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What Does It Mean When Your A1c Is 9?

What Is The A1c Test? How Does A1c Relate To Blood Glucose?

What Is The A1c Test? How Does A1c Relate To Blood Glucose?

Anyone with diabetes will be familiar with finger-prick testing for monitoring blood glucose to see how well they are managing their disease. This kind of regular testing is essential for most people with diabetes, but what role does an occasional hemoglobin A1C blood test play in controlling blood sugars, and how does it work? Contents of this article: What is the A1C test? The abbreviation A1C is used in the US (sometimes with a lower-case 'c' - A1c) and is short for glycated hemoglobin (sometimes called 'glycosylated' hemoglobin or glycohemoglobin). The other abbreviations in use are: HbA1c (widely used internationally) HbA1c Hb1c HgbA1C. The A1C test is a blood test used to measure the average level of glucose in the blood over the last two to three months. This test is used to check how well blood sugar levels are being controlled in a person with diabetes and can also be used in the diagnosis of diabetes.1 Hemoglobin is the protein in red blood cells which is responsible for transporting oxygen around the body. When blood glucose levels are elevated, some of the glucose binds to hemoglobin and, as red blood cells typically have a lifespan of 120 days, A1C (glycated hemoglobin) is a useful test because it offers an indication of longer term blood glucose levels.2 The particular type of hemoglobin that glucose attaches to is hemoglobin A, and the combined result is call glycated hemoglobin. As blood glucose levels rise, more glycated hemoglobin forms, and it persists for the lifespan of red blood cells, about four months.2 Therefore, the A1C level directly correlates to the average blood glucose level over the previous 8-12 weeks; A1C is a reliable test that has been refined and standardized using clinical trial data.3 There are two key things to know about the appl Continue reading >>

What Is The A1c Test?

What Is The A1c Test?

The A1C ("A-one-C") is a blood test that checks your average blood sugar over the past 2 to 3 months. This average is different from your day to day blood sugar. Sugar absorbed from your food goes into the bloodstream. The sugar sticks to the hemoglobin protein in red blood cells, forming hemoglobin A1C. The A1C stays in the blood for the life of the red blood cell, which is 90 to 120 days. This means that the amount of A1C in your blood reflects how high your blood sugar has been over the past 3 months. Another name for this test is hemoglobin A1C test. It is different from a regular blood sugar or blood glucose test. Why is this test done? There are 3 reasons to check your A1C: To diagnose prediabetes To diagnose diabetes To see how well you are controlling your blood sugar A1C tests are important because: They can check the accuracy of the blood sugar results you get at home. They help predict your risk of diabetic complications. A high A1C percentage means that your average blood sugar has been high, and this increases your risk of serious problems, like eye, kidney, blood vessel, and nerve damage problems. If your A1C is high, your diabetes plan will need to be changed. How do I prepare for this test? You don’t need to do anything to prepare for this test. One of the advantages of this test is that you don’t have to fast before you take it. How is the test done? Having this test will take just a few minutes. A small amount of blood is taken with a prick of the finger or from a vein in your arm with a needle. At some pharmacies you may be able to buy a device that allows you to test A1C at home. You may find that the results of the home test are not the same as results of tests done at your healthcare provider's office. Talk with your provider about whether it Continue reading >>

Going Beyond A1c – One Outcome Can’t Do It All

Going Beyond A1c – One Outcome Can’t Do It All

By Adam Brown, Lynn Kennedy, Ava Runge, and Kelly Close What does A1c miss and what can we do about it? The diaTribe Foundation presented at FDA! Check out the slides here. The Food and Drug Administration (FDA) hosted a landmark Public Workshop on August 29 – “Diabetes Outcome Measures Beyond Hemoglobin A1c (HbA1c)” – co-organized by The diaTribe Foundation, ADA, AACE, JDRF, and Scripps Translational Science Institute. For the FDA and many payers, A1c is currently the “gold standard” used to assess diabetes therapy – it reflects average blood glucose levels over a two-to-three-month period, and in turn, the long-term risk of complications from high blood sugar (hyperglycemia). An A1c of less than 6.5% or 7% is the goal for most people with diabetes. But A1c has limits: it cannot capture other critical outcomes that matter to patients on a daily basis. Low blood sugar (hypoglycemia) can be fatal, and yet, A1c tells us nothing about it. New therapies may dramatically improve quality of life, but those improvements won’t show up in an A1c value. Two people can have the exact same A1c value, but spend wildly different amounts of time at high and low blood glucose values. The diaTribe Foundation believes the review of new diabetes therapies should expand to reflect both the long-term and short-term risks that patients face, the daily tradeoffs that patients make, and the key barriers to better outcomes. This means going beyond A1c! Given recent improvements in glucose sensing devices and understanding of people living with diabetes, A1c can now be supplemented by other important tools. This article unpacks why going beyond A1c is important and shares other ways of measuring diabetes success. Click any of the points in the summary section immediately below fo Continue reading >>

High Triglycerides: Avoid The Metabolic Syndrome Complications

High Triglycerides: Avoid The Metabolic Syndrome Complications

It is estimated that about 50 million U.S. adults have the metabolic syndrome. Nearly one in four women has that syndrome -- but doesn't know it! As you know, hypertriglyceridemia is the key symptom of the metabolic syndrome which has become increasingly common in the United States. Because of its close association with insulin resistance, in which the body can’t use insulin efficiently, metabolic syndrome is also called the insulin resistance syndrome. People with this syndrome are at increased risk of coronary heart disease and other diseases related to plaque buildups in artery walls (e.g., stroke and peripheral vascular disease) and type 2 diabetes. According to the current criteria, the metabolic syndrome is identified by the presence of three or more of the following components: Central obesity, the so called apple figure, present in most people with insulin resistance, as measured by waist circumference: in men - greater than 40 inches, or >101 cm; in women - greater than 35 inches, or >89 cm High blood triglycerides: greater than or equal to 150 mg/dL, or 1.7 mmol/L Low blood HDL-"good" cholesterol: in men - less than 40 mg/dL, or <1.0 mmol/L; in women - less than 50 mg/dL, or <1.3 mmol/L High blood pressure: greater than or equal to 130/85 mmHg Pre-diabetes: fasting glucose greater than or equal to 110 mg/dL In other words, you are at risk for the insulin resistance syndrome, if you have three or more of these symptoms. If not controlled properly, this syndrome, also called pre-diabetic syndrome can lead to: heart disease non-alcoholic fatty liver colon cancer or ovarian cancer. Elevated blood triglycerides are the most common lipid (blood fat) disorder in people with pre-diabetes or diabetes. Poor sugar control in type 2 diabetes directly increases triglycer Continue reading >>

Ecqm: Diabetes: Hemoglobin A1c (hba1c) Poor Control (>9%) (cms 122v5)

Ecqm: Diabetes: Hemoglobin A1c (hba1c) Poor Control (>9%) (cms 122v5)

eCQM: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) CMS ID: CMS 122v5 NQF Number: 0059 NQS Domain: Effective Clinical Care Measure Type: Intermediate Outcome MIPS High Priority Measure: Yes Eligible for Quality Programs: Merit-Based Incentive Payment System (MIPS) Medicaid EHR Incentive Program (Meaningful Use) Comprehensive Primary Care Plus (CPC+) Description: Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period Numerator: Patients from the denominator whose most recent HbA1c level (performed during the measurement period) is > 9.0%. Denominator: Patients 18-75 years of age with diabetes with an eligible visit (chart notes with one of the following encounter types: Office Visit, Nursing Home Visit, Nurse Visit or Home Visit) during the measurement period. Denominator Exclusions: None Denominator Exceptions: None Performance Benchmark for MIPS: 0% (Zero Percent*) This eCQM is an inverse measure, which means a lower performance rate indicates better performance. In Practice Fusion’s eCQM Dashboard, the EHR displays an inverse performance rate for this measure to make it easier to quickly see how you are performing. This means that the measure percentage will increase as the measure numerator decreases. Specifically, a higher measure percentage and lower measure numerator are an indicator of better measure performance. For further benchmarks and details on how this measure will be scored within the Quality performance category of MIPS, please click here. Practice Fusion Suggested Workflow Practice Fusion suggests the following workflow to help ensure that you are able to meet the requirements of this measure within the Practice Fusion EHR. Ensure that patients with diabetes have an appropriate diagnos Continue reading >>

Asknadia: What’s The Science Behind The A1c Test

Asknadia: What’s The Science Behind The A1c Test

Dear Nadia, What’s the science behind the A1C test ? My husband is a type 2 diabetic and recently received his A1C results which was 9 percent. What is considered a good A1C range? RAS Dear RAS, The A1C sometimes referred to as the Hemoglobin A1C, glycosylated hemoglobin, glycated Hemoglobin and HbA1C measures your husband’s average glucose from 60 to 90 days. When your husband tests his blood sugars with a blood glucose meter, this only tells him what his glucose level is at that moment in time. It does not accurately reflect the highs and lows he experiences nor does it reflect the direction his glucose could be trending. Blood cells form and die within a 90 day period. The A1C test records the memory in the red blood cells, giving us an average reading that correlates with a percentage. People that don’t have diabetes have an average A1C of 4 to 6%. A 9 percent A1C means your husband’s blood sugars are averaging around 212 milligrams per deciliter and millimoles per liter Sometimes you can get a false A1C high if you have anemia, an iron deficiency or a blood transfusion. The percentage can also vary depending on where you get your A1C tested. It’s best to use the same lab. The American Diabetes Association recommends taking your A1C test twice a year. Their target A1C is 7 percent. The American Association of Clinical Endocrinologists (AACE) feel that this number is not aggressive enough because it means the average blood sugar is running around 154 milligrams per deciliter and millimoles per liter. They recommend an A1C of 6.5 percent or less which gives you an average blood sugar above 126 milligrams per deciliter and millimoles per liter. Your husband’s A1C reading will play a significant role in preventing diabetes complications. Maintaining a lower Continue reading >>

David’s Guide To Getting Our A1c Under 6.0

David’s Guide To Getting Our A1c Under 6.0

The A1C test is our best scorecard to show how well we are controlling our diabetes. It measures how much glucose has been sticking to our red blood cells for the previous two or three months. Since our bodies replace each red blood cell with a new one every four months, this test tells us the average of how high our glucose levels have been during the life of the cells. The experts recommend that we should get our A1C level tested at least twice a year. People who take insulin need to get it about four times a year. If the test shows that our blood glucose level is high, it means that we have a greater risk of having diabetes problems. Think of the A1C as an early warning system for the insidious complications that we can get down the road when we don’t control our condition. But what do we mean by a “high” A1C level? Here the experts disagree. The American Diabetes Association says that we need to keep our A1C results below 7.0 percent. The American Association of Clinical Endocrinologists sets the target at 6.5 percent. The International Diabetes Federation, or IDF, also recommends that most people with diabetes keep their levels below 6.5 percent. The more our A1C level is higher than normal, the greater the likelihood that we will suffer from one or more of the complications of diabetes. And here too the experts disagree with how they define “normal.” People who don’t have diabetes have A1C levels below 6.0 percent. That’s the gist of what I wrote here recently in “The Normal A1C Level.” The IDF agrees. But more aggressive endocrinologists say that a truly normal A1C ranges from 4.2 percent to 4.6 percent. That’s what Dr. Richard K. Bernstein wrote in Dr. Bernstein’s Diabetes Solution. No matter what our level is, we can be sure that lower is Continue reading >>

Your Most Important Blood Test

Your Most Important Blood Test

This week, the British Journal of Cancer published an incredibly important report that found a strong relationship between a simple blood test and the risk for various forms of cancer. The study found that the common blood test used by diabetics to measure their average blood sugar, A1c, was strongly predictive in terms of cancer development. For those of you who are not diabetic, you may not be familiar with this simple test that has profound health implications well beyond diabetes. Basically, the A1c test measures the amount of glycation that the protein hemoglobin has undergone. Glycation simply means that sugar has become bonded to a protein, in this case hemoglobin, and this is a relatively slow process. Hence, it’s a way to get a sense as to how high the blood sugar has been, in this case over a 3-4 month period of time, and this is why it’s so helpful for diabetics. But with this new report, we now understand that having elevated A1c translates to risk for cancer, and as I’ve explained in Grain Brain, it is also a powerful indicator of risk for developing dementia. If you look at the chart on page 117 of the book, reproduced below, you’ll note that A1c is also directly related to the rate at which the brain shrinks on an annual basis. Think of it, this one simple blood test can give you incredibly important information about cancer risk, risk for dementia, and even risk for shrinkage of your brain! Most commonly people are told that having an A1c of 5.6 – 5.8 should be considered normal, but when you look at the graph above, these levels already put you in the second highest category for brain shrinkage! I believe that, based on this information, we should strive to keep our A1c at 5.2 or even lower. The way to accomplish this is simply by reducing you Continue reading >>

Your A1c Results: What Do They Mean?

Your A1c Results: What Do They Mean?

If you have diabetes, you should have an A1C test at least twice each year to find out your long-term blood glucose control. The A1C test measures your average blood glucose during the previous 2-3 months, but especially during the previous month. For people without diabetes, the normal A1C range is 4-6%. For people with diabetes, the lower the A1C value, the better the diabetes control and the lower the risk of developing complications such as eye, heart, and kidney disease. Your goal should be to have A1C values less than 7%. That may be a hard target to hit, but it is important to try because the lower your A1C, the lower your health risk. The table on this page shows what your A1C results say about your blood glucose control during the past few months. Some people are surprised when they have a high A1C result because when they check their blood glucose with their meter, they have relatively low numbers. But remember that checking your blood glucose gives you only a momentary sample of your blood glucose control. The A1C test measures your blood glucose control at all times during the previous 2-3 months, even times such as after meals or when you are asleep, when you don't usually check your blood glucose. Think of the A1C test as feedback to help you better control your diabetes and improve your diabetes care habits. By giving you important information about your long-term control, the A1C test can help you stay motivated to do your best on diabetes self care. Talk with your doctor and other members of the health care team about your A1C results and how you can use them to better manage diabetes. Within the next few months, the federal government will implement the first major reorganization of the Medicare system for many years: the Medicare Prescription Drug Imp Continue reading >>

Hemoglobin A1c Test (hba1c, A1c, Hb1c)

Hemoglobin A1c Test (hba1c, A1c, Hb1c)

Hemoglobin A1c definition and facts Hemoglobin A1c is a protein on the surface of red blood cells that sugar molecules stick to, usually for the life of the red blood cell (about three months). The higher the level of glucose in the blood, the higher the level of hemoglobin A1c is detectable on red blood cells. Hemoglobin A1c levels correlate with average levels of glucose in the blood over an approximately three-month time period. Normal ranges for hemoglobin A1c in people without diabetes is about 4% to 5.9%. People with diabetes with poor glucose control have hemoglobin A1c levels above 7%. Hemoglobin A1c levels are routinely used to determine blood sugar control over time in people with diabetes. Decreasing hemoglobin A1c levels by 1% may decrease the risk of microvascular complications (for example, diabetic eye, nerve, or kidney disease) by 10%. Hemoglobin A1c levels should be checked, according to the American Diabetic Association, every six months in individuals with stable blood sugar control, and every three months if the person is trying to establish stable blood sugar control. Hemoglobin A1c has many other names such as glycohemoglobin, glycated hemoglobin, glycosylated hemoglobin, and HbA1c. To explain what hemoglobin A1c is, think in simple terms. Sugar sticks to things, and when it has been stuck to something for a long time it's harder to the get sugar (glucose) off. In the body, sugar sticks too, particularly to proteins. The red blood cells that circulate in the body live for about three months before they die. When sugar (glucose) sticks to these red blood cells by binding to hemoglobin A1c, it gives us an idea of how much glucose has been around in the blood for the preceding three months. Hemoglobin A1c is a minor component of hemoglobin to which gl Continue reading >>

The A1c Test For People With Type 2 Diabetes

The A1c Test For People With Type 2 Diabetes

This article will help you to learn about the A1C test: what it is and why it is important for people with type 2 diabetes. What is the A1C test? The A1C test is a blood test that shows the average amount of glucose in your blood over the past 3 months. Your A1C level is shown as a percentage: for example, 6.8%. This is different than the numbers that you see when you check your blood glucose at home. These numbers, which are shown in milligrams per deciliter, or mg/dL, give you a snapshot of your blood glucose level at that moment. Because people with type 2 diabetes are used to seeing blood glucose numbers, it can be confusing to understand what the A1C test result means. The chart below lists A1C levels in one column and the average estimated glucose in the next column. For example, if your A1C is 8.5%, that means that your average blood glucose over the past 3 months has been around 197 mg/dL. A1C% Estimated average glucose mg/dL 6.5 140 7 154 7.5 169 8 183 8.5 197 9 212 9.5 226 10 240 Because the A1C number tells you about your blood glucose day and night, before and after meals over 3 months, your average blood glucose may not match the numbers on your glucose meter. This is the reason why the A1C test is so important: it gives you different information about your blood glucose than you get when you check your own blood glucose day-to-day. Q: What should my A1C and estimated average glucose levels be? The American Diabetes Association (ADA) recommends an A1C level of less than 7% for most adults with type 2 diabetes, which is an estimated average glucose of 154 mg/dL. No matter what your A1C is, the closer you get to 7%, the better your chances for preventing health problems from diabetes. Q: How often should my A1C be tested? The ADA recommends two A1C tests per Continue reading >>

How To Lower Your A1c Levels: More Steps You Can Take

How To Lower Your A1c Levels: More Steps You Can Take

You may be familiar with the “ABCs” of diabetes: A1C, blood pressure, and cholesterol. This acronym is part of a larger diabetes campaign called “Know Your Numbers,” and hopefully you’re aware of all of your numbers — what they are, what they should be, and how often to get them checked. Obviously, knowing your A1C and knowing what you can do if it’s not at goal is a big part of diabetes management. The focus last week and this week has been on all things A1C: what it is, what the general goal is, why it matters, and ways to get it to where it needs to be. What else does it take to lower your A1C? Figuring out how to lower your A1C to whatever your personal goal is can sometimes seem like solving a puzzle. You try something and it may or may not help, or it helps but not enough. Then you try something else. Yes, it can be frustrating, but eventually you’ll hit on a strategy that works for you. Last week, we looked at how a healthy eating plan (including keeping carbs consistent and sticking to an eating schedule) and a physical activity program can help. Research shows that an eating plan can lower A1C levels by 1–2%; physical activity can lower A1C by 0.6–1%, according to various studies. But what if these two strategies aren’t enough? Then what? Time for medication? Diabetes medicines generally lower A1C levels anywhere from 0.5% to as much as 3.5%. The A1C-lowering effect of medicines can vary from person to person, however, and the effect is often dependent upon how high the A1C is to begin with. Insulin. We know that people who have Type 1 diabetes must take insulin. Insulin can be delivered using a syringe or an insulin pen; it can also be administered using an insulin pump. How you decide to take your insulin is a decision best made with you Continue reading >>

Pardon Our Interruption...

Pardon Our Interruption...

As you were browsing something about your browser made us think you were a bot. There are a few reasons this might happen: You're a power user moving through this website with super-human speed. You've disabled JavaScript in your web browser. A third-party browser plugin, such as Ghostery or NoScript, is preventing JavaScript from running. Additional information is available in this support article. After completing the CAPTCHA below, you will immediately regain access to Continue reading >>

A1c Basics

A1c Basics

On-target blood glucose control helps you feel your best and prevent or delay complications. The best measure of long-term average blood glucose control is a simple laboratory test called the A1C. What is A1C? An A1C (pronounced A-one-C) test reflects your average blood sugar or glucose level over the past two to three months. When you check your blood sugar with a meter after fasting and before or after meals, you won’t capture all the ups and downs. The A1C, also known as a glycosylated hemoglobin test or HbA1c, offers you an overview to compare with your blood sugar checks. The test requires a small blood sample—no fasting is necessary—for a lab analysis. How does it work? The test measures glycosylated hemoglobin, or the percentage of hemoglobin molecules in your red blood cells with glucose attached to them. (Hemoglobin is a protein in red blood cells that carries oxygen.) Glucose naturally sticks, or “glycosylates,” to some of the hemoglobin in red blood cells. When blood glucose is high, more hemoglobin molecules have glucose attached to them. The glucose stays there for the life of the red blood cell (about 120 days), which is why the test covers a three-month period. What are “good” A1C levels? For people without diabetes, about 4 to 6 percent of hemoglobin is glycosylated, so an A1C of 4 to 6 percent is considered normal. An A1C that’s 6.5 percent or higher is sufficient for the diagnosis of diabetes, according to the American Diabetes Association (ADA). The ADA states that an A1C 5.7 to 6.4 percent is diagnostic for prediabetes. For people with diabetes, maintaining an A1C of less than 7 percent over time can reduce the risk of the heart, eye, kidney and nerve damage associated with having diabetes for many years. Talk to your doctor about wha Continue reading >>

Diabetes And The Hemoglobin A1c Test

Diabetes And The Hemoglobin A1c Test

Walter L. Aument Family Health Center The hemoglobin A1c ("A-one-C") test is a blood test used in the care of people who have diabetes. The hemoglobin A1c percentage is a way of looking at your average blood sugar control over a period of 3 months. Sugar absorbed from your digestive system circulates in the bloodstream. When the blood sugar is high, the sugar attaches to the hemoglobin protein in red blood cells, forming hemoglobin A1c. Red blood cells live 90 to 120 days. This means that once sugar has combined with the hemoglobin in red blood cells, the hemoglobin A1c stays in the blood for 90 to 120 days. This means the amount of hemoglobin A1c in your blood reflects how often and how high your blood sugar has been over the past 3 months. Hemoglobin A1c is an excellent way to check how well you are controlling your blood sugar over a 3-month period. Hemoglobin A1c measurements are important because: They confirm your daily home blood sugar monitoring results. They help predict your risk of diabetic complications. The higher the hemoglobin A1c percentage, the greater the risk of developing diabetic eye, kidney, cardiovascular, and nervous system disease. No preparation is necessary. One of the advantages of this test is that you do not have to fast before you take it. A small amount of blood is taken from your arm with a needle. The blood is collected in tubes and sent to a lab. There are also portable machines that can determine the value from a fingerstick – these can be performed in physician offices or even in a patient’s home. The hemoglobin A1c percentage rises as your average blood sugar level rises. For adult diabetics the results are usually judged as follows: less than 7%: excellent blood sugar control (some experts recommend less than 6.5%) less than 8% Continue reading >>

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