Evaluation of fructosamine concentration as an index marker for glycaemic control in diabetic dogs

Abstract

Background: Although fructosamine is a commonly used surrogate marker to assess glycaemic control in diabetic dogs, its diagnostic accuracy has been questioned. The main objective of this study was to evaluate the reliability of fructosamine measurements to diagnose well and poorly controlled diabetes mellitus (DM), using continuous glucose monitoring as a gold standard. Methods: Twenty-four dogs with treated DM and continuous glucose monitoring for mean (±SD) 13.1 (±1.7) days were retrospectively analysed. Two assessment strategies were applied to categorize glycaemic control, and fructosamine concentrations were determined shortly after sensor cessation using a colorimetric assay. Results: Correlations of individual fructosamine concentrations with mean glucose as well as percentage of measurements > 15 mmol/L were not significant (p = 0.372, p = 0.129). Fructosamine did not differ between dogs with and without hypoglycaemic episodes (p = 0.64). Receiver operating characteristic analysis for fructosamine to diagnose either good or poor glycaemic control revealed AUC values of 0.71 (p = 0.025) indicating moderate accuracy, and 0.7 (p = 0.135) indicating AUC is non-discriminatory, respectively. The respective positive likelihood ratios for the optimal cutoffs to identify good (<396 µmol/L) and poor control (>449 µmol/L) were three. Conclusions: Fructosamine measurement is an imperfect surrogate marker for classifying glycaemic control in diabetic dogs and can only complement serial glucose measurements.

Successful Insulin Glargine Treatment in Two Pet Guinea Pigs with Suspected Type 1 Diabetes Mellitus

“…Though the use of fructosamine as a monitoring tool is a matter of controversial debate in cats and dogs and has rarely been used in GPs, plasma fructosamine was used as an additional tool in the present study [26,39,40]. Noticeably, plasma fructosamine concentrations decreased within only a few weeks after the start of the insulin treatment but stayed slightly above the upper reference limit during the entire observation period.…”

Clinical utility of serum fructosamine in long‐term monitoring of diabetes mellitus in dogs

“…The study only included revisits held at least a month after the commencement of insulin treatment to allow insulin equilibrium to be achieved. 11 Followup visits held more than 120 days after the previous documented visit were also excluded to reflect the actual clinical utility of sFA for continuous monitoring of DM and decrease the chance of unrecorded between-visit developments (e.g., emerged comorbidities or administration of additional treatments). The first follow-up visit recorded in the medical record was therefore not included in the analyses, either because the time lag between that visit and the previous follow-up visit could not be precisely determined (i.e., in cases diagnosed with DM in referring clinics), thereby precluding comparisons, or because the revisit met the exclusion criteria (i.e., held more than 120 days after the previous visit or less than 1 month after diagnosis of DM).…”

“…The study only included revisits held at least a month after the commencement of insulin treatment to allow insulin equilibrium to be achieved 11 . Follow‐up visits held more than 120 days after the previous documented visit were also excluded to reflect the actual clinical utility of sFA for continuous monitoring of DM and decrease the chance of unrecorded between‐visit developments (e.g., emerged comorbidities or administration of additional treatments).…”

“…The study recorded 321 follow-up visits overall. The median number of visits per dog (after excluding the first recorded follow-up visit) was 3 (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The median time between insulin treatment commencement and the first included follow-up visit was 2 months (range 1-63).…”

“…11 Nevertheless, in that study, dogs were only followed for 2 weeks. 11 Furthermore, FGMS devices have certain disadvantages potentially limiting their use in monitoring DM, including common technical problems (e.g., accidental sensor detachment and persistent incorrect readings) necessitating early and costly sensor replacement. 16 Additionally, certain FGMS devices require sensor scanning at least every 8 hours to obtain sufficient and clinically relevant glucose measurements, which might not be feasible for some dog owners.…”