Evidence Based

Fructosamine Test: High & Low Levels + Normal Range

Written by Helen Quach, BS (Biochemistry) | Reviewed by Biljana Novkovic, PhD | Last updated:

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Fructosamine is a measure of your 2-3 week average blood sugar levels. It is used in diabetic patients to measure glucose control. However, many health conditions can affect fructosamine levels. Keep reading to learn more about high and low fructosamine levels and how to improve them.

What is Fructosamine?

Sugar (glucose) in the blood tends to stick to proteins. Fructosamine is formed when a sugar and a protein (usually albumin, globulin, or lipoprotein) are combined [1].

Similarly to HbA1c (glucose + hemoglobin), fructosamine is a measure of the amount of glucose in the blood. However, while HbA1c measures your 3-month average glucose, fructosamine reflects mean blood glucose over the previous 2-3 weeks. This is due to the shorter life cycle of albumin [1, 2].

The advantage of fructosamine over HbA1c is that it’s not affected by changes in red blood cells and hemoglobin caused by anemia, blood loss, or nutrient deficiencies [1].

That said, there are also drawbacks to using fructosamine. Temperature, vitamin C, bilirubin, urea, and total protein levels can all affect fructosamine levels. All conditions that increase or decrease albumin levels will also affect fructosamine [1, 3].

Fructosamine tests will not be a good measure of glucose control and should not be used in people who have [1, 3, 4, 5]:

  • thyroid disease
  • intestinal disease (protein-losing enteropathy)
  • kidney disorder (nephrotic syndrome)
  • liver disease
  • increased immunoglobulin levels (especially IgA)

Fructosamine is used less often compared to HbA1c, mainly because it’s not standardized and is less reliable than an HbA1c test. In addition, because there is considerable overlap between the ranges of healthy people and diabetics, it can not be used to screen for diabetes [6].

Your doctor may test fructosamine to see how well you control your blood sugar levels. This test is useful to see short-term effects of diet, exercise, or medication, without having to wait a couple of months to test HbA1c.

Fructosamine can also be useful in pregnancy when your body is going through week-to-week changes. Its shorter life cycle allows you to track your blood glucose levels more closely [7].

Normal Range

In non-diabetics with normal albumin, fructosamine levels normally range between 190 – 285 umol/L (micromols per liter) [1, 8].

In people with diabetes, fructosamine ranges from 210 – 563 umol/L. In poorly controlled diabetes, levels will be higher.

Levels tend to increase with age [9].

Low Fructosamine Levels

Causes of Low Fructosamine Levels

1) Low Protein Levels

Fructosamine levels will be low when total blood protein and/or albumin levels are decreased [10].

Protein/albumin levels can decrease due to:

  • Lack of protein in the diet (malnutrition) [11]
  • Gut disease (protein-losing enteropathies) [1]
  • Kidney disease (nephrotic syndrome), in which higher than normal amounts of protein are lost via kidneys [1]
  • Liver disease, where there are issues with albumin production [1]
  • Hyperthyroidism, where there is increased protein turnover [12]
  • Inflammation. Fructosamine is, much like albumin, a negative acute phase reactant. It decreases in acutely ill patients [13]

2) Obesity

Obese people have lower fructosamine levels than non-obese people, even in diabetics [14, 15, 16].

If you are overweight, this test may underestimate the average glucose levels in your blood.

3) Pregnancy

Blood volume will normally increase in pregnancy [17].

While the absolute protein and albumin content stay the same, they become ‘”diluted”. That is why pregnant women have lower fructosamine levels [18].

Health Effects of Low Fructosamine Levels

1) Low Fructosamine Levels Increase the Risk of Fractures

In 477 women, low fructosamine levels increased the risk of hip fracture by three-fold. This likely reflects frailty or malnutrition linked with lower protein levels [19].

2) Low Fructosamine Levels are Associated with Cancer Risk

In an observational study of 12k people, the ones with low fructosamine but high glucose levels had a higher risk of developing cancer, including prostate, colon, and lung cancer [20].

3) Low Fructosamine Levels Increase the Risk of Heart Disease

In a study of over 11k people, low fructosamine increased the risk of heart disease [21].

4) Low Fructosamine Levels are Associated with an Increased Risk of Death

In an observational study of 215k people without diabetes, those with low fructosamine levels had an increased risk of death. This was partly explained by the effect of smoking and chronic inflammation [22].

Ways to Increase Fructosamine Levels

If your fructosamine levels are low due to low protein/albumin levels, make sure your diet is well balanced and contains adequate amounts of protein [11].

You should also address any underlying health issue by consulting a medical professional.

Lose weight if you are overweight. Fructosamine tends to decrease with increasing BMI [14, 15, 16].

High Fructosamine Levels

Causes of High Fructosamine Levels

1) Elevated Glucose Levels

The main cause of high fructosamine levels is high blood glucose. Fructosamine will increase with your blood glucose levels in the previous 2-3 weeks. If there is a trend of elevated fructosamine over time that means that you don’t have good control over your blood sugar [1].

2) Exercise

In a study of 6 type 1 diabetic patients, long-term exercise over 8 months helped improve fructosamine and HbA1c levels. However, short-term, acute exercise increased both fructosamine and HbA1c [23].

Doctors should take exercise into consideration when testing fructosamine.

3) UV Exposure

Exposure to UV rays can increase fructosamine levels because it can increase the body’s temperature. This increases fructosamine production. In a clinical trial of 55 people sunbathing over 7 days, people who were exposed to UV rays had higher fructosamine levels than those who used sunscreen [24].

4) Hypothyroidism

People with hypothyroidism have a decreased turnover of proteins, resulting in higher fructosamine levels [25].

In a study of 80 people, those with hypothyroidism had higher fructosamine levels than healthy people. The longer that a person had hypothyroidism, the higher their fructosamine levels got [26].

5) Increased Antibody Production

Fructosamine can increase when there is an increased amount of antibodies (globulin proteins) in the blood [27].

When fructosamine is elevated in spite of normal glucose and albumin levels, you should check your immunoglobulin levels [28, 29, 30].

6) Iron-deficiency Anemia

Patients with iron-deficiency anemia have significantly increased levels of fructosamine, probably as a result of increased oxidative stress [31, 32].

7) AIDs

In AIDs patients, glucose adheres more readily to proteins. This causing fructosamine levels to increase. In an observational study of 75 people, the AIDs patients had higher fructosamine levels than healthy people [33].

8) Glucocorticoid Treatment

In two clinical trials of 40 patients, the patients treated with glucocorticoids for asthma (prednisolone, budesonide) had increased fructosamine levels [34].

Health Effects of High Fructosamine Levels

1) High Fructosamine Levels are Associated with Depression

In an observational study of over 600 people, the ones who had higher fructosamine levels had a higher risk of depression. Elderly women with high fructosamine levels have a higher prevalence of major depressive disorder [35].

2) High Fructosamine Levels are Associated with Heart Disease

In two observational studies of more than 20k people, those with high fructosamine levels had a higher risk of heart disease, heart failure, stroke, and heart-disease associated mortality [36, 37].

3) High Fructosamine Levels are Associated with Kidney Disease

In a study of more than 12k people, those with high fructosamine levels were more likely to have chronic kidney disease compared to people with normal levels [38].

4) High Fructosamine Levels Increase Recurrent Pregnancy Loss Risk

In case-control studies of 120 women, those who had recurrent pregnancy loss (RPL, two or more unexplained pregnancy losses) had higher fructosamine levels than women who did not have RPL. With each 20-umol/L increase in fructosamine, there was a three times higher risk of RPL [39].

5) High Fructosamine Levels Increase Cancer Risk

In over 10k women followed over 5 years, higher fructosamine levels were associated with a higher risk of breast cancer in both premenopausal and menopausal women [40].

In a study of over 200 people, those with high fructosamine levels had more than 2 times higher risk of colon cancer [41].

6) High Fructosamine Levels Increase Mortality

In two studies of over 350k people, all-cause mortality (the risk of dying) increased with higher fructosamine levels [42, 36].

Ways to Decrease Fructosamine Levels

Fructosamine is a measure of your average glucose levels. Therefore, everything that helps decrease your day-to-day glucose levels will also help decrease your fructosamine.

Eat foods with lower glycemic index. These are foods that don’t cause spikes in your blood glucose. A meta-analysis of 119 studies showed that fructosamine is lower in people eating foods with lower glycemic index [43]. Avoid processed carbs.

Eat more legumes. Non-oil-seed pulses, such as beans, chickpeas, peas, and lentils, all lower fructosamine levels [44].

Drinking herbal and oolong tea lowers fructosamine levels [45, 46].

Exercise regularly. Exercise improves blood sugar control and decreases fructosamine both in people with type 1 and type 2 diabetes [47, 23].

These supplements can help:

Irregular Fructosamine Levels?

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About the Author

Helen Quach

BS (Biochemistry)

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