Abstract • Circulating glycosylated hemoglobin (Hb A1) and/or fasting blood glucose (FBG) levels, measures of the extent to which diabetes is clinically controlled, were correlated with the contents of fructose, sorbitol, glucose, and inositol in 27 cataracts removed by intracapsular extraction. In the series of patients studied, Hb A1 levels ranged from 6.0% to 15.5% of the total hemoglobin value. The levels of fructose and sorbitol (micromoles per gram of lens) in their cataracts ranged from 0 to 8.4 and 0 to 10.2 μmole/ g, respectively, with correlation coefficients greater than.8. Similar correlations were noted with FBG. The Hb A1 correlated with lens glucose (r =.58) and not with inositol. However, FBG had no correlation with either lens glucose or inositol. The observed correlation of the polyol pathway metabolites with both Hb A1 and FBG suggests that the lens can synthesize substantial quantities of sorbitol and fructose in response to the excess glucose available to lenses of human diabetics. A synergistic role of the polyol pathway in the cause of senile cataracts is thus possible. References 1. Van Heyningen R: Formation of polyols by the lens of the rat with sugar cataract . Nature 1959;184:194-195.Crossref 2. Kuck J Jr: The formation of fructose in the ocular lens . Arch Ophthalmol 1961;65:840-846.Crossref 3. Patterson JW, Bunting KW: Changes associated with the appearance of mature sugar cataracts . Invest Ophthalmol Vis Sci 1965;4:167-173. 4. Dvornik D, Simard-Duquesne N, Krami M, et al: Polyol accumulation in galactosemic and diabetic rats: Control by an aldose reductase inhibitor . Science 1973;182:1146-1148.Crossref 5. Varma SD, Mizuno A, Kinoshita JH: Diabetic cataracts and flavonoids . Science 1977; 195:205-206.Crossref 6. Fukushi S, Merola LO, Kinoshita JH: Altering the course of cataracts in diabetic rats . Invest Ophthalmol Vis Sci 1981;19:313-315. 7. Varma SD, Kinoshita JH: Sorbitol pathway in diabetic and galactosemic lenses . Biochem Biophys Acta 1974;338:632-640.Crossref 8. Kadish AH, Little RL, Sternberg JC: A new and rapid method for the determination of glucose by measurement of rate of oxygen consumption . Clin Chem 1968;14:116-131. 9. Abraham EC, Huff TA, Cope ND, et al: Determination of the glycosylated hemoglobin (Hb A,) with a new micro-column procedure . Diabetes 1978;27:931-937.Crossref 10. Pirie A, van Heyningen R: The effect of diabetes on the content of sorbitol, glucose, fructose and inositol in the human lens . Exp Eye Res 1964;3:124-131.Crossref 11. Heaf DJ, Galton DJ: Sorbitol and other polyols in lens, adipose tissue and urine in diabetes mellitus . Clin Chim Acta 1975;63:41-47.Crossref 12. Pfaffenberger CD, Szafranek J, Horning EC: Gas chromatographic study of free polyols and aldoses in cataractous human lens tissue . J Chromatogr 1976;126:535-545.Crossref 13. Varma SD, Schocket SS, Richards RD: Implications of aldose reductase in cataracts in human diabetes . Invest Ophthalmol Vis Sci 1979; 18:237-241. 14. Koening RJ, Peterson CM, Jones RL, et al: Correlation of glucose regulation and hemoglobin A1c in diabetes mellitus . N Engl J Med 1976;295:417-420.Crossref 15. Gabbay KH, Hasty K, Breslow JL, et al: Glycosylated hemoglobins and long-term blood glucose control in diabetes mellitus . J Clin Endocrinol Metabol 1977;44:859-864.Crossref 16. Gonen B, Rubenstein AH, Rochman H, et al: Haemoglobin A,: An indicator of the metabolic control of diabetic patients . Lancet 1977;2:734-736.Crossref 17. Jedziniak JA, Chylack LT Jr, Cheng H, et al: The sorbitol pathway in the human lens: Aldose reductase and polyol dehydrogenase . Invest Ophthalmol Vis Sci 1981;20:314-326.
Archives of Ophthalmology – American Medical Association
Published: Jun 1, 1984