Use of Fructosamine for Glycemic Monitoring in Patients With Sickle Cell Disease and Diabetes: A Systematic Review

Sickle cell disease is characterized by various forms of hemoglobin that interfere with hemoglobin A1c (HbA1c) testing, which is commonly used to diagnose and monitor diabetes. This interference puts patients with sickle cell disease at risk of inaccurate monitoring and misdiagnosis due to improperly planned HbA1c testing. Despite awareness of these issues, there is still disagreement regarding the most appropriate method of measuring HbA1c in patients with sickle cell disease, along with a lack of clear guidance on using fructosamine as an alternative marker in patients with diabetes and sickle cell disease. We employed a systematic review technique to assess the efficacy of fructosamine in diagnosing and monitoring diabetes in patients with sickle cell disease. The study showed that fructosamine is highly associated with fasting blood glucose levels in patients with sickle cell trait, and even more so in those with sickle cell disease and poorly controlled diabetes. It also demonstrated a fair association with HbA1c, as measured by some of the recommended instruments for use in patients with sickle cell disease. These results suggest that fructosamine can play a valuable role in managing diabetes in patients with sickle cell trait and disease, along with HbA1c, as HbA1c is widely used to monitor diabetes, even in patients with diseases that might affect the accuracy of HbA1c measurement.