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HbA1C and Fructosamine levels during Infancy

Rebecca Schneider Aguirre, Abeer Al-Raddadi, Linda A DiMeglio

    Medrxiv : the Preprint Server for Health Sciences
    |May 19, 2025
    PubMed

    Insights

    Hemoglobin A1C (HbA1C) is unreliable for infant glucose monitoring due to high fetal hemoglobin (HbF). Fructosamine may be a better indicator in infants under six months old.

    Area of Science:

    • Pediatrics
    • Clinical Chemistry
    • Endocrinology

    Background:

    • Hemoglobin A1C (HbA1C) is commonly used to assess long-term glycemia.
    • High levels of fetal hemoglobin (HbF) in infants interfere with HbA1C accuracy.
    • The utility of HbA1C and fructosamine for assessing glycemia in infants is not well-established.

    Purpose of the Study:

    • To determine the age at which HbA1C becomes a reliable measure of glycemia in infants.
    • To evaluate the effectiveness of fructosamine as an alternative marker for infant glycemia.
    • To investigate the correlation between HbA1C, HbF, and fructosamine levels in infants.

    Main Methods:

    • HbA1C, hemoglobin electrophoresis, fructosamine, and albumin levels were measured in healthy infants aged 3 weeks to 12 months.
    • Statistical analysis was performed to assess correlations between HbA1C, HbF, age, and fructosamine levels.
    • HbA1C values were analyzed in relation to age and HbF percentages.

    Main Results:

    • HbA1C percentages showed a negative correlation with HbF percentages (p < 0.005).
    • HbA1C levels increased with age in infants younger than 6 months (p < 0.01).
    • Fructosamine levels did not significantly vary with infant age.

    Conclusions:

    • HbA1C measured by HPLC is likely a reliable indicator of glycemia in infants after 6 months of age.
    • Fructosamine may serve as a more accurate biomarker for assessing glycemia in infants younger than 6 months.
    • Adjusting HbA1C or fructosamine for hemoglobin or albumin fractions, respectively, did not improve diagnostic significance.

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