Version June 2024
| Brief description | Duration of glycemia reflected | Strengths | Limitations | |
| Traditional markers of hyperglycemia | ||||
| Fasting glucose | Direct measure of circulating blood glucose | Acute/immediate | Direct measure; widely accepted; inexpensive | Requires fasting; affected by acute illness and stress; pre-analytical issues (sample stability)[1]; moderate within-person variability |
| A1C | Proportion of hemoglobin that is glycated | 2 to 3 months | Reflects 2- to 3-month control Low within-person variability; no patient preparation needed; not affected by acute illness, stress, or recent activity levels | Affected by alterations in red cell turnover; some methods for measurement can give inaccurate results in the presence of certain hemoglobin variants*; requires whole blood; cost |
| Nontraditional markers of hyperglycemia | ||||
| Fructosamine | Total serum protein glycation | 2 to 3 weeks | Does not require fasting; highly reliable automated methods are widely available; can be measured in serum or plasma; inexpensive | Affected by changes in serum protein metabolism (mostly albumin), thyroid dysfunction; limited evidence linking to outcomes |
| Glycated albumin | Proportion of albumin that is glycated | 2 to 3 weeks | Does not require fasting; can be measured in serum or plasma | Affected by changes in albumin metabolism, thyroid dysfunction; method performance may vary; availability in the United States is limited; limited evidence linking to outcomes |
| 1,5-AG | Monosaccharide filtered by the kidney and normally reabsorbed; reabsorption inhibited and it is excreted at high levels of glycemia, so serum levels drop | 2 to 14 days | Does not require fasting; can be measured in serum or plasma; test is available from major laboratories in the United States; expense | Affected by changes in renal threshold for glucose, dialysis, or stage 4 or 5 kidney disease, pregnancy; limited evidence linking to outcomes |
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