Glycated protein is an alternative test for assessing diabetes control when Hb A1c is inappropriate, however FBS and 2 hours post prandial are simple and readily available method for assessing control.

See this link

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6347654/

Glycated protein is an alternative test for assessing diabetes control when Hb A1c is inappropriate, however FBS and 2 hours post prandial are simple and readily available method for assessing control.

Agree with Dr. Anmar Aldewachi

It is difficult to use HbA1c as an indicator of glycaemic control in patients with neonatal diabetes mellitus (NDM) because of high levels of fetal hemoglobin (HbF) remaining in the blood. So, glycated albumin (GA) is a useful indicator of glycaemic control in patients with NDM, whereas HbA1c is influenced by age-related changes in HbF and does not accurately reflect glycaemic control.

Interesting

Dear Dr Isam Alkhalifawi. Thanks a lot for your kindful contribution and attached link. SIncere gratitude

Dear Dr Anmar Aldewachi. Really thank you so much for your kindful contribution and reply. I agree with you that glycated albumin ( Fructosamine) is a useful alternative tool of assessing glycaemic control in patients with diabetes when the use of HbA1c is inappropriate. Best regards.

Dear Dr Sura Aldewachi. Thank you so much for your kindful contribution and comment. Best regards.

Dear Dr Manal Hadi Kanaan. Really thank you so much for your kindful contribution and reply. I fully agree with your comment of the useful alternative role of fructosamine in evaluating the status of glycaemic control when the measurement of HbA1c may be inaccurate. Sincere gratitude.

In fact, several alternative means may be useful in evaluating the status of glycaemic control in patients with diabetes other than HbA1c, however with variable indications, time factor of reflecting the degree of glycaemic status, feasibility and practical use. These include glycated albumin (fructosamine), 1,5 Anhydroglucitol (1,5 AG) and other forms of glucose monitoring including self monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM). Fructosamine reflects glycaemic status in the previous 2-3 weeks , a period shorter in comparison to that of HbA1c.

Dear Dr Sana MH Al-shimmary. Thank you so much for your kindful contribution and comment. Best regards.

I agree with Dr Anmar Aldewachi

Dear Dr Raya Al-Naimi. Thank you so much for your kindful contribution and comment. Best regards.

Dear Salman Ajlan

FBS and postprandial tests are alternatives. However, these tests suffer from a fundamental issue. This is the patient may limit his/her food intake in an attempt to show, for himself and the surroundings, the diabetic state is controlled.

Regards

The HbA1C was introduced as a means of determining long-term blood glucose control and is an average of the blood sugar levels (as determined by by the "sugar coating" of hemoglobin). It is comprised of both fasting and (mainly) the postprandial blood--and more importantly mainly represents blood sugar levels from 3-6 months ago. Hence, I use fasting and two-hour post-prandial blood sugars to assess diabetes control. And hence I agree with Dr Aldewachi and I accept the response of Dr Mustafa as well. Evenso, this approach works out well for my patients.

Dear Dr Yasser Fakri Mustafa. Really thank you so much for your kindful contribution and wonderful comment. In fact, single blood glucose measurement reflects glucose level at the moment of sampling, thus it is of little benefit in assessing the long term glycaemic control as it is affected greatly by feeding or fasting. On the other hand serial blood glucose measurements would be informative. Sincere gratitude dear Dr Yasser.

Dear Dr William Feeman. Thank you so much for your kindful contribution and reply. Your amazing and valuable comment is highly appreciated. In fact, reviewing patient's records of serial fasting and postprandial blood glucose measurements would be very valuable in terms of management of diabetes. Sincere gratitude.

Happy to have been of help.

Dear Dr William Feeman. Your amazing contribution is highly appreciated. Kind regards

I agree with what has been said generally. I would like to add that to assess glycemic control when Hb1Ac is not feasible, fructosamine should be considered first because of its advantages over other alternatives such as fasting blood glucose and 2 hours postprandial glucose. These advantages include inability to be influenced by certain factors prior to frutosamine test and include diets (types, quantity and quality), mood of patients (angry vs happy mood), exercise (various types and duration), use of drugs (including antidiabetic drugs), etc.

Fructosamine provides a measure of glycemic control over a period of 2-3 weeks whereas fasting blood glucose and 2-hour postprandial tests provide info on blood glucose over a shorter period (even hours) and these blood glucose values can easily fluctuate or be influenced. Hence, they are less reliable compared to fructosamine.

For instance, if two patients choose to come to the hospital for glucose tests via 2 different modes of transportation - one by trekking (walking) and the other by a car. Their fasting blood glucose and 2-hour postprandial glucose concentrations may be influenced by these different modes of transportation but their fructosamine result will not change.

Hi Salman,

There's Glycated albumin (GA) which appears to be the most promising, as its assessment enables both faster detection of changes in glycaemic control in cases of poor metabolic discipline and documentation of glycaemic control improvement. You'll find in the link below an article that addresses this issue.

Article Is HbA1c the only choice? Alternative biomarkers for glycaem...

Good luck.

How to judge the approximate HbA1c from average blood glucose measurements?

The cost of testing for HbA1c is much higher than checking for fasting and random or postprandial blood glucose. Due to the cost-effective measures, many hospitals will reject ordering an HbA1c test if such test has been done previously within a TWO month period. If HbA1c is not available in a hospital due to availability or patient can not afford this test due to cost, chances of having a test for Glycated albumin or protein will be even more remote and even more expensive and less reliable than HbA1c.

A good glycemic control whatever way it is tested and evaluated translates into reduction of diabetic complications (mainly microvascular, and macrovascular if other associated risk factors like hypertension, dyslipidemia, and smoking can be controlled).

By having an average random blood glucose values over a period of time ne can gauge how would be the rough equivalent HbA1c (1-2).

1. Article Hemoglobin A1c and Self-Monitored Average Glucose: Validatio...

2. Article Glycated Hemoglobin (HbA1c): Clinical Applications of a Math...

It has become apparent in recent years that other glycated proteins such as fructosamine, glycated albumin, and the nutritional monosaccharide 1,5-anhydroglucitol, as well as integrated measures from direct glucose testing by an SMBG/continuous glucose monitoring system, may provide valuable complementary data, particularly in circumstances when HbA1c results may be unreliable or are insufficient to assess the risk of adverse outcomes. Long-term associations of these alternative biomarkers of glycemia with the risk of complications need to be investigated in order to provide clinically relevant cut-off values and to validate their utility in diverse populations of diabetes patients.

It has become apparent in recent years that other glycated proteins such as fructosamine, glycated albumin, and the nutritional monosaccharide 1,5-anhydroglucitol, as well as integrated measures from direct glucose testing by an SMBG/continuous glucose monitoring system, may provide valuable complementary data, particularly in circumstances when HbA1c results may be unreliable or are insufficient to assess the risk of adverse outcomes. Long-term associations of these alternative biomarkers of glycemia with the risk of complications need to be investigated in order to provide clinically relevant cut-off values and to validate their utility in diverse populations of diabetes patients.

Dear Dr Omotayo Erejuwa. Thank you so much for your kindful contribution and reply. Indeed, I agree with your wonderful and valuable comment. Best regards.

Dear Dr Walid Hassene Hamri. Thank you so much for your kindful contribution and comment as well as the valuable link. Best regards

Dear Dr Muhammad Yousuf. Thank you so much for your kindful contribution and reply. Your wonderful comment, valuable notes and the provided links are highly appreciated. Best regards.

Dear Dr Faraed Salman. Thank you so much for your kindful contribution and reply. I fully agree with your wonderful comment and valuable notes. Best regards.

Dear Dr Alaa Ali. Really thanks a lot for your kindful contribution and comment. Best regards

I agree with Dr. Anmar Aldewachi

Dear Dr Zena A.M. Aljawadi. Thank you so much for your kindful contribution and comment. Best regards.

Kindly check https://www.diabetes.org.uk/professionals/position-statements-reports/diagnosis-ongoing-management-monitoring/new_diagnostic_criteria_for_diabetes

Also check https://www.diabetes.co.uk/hba1c-test.html

Dear Dr Chinaza Godswill Awuchi. Thanks a lot for your kindful contribution and attached links. Best regards

I agree with Dr. Anmar.

Fructosamines ! Article Advantages and Pitfalls of Fructosamine and Glycated Albumin...

Dear Dr Isam Alkhalifawi. Really thanks a lot for your kindful contribution and comment. Sincere gratitude.

Dear Dr Daniel Constantin Manolescu. Really thank you so much for your kindful contribution and valuable link. Sincere gratitude.

Very interesting

introduction of continuous glucose monitoring CGM a few years ago was noted. Isolated poor control of fasting blood glucose also causes poor Hb A1c results. Any updates in these regards? thanks.

Dear Dr Nuraldeen Al-Khanati. Thanks a lot for your kindful contribution and comment. Sincere gratitude.

Dear Dr Win Hlaing Than. Thanks a lot for your kindful contribution and valuable comment. Sincere gratitude.