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Summary: Background Control of blood glucose is important in reducing both the incidence and the severity of complications in diabetes mellitus.One consequence of long-term hyperglycaemia is the formation and accumulation of advanced glycation end-products (AGEs) on tissue macromolecules. An AGE-modified form of human haemoglobin (Hb-AGE), present at high levels in the red cells of diabetic patients, differs from the glucose-derived Amadori product HbA1c in being chemically irreversible and thus persisting for the circulating life of the red cell. We therefore compared Hb-AGE with HbA (1c) as indicators of long-term blood glucose control.

Methods In an open study we measured circulating HbA1c and Hb-AGE concentrations in eight patients with poorly controlled non-insulin-dependent diabetes after a switch to subcutaneous insulin therapy and careful blood glucose monitoring.

Results After 16 weeks of insulin therapy, the mean HbA1c had decreased from 13.3 (SD 1.2) to 7.3 (0.9) percent and the mean Hb-AGE from 12.1 (1.5) to 7.3 (1.3) U/mg Hb. The rate of Hb-AGE decline was 23 percent slower than that of HbA1c (p=0.044).

Interpretation The observation that Hb-AGE declines more slowly than HbA (1c) is consistent with the irreversible nature of the AGE product. Because of this property, Hb-AGE may prove superior to HbA1c as a long-term index of circulating glucose concentrations.

Lancet 1996; 347: 513-15

Copyright. (C) The Lancet Ltd, 1996.