title: Gestational diabetes: an evaluation of serum fructosamine as a screening test in a high-risk population.
abstract: OBJECTIVE
  To evaluate the value of serum fructosamine as a screening test for gestational diabetes mellitus (GDM).
  
  
  METHODS
  849 pregnant women underwent the one-step 75 g oral glucose tolerance test (OGTT) for universal screening of GDM. The fasting serum fructosamine (cFruc) was assessed using the area under the receiver operating characteristic curve (AUC). The GDM diagnostic criteria used were those of the American Diabetes Association; however, the cFruc performance was also evaluated using criteria of the World Health Organization, Australian (ADIPS), European (EASD) and International Association of Diabetes and Pregnancy Study Groups (IADPSG).
  
  
  RESULTS
  113 (13.3%) women had GDM. The AUC of the cFruc was 0.60 (95% CI 0.54-0.66). A cFruc threshold of 237 μmol/l achieved an acceptable sensitivity of 85.8% (95% CI 78.0-91.0%), but the associated specificity remained poor at 23.4% (95% CI 20.0-27.0%) with a positive predictive value of just 14.7%. Overall, over 4 out of 5 pregnant women, being over this cutoff, would need the confirmatory OGTT. No cFruc threshold reached acceptable likelihood ratios to rule-in or rule-out GDM. The AUC for cFruc remained unacceptable independent of the diagnostic criteria.
  
  
  CONCLUSIONS
  Despite all the advances in technology, serum fructosamine is a poor test to screen for GDM.
authors.affiliation: Department of Pathology, Faculty of Medicine, UAE University, Al Ain, United Arab Emirates. magarwal7@gmail.com
authors.forename: Mukesh M
authors.initials: MM
authors.lastname: Agarwal
authors.forename: Gurdeep S
authors.initials: GS
authors.lastname: Dhatt
authors.forename: Yusra
authors.initials: Y
authors.lastname: Othman
authors.forename: Milos R
authors.initials: MR
authors.lastname: Ljubisavljevic
mesh_terms: D000328:Adult; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis*; D005215:Fasting / Q000097:blood; D005260:Female; D019270:Fructosamine / Q000097:blood*; D005951:Glucose Tolerance Test; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D011237:Predictive Value of Tests; D011247:Pregnancy; D018566:Pregnancy, High-Risk / Q000097:blood*; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D019270:Fructosamine