Hemoglobin A1c for Monitoring Diabetes

Cerami, Anthony

Anyone who has diabetes or is at risk for the disease is familiar with the blood test for hemoglobin A1c. This test, developed by Anthony Cerami (1940- ) at the Rockefeller Hospital, provides an average measure of blood glucose levels for the previous two to three months. It depends on the protein hemoglobin, found in red blood cells, which carries oxygen from the lungs to the rest of the body. Hemoglobin can react with glucose in the blood to form a compound containing the glucose sugars attached to the hemoglobin molecules. The extent of the reaction depends on the blood glucose content. When blood glucose levels are high, as in uncontrolled diabetes, the amount of hemoglobin that reacts with glucose rises and accumulates. Because red blood cells have a life span of about 120 days, the amount of this combined molecule, or A1c, reflects glucose levels over that period of time. Testing for hemoglobin A1c at regular intervals helps tell people with diabetes, and their doctors, whether their treatment plan is effective or needs to be modified.

The measurement of hemoglobin A1c can indentify the presence of diabetes and provide an accurate measurement of the average glucose concentration in the blood

Cerami was studying another disease—sickle cell anemia—when he realized the potential of A1c for monitoring diabetes. Cerami and a colleague had studied a substance called cyanate, which also reacts with hemoglobin, for preventing red blood cells from sickling. But when cyanate was tested in patients, complications developed such as cataracts and certain types of nerve damage—the same complications as in people with uncontrolled diabetes. Cerami suspected that something similar to cyanate was reacting with hemoglobin in the blood to cause this effect. It turned out to be glucose. Although other researchers had already observed elevated hemoglobin A1c levels in diabetics, Cerami and his colleagues first proposed its use for monitoring glucose control.

Anthony Cerami received the BS from Rutgers University, and the PhD from The Rockefeller University (1967). After postdoctoral work at Harvard Medical School and the Jackson Laboratory, he returned to Rockefeller in 1969. For 20 years Cerami headed the laboratory of medical biochemistry. He also served as dean of graduate and postgraduate studies. In 1991 he established the Picower Institute for Medical Research, and in 1996 he co-founded the Kenneth S. Warren Institute. Cerami, founder of Warren Pharmaceuticals, Inc., now serves as chairman and CEO of that company. He is the recipient of numerous awards, including the Luft Award in Diabetes and the Banting Medal for Scientific Achievement, from the American Diabetes Association. He is also the co-inventor of one of the anti-TNF monoclonal antibodies used to treat Crohn's disease and rheumatoid arthritis.

Selected Publications

Koenig RJ, Peterson CM, Jones RL, Saudek C, Lehrman M, Cerami A. Correlation of glucose regulation and hemoglobin AIc in diabetes mellitus. N Engl J Med, 1976, 295: 417-420

Koenig RJ, Cerami A. Hemoglobin A Ic and diabetes mellitus. Annu Rev Med, 1980, 31: 29-34

Peterson CM, Jovanovic LB, Brownlee M, Jones RL, Cerami A. Closing the loop: practical and theoretical. Diabetes Care, 1980, 3: 318-321