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HEMOGLOBIN Ale AND DIABETES MELLITUS Ronald J. Koenig, Ph.D., MD. Peter B. Brigham Hospital, Boston, Massachusetts Anthony Cerami, Ph.D. Rockefeller University, New York, NY Hemoglobin (Hb) Alc is a minor red cell constituent that comprises 5% of the total Hb in normal individuals but up to 15% in patients with diabetes mellitus (1). It may be assayed by ion exchange chromatography (1-3), isoelectric focusing (4), radioimmunoassay (5), or colorimetry (6). Current data suggest that the quality of diabetic control can best be assessed by monitoring Hb Alc levels, and that the synthesis of Hb Alc may represent a unifying model reaction that underlies the pathogenesis of many of the sequelae of chronic diabetes. This review summarizes the biochemical and clinical implications of Hb Alc' STRUCTURE AND BIOSYNTHESIS Hemoglobin Alc and the major adult hemoglobin, Hb A, have identical amino acid sequences (7). The unique structural feature of Hb Ale is the presence of 1-deoxy fructose linked through carbon number 1 to the NH2terminus of the fJ chain (8, 9). This apparently derives nonenzymatically from glucose forming a Schiff base with the NH2-terminal valine and subse quently undergoing an Amadori rearrangement (10). [For a review of whether glucose-6-phosphate may
Annual Review of Medicine – Annual Reviews
Published: Feb 1, 1980
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