- Sacks DB, Arnold M, Bakris GL, et al. Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus. Diabetes Care. 2023. https://doi.org/10.2337/dci23-0036
- Selvin E, Warren B, He X, Sacks DB, Saenger AK. Establishment of Community-Based Reference Intervals for Fructosamine, Glycated Albumin, and 1,5-Anhydroglucitol. Clinical Chemistry. 2018. https://doi.org/10.1373/clinchem.2017.285742
- Pedrosa W, Sander Diniz MFH, Barreto SM, Vidigal PG. Establishing a blood fructosamine reference range for the Brazilian population based on data from ELSA - Brasil. Practical Laboratory Medicine. 2019. https://doi.org/10.1016/j.plabm.2018.e00111
- Selvin E, Rawlings AM, Grams M, et al. Fructosamine and glycated albumin for risk stratification and prediction of incident diabetes and microvascular complications: a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study. The Lancet Diabetes and Endocrinology. 2014. https://doi.org/10.1016/S2213-8587(13)70199-2
- Juraschek SP, Steffes MW, Miller ER, Selvin E. Alternative Markers of Hyperglycemia and Risk of Diabetes. Diabetes Care. 2012. https://doi.org/10.2337/dc12-0787
- Selvin E, Rawlings AM, Lutsey PL, et al. Fructosamine and Glycated Albumin and the Risk of Cardiovascular Outcomes and Death. Circulation. 2015. https://doi.org/10.1161/CIRCULATIONAHA.115.015415
- Malmström H, Walldius G, Grill V, Jungner I, Hammar N. Fructosamine is a risk factor for myocardial infarction and all-cause mortality: Longitudinal experience from the AMORIS cohort. Nutrition, Metabolism and Cardiovascular Diseases. 2015. https://doi.org/10.1016/j.numecd.2015.07.002
- Malmström H, Wändell PE, Holzmann MJ, et al. Low fructosamine and mortality: A long term follow-up of 215,011 non-diabetic subjects in the Swedish AMORIS study. Nutrition, Metabolism and Cardiovascular Diseases. 2016. https://doi.org/10.1016/j.numecd.2016.08.006
- Malmström H, Walldius G, Grill V, et al. Fructosamine Is a Useful Indicator of Hyperglycaemia and Glucose Control in Clinical and Epidemiological Studies: Cross-Sectional and Longitudinal Experience from the AMORIS Cohort. PLoS ONE. 2014. https://doi.org/10.1371/journal.pone.0111463
- Cohen RM, Holmes YR, Chenier TC, Joiner CH. Discordance Between HbA1c and Fructosamine: Evidence for a glycosylation gap and its relation to diabetic nephropathy. Diabetes Care. 2003. https://doi.org/10.2337/diacare.26.1.163
- Schleicher ED, Vogt BW. Standardization of serum fructosamine assays. Clinical Chemistry. 1990. https://doi.org/10.1093/clinchem/36.1.136
- Montagnana M, Paleari R, Danese E, et al. Evaluation of biological variation of glycated albumin (GA) and fructosamine in healthy subjects. Clinica Chimica Acta. 2013. https://doi.org/10.1016/j.cca.2013.04.003