The maillard or browning reaction in diabetes

A major pathophysiological consequence of hyperglycae­ mia is the extensive chemical interaction of glucose with proteins, leading to its attachment to these proteins with­ out the aid of enzymes. Even though the Maillard reac­ tions have been of considerable interest to food chemists since the tum of the century,' it has only been relatively recently that attention has focused on non-enzymic glyca­ tion of proteins in vivo. Although non-enzymic glycation leading to formation of reversible Amadori products acts on many proteins throughout the body, it is less obvious how these products are related to the pathophysiology of diabetic complications. Recent efforts have focused on biologically important further products of the glycation reaction, which are derived slowly from the Amadori product following a sequence of further reactions and rearrangements? These compounds, in contrast to the Amadori product, are formed irreversibly resulting in accumulation on long-lived proteins; these have been called advanced glycation end (AGE) products.