Abstract
Blood glucose concentrations may change from physiologic to pathologic levels and vice versa within a few minutes. This is particularly true of insulin deficient diabetes and therefore the evaluation of glycemic control in children with diabetes is difficult. A less volatile indicator of hyperglycemia is the fraction of hemoglobin A (HbA) that is glycosylated (HbA1). HbA1 was determined chromatographically in 30 children with diabetes (13.9 ± 2.1%) and 10 non-diabetics (6.8 ± 1.4%). Incubation of washed red cells from diabetic patients in Krebs bicarbonate buffer with 5mM glucose for 3 hrs. results in no change in the % of HbA1. Sorbitol, a polyol of glucose, accumulates in red blood cells (RBC) in concentrations that correlate directly with the blood glucose concentration (r=.84). RBC sorbitol concentration in 30 ambulatory diabetics was 33nM/ccPRBC ± 13.7 while 10 non-diabetics had sorbitol levels of 5.3 ± 2.1. Incubation of non-diabetic RBC's in 50mM glucose produced an hourly linear increase in sorbitol concentration throughout the 3 hr. incubation reaching diabetic levels in one hour. Reduction of the glucose concentration to 5mM resulted in decreasing but still elevated sorbitol concentrations at one hour with a return to non-diabetic levels by 3 hours.
Thus RBC sorbitol concentration may be a more useful indicator of glycemic control in diabetes than either the blood glucose or HbA1.
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Steinberg, M. RED CELL SORBITOL AN INDICATOR OF GLYCEMIC CONTROL. Pediatr Res 11, 519 (1977). https://doi.org/10.1203/00006450-197704000-00896
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DOI: https://doi.org/10.1203/00006450-197704000-00896