{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T04:13:11Z","timestamp":1788235991129,"version":"build-2803163510"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Kutahya University of Health Sciences"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Diabetol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to evaluate the reliability of haemoglobin A1c (HbA1c) for assessing glycaemic status in patients with type 2 diabetes mellitus (T2DM) and secondary polycythaemia, and to determine whether fructosamine serves as a more reliable complementary glycaemic marker in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this prospective observational study, patients with T2DM and secondary polycythaemia (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200962) and T2DM controls with normal haematological indices (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200940) were enrolled. HbA1c- and fructosamine-derived estimated mean plasma glucose (eMPG) were compared with structured home capillary blood glucose (CBG; 7 measurements\/day \u00d7 5 days). Bland-Altman analysis and multivariate linear regression (adjusting for age, sex, diabetes duration, BMI, smoking, fasting glucose, haemoglobin, haematocrit) were performed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fasting plasma glucose and HbA1c were similar between groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.352 and\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.816), while fructosamine (456.53\u2009\u00b1\u200990.18 vs. 404.18\u2009\u00b1\u200997.63 \u00b5mol\/L;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) and Home-CBG (207.23\u2009\u00b1\u200949.18 vs. 181.98\u2009\u00b1\u200955.31\u00a0mg\/dL;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002) were significantly higher in the polycythaemia group. Bland-Altman analysis confirmed a systematic negative bias of HbA1c-derived eMPG (mean bias: \u221223.73\u00a0mg\/dL; 95% LoA: \u221245.97 to \u2212\u20091.48). On multivariate regression, polycythaemia group assignment was the strongest independent association with HbA1c underestimation (\u03b2=\u221216.80\u00a0mg\/dL; 95% CI: \u221225.53 to \u2212\u20098.07;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Fructosamine-derived eMPG showed substantially better agreement with Home-CBG (bias: +7.68\u00a0mg\/dL). Overall, 60% of polycythaemia patients would have been assigned to a different glycaemic control category based on fructosamine versus HbA1c.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HbA1c systematically underestimates glycaemic status in patients with polycythaemia and may lead to clinically relevant misclassification. In contrast, fructosamine appears to provide a more reliable estimate of glycaemic control in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00592-026-02735-z","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:42:14Z","timestamp":1782106934000},"page":"1545-1552","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Glycemic assessment in diabetic patients with secondary polycytheamia: limitations of HbA1c and the potential role of fructosamine\u2014a prospective comparative study"],"prefix":"10.1007","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6816-4154","authenticated-orcid":false,"given":"Sertas","family":"Erarslan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Turkan P.","family":"Kilit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aycan","family":"Acet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"issue":"Suppl 1","key":"2735_CR1","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.2337\/dc24-S001","volume":"47","author":"American Diabetes Association","year":"2024","unstructured":"American Diabetes Association (2024) Standards of Medical Care in Diabetes\u20142024. 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