Women with prior gestational diabetes mellitus (GDM) remain at increased risk for prediabetes and type 2 diabetes mellitus (T2DM) after pregnancy, highlighting the need for practical tools that capture glycemic abnormalities beyond conventional measures. A study published in Diabetes & Metabolic Syndrome: Clinical Research & Reviews evaluated the relationship between fructosamine and multiple glycemic control indices in individuals with previous GDM.

This analysis included 844 individuals assessed 5-9 months postpartum. Data collection included demographics, medical history, glycated hemoglobin (HbA1c), oral glucose tolerance testing (OGTT), fructosamine levels, and blinded continuous glucose monitoring (CGM). Regression models with interaction terms for dysglycemia evaluated associations between fructosamine and glycemic indices. Standardized models and partial R² analyses enabled direct comparison with HbA1c.

Findings

• Among 844 participants, 407 (48.2%) had prediabetes and 47 (5.5%) had T2DM.
• Mean fructosamine levels were significantly higher in participants with T2DM compared with normoglycemic and prediabetes groups (255.6 ± 4.0 vs 235.7 ± 22.0 and 238.3 ± 21.4 μmol/L; P<0.001).
• Fructosamine correlated with 2-hour post-load glucose (β=0.018; P<0.001) and HbA1c (β=0.054; P<0.001), but not fasting glucose.
• Higher fructosamine levels were associated with lower CGM time-in-range and higher time-above-range, time-below-range, glucose management indicator, glycemic variability, and coefficient of variation.
• Associations between fructosamine and glycemic indices were strongest among participants with T2DM.
• HbA1c demonstrated stronger relationships with time-in-range, whereas fructosamine more strongly reflected glycemic variability. Combined models improved overall model fit.

This analysis showed that fructosamine captured adverse glycemic patterns, particularly glycemic variability, in individuals with prior GDM. The findings suggest fructosamine may provide complementary information to HbA1c and could support glycemic assessment when CGM is unavailable.