Diabetic retinopathy (DR) can occur in patients with type 2 diabetes mellitus (T2DM) even when hemoglobin A1c (HbA1c) is within recommended targets, suggesting that additional markers of glycemic exposure may be relevant. A retrospective cross-sectional study published in Diabetes Research and Clinical Practice reported an independent association between higher albumin-corrected fructosamine (AlbF) levels and DR.

The study evaluated 1,090 patients with T2DM. AlbF was derived from the ratio of serum fructosamine to albumin. Standardized ophthalmic examinations were used to determine DR status. Multivariable logistic regression models were applied after adjustment for demographic, metabolic, and clinical factors. Separate subgroup analyses were conducted according to HbA1c level.

After full adjustment, each 10 μmol/g increase in AlbF was related to higher odds of DR (OR 1.65; 95% CI 1.40-1.95). Compared with the lowest tertile, patients in the highest AlbF tertile had substantially greater odds of DR (OR 4.77; 95% CI 2.99-7.60).

The association was also present in patients with HbA1c below 7.0%. When AlbF was added to the analytical model, discrimination improved modestly (ΔAUC 0.045; P = 0.002).

These findings suggest AlbF may reflect aspects of glycemic exposure not fully captured by HbA1c. Because the study used a cross-sectional design, the results indicate association rather than causation or predictive performance.