concerns. First, diabetes care is rarely changed in short (1–4 week) intervals, since diabetes medications can take months to reach a steady state. An exception to this is pregnancy, where medication needs can change more rapidly and fructosamine may help provide closer short-term monitoring. Second, fructosamine has higher variability than A1c tests. Third, the overwhelming majority of studies in diabetes care are based on A1c measurements, which can make fructosamine results difficult to interpret. Fourth, the A1c test is very well standardized and trusted due to its nearly universal use. A variety of more advanced forms of the A1c test (e.g. some types of HPLC, immunoassay and capillary electrophoresis) can more accurately assay A1c levels during complex hemoglobinopathies and other conditions. However this does not overcome the effect of shortened red blood cell lifespan on A1c results. In End Stage Renal Disease (ESRD) Because glycated albumin (GA) has a shorter half-life than glycated hemoglobin (HbA1c), glycated albumin reflects recent glycemic control more accurately and usefully for monitoring patients with diabetic end stage renal disease (ESRD) (hemodialysis and peritoneal dialysis patients). It can be used less often than blood sugar testing. An average blood glucose level of 155–160 mg/dL could be matched to a GA value of 18–19% in patients with ESRD. The ratio of GA/HbA1c is 3.0 approximately. Interpretation of results There is no standard reference range available for this test. The reference values depend upon the factors of patient age, gender, sample population, and test method. Hence, each laboratory report will include the patient's specific reference range for the test. An increase in fructosamine in lab testing results usually means an increase in glucose in the blood. On average, each change of 3.3 mmol (60 mg/dl) in average blood sugar levels will give rise to changes of 2% HbA1c and 75 µmol fructosamine values. However, this overemphasizes the upper limit of many laboratories' reference ranges of 285 μmol/L as equivalent to HbA1c 7.5% rather than 6.5%. A comparative study, which has been used in official advice for Quality and Outcomes Framework guidance in the UK and summarized by the United States' National Quality Measures Clearinghouse, gives the following formula and resulting values: Hence: See also Fructosamine kinase family Diabetes mellitus Blood sugar regulation Human serum albumin End Stage Renal Disease Program ECRI Institute Footnotes External links Fructosamine at Lab Tests Online Fructosamine: analyte monograph – The Association for Clinical