Both glycohemoglobin and fructosamine may be low in diabetics with liver disease. Lahousen et al identified situations when both tests should be interpreted with caution. The authors are from the Medical University Graz and the University of Missouri.


Potential problems that may arise:

(1) very low laboratory values for one or both tests

(2) belief that glucose control is better than it actually is


Risk factors for a falsely low glycohemoglobin and/or fructosamine:

(1) advanced liver disease

(1a) cirrhosis

(1b) chronic viral hepatitis C treated with ribavirin

(2) hemolytic anemia



• Ribavirin therapy may be associated with a hemolytic anemia.

• A reticulocyte count be a useful test to indicate increased erythrocyte turnover.

• Hemoglobin electropheresis should also be considered, since a hemoglobinopathy can cause both hemolytic anemia and abnormal glycated hemoglobins.


In these patients frequent glucose monitoring may offer the best insight into glucose control.


To read more or access our algorithms and calculators, please log in or register.