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Background: Glycated hemoglobin (HbA1C) levels are enhanced by elevated glucose concentrations. Glycation of hemoglobin is also modulated by lipid peroxides, ascorbic acid and reduced glutathione (GSH). We determined the strength of the relationships among these variables in a group of hyperthyroid patients., Methods: Twenty-two untreated hyperthyroid patients and 17 healthy controls were recruited for the study. Whole blood GSH, HbA1C, plasma lipid peroxides, ascorbic acid and fasting glucose were analyzed in both the groups. Direct and partial correlation analysis was performed to explore the possible relationships between these variables., Results: In hyperthyroid patients, HbA1C and lipid peroxides levels were found to be significantly increased than the controls. Ascorbic acid and GSH were decreased significantly in the test group when compared with the healthy control group. With partial correlation analysis, fasting glucose and lipid peroxides were found to have a significant positive correlation with HbA1C. Ascorbic acid and GSH showed no significant association with HbA1C levels., Conclusion: These data suggest that HbA1C levels are closely associated with fasting glucose and lipid peroxides in hyperthyroid patients. Therefore, serum lipid peroxides level should be kept in mind while interpreting HbA1C as a long-term glycemic index in hyperthyroid cases.

We examined the stability of the ketoamine adduct, termed HbA1c, formed between the N-terminal valine of the haemoglobin A (HbA) beta chain and D-glucose using an isoelectric focusing method. Prolonged saline incubation of purified HbA1c followed by renewed isoelectric focusing revealed that the HbA1c concentration decreased while a corresponding increase in the HbA concentration occurred. The emergence of haemoglobin A on saline incubation indicates that the non-enzymatic glucosylation of haemoglobin A to HbA1c is a reversible process. This finding was further substantiated by kinetic studies on the formation and breakdown of the ketoamine adduct during incubation of red cells in glucose and saline. It appeared that the rate constant for the formation k2 was 14.2 X 10(-6) X s-1 at 37 degrees C while the rate constant for dissociation k-2 was 1.7 X 10(-6) X s-1. From these data an equilibrium constant K of 8.4 was calculated. This information should be of importance in interpretation of HbA1c levels during abrupt changes in diabetic control.