What Does Your A1c Number Really Mean?
We dFolk are bombarded with numbers, goals, and targets. We’re frequently told where we should be, but not how high our risk is when we can’t reach our targets. Here, we break down A1C numbers into a simple green-light, yellow-light, red-light format, to give you perspective on when (and how much) to worry, when to relax, when to call your doc, and when to call 911. Green-light A1C score For most people, the target for A1C, the green light, is between 6.0% and 6.9%. These numbers are commonly expressed simply as 6.0 and 6.9, without the % sign. If your A1C falls into this zone, you’re considered to be in control. For perspective, these numbers can be converted into “meter” numbers called estimated average glucose—eAG for short. The green light eAG range is 126 mg/dL (7 mmol/l) to 151 mg/dL (8.39 mmol/l). But what if your numbers are higher than target? Or lower than target? When are you actually in danger? Yellow-light A1C score If the light turns yellow as you approach the intersection, you need to either speed up or stop. Whichever is safe under the circumstances, right? If your A1C is between 7.0 and 8.9, you’ll be classified as “out of control.” But how much danger are you in? Frankly, it depends upon how close you are to either end of the spectrum. Yellow-light A1Cs are higher than is strictly healthy, but pose no immediate harm. However, the higher you are in this range, the closer you are to a red light. We’ll talk about just how serious that can be in a minute. I should point out that there are some special cases. If you’re a very young type 1, a yellow-light A1C score may be considered in-target for you until you get older. Similarly, if you’re an elderly type 2, or have a history of severe hypoglycemia, you doctor may choose to “green Continue reading >>
5 Ways To Lower Your A1c
For some, home blood sugar testing can be an important and useful tool for managing your blood sugar on a day-to-day basis. Still, it only provides a snapshot of what’s happening in the moment, not long-term information, says Gregory Dodell, MD, assistant clinical professor of medicine, endocrinology, diabetes, and bone disease at Mount Sinai Health System in New York City. For this reason, your doctor may occasionally administer a blood test that measures your average blood sugar level over the past two to three months. Called the A1C test, or the hemoglobin A1C test, this provides a more accurate picture of how well your type 2 diabetes management plan is working. Taking the A1C Test If your diabetes is well controlled and your blood sugar levels have remained stable, the American Diabetes Association recommends that you have the A1C test two times each year. This simple blood draw can be done in your doctor's office. Some doctors can use a point-of-care A1C test, where a finger stick can be done in the office, with results available in about 10 minutes. The A1C test results provide insight into how your treatment plan is working, and how it might be modified to better control the condition. Your doctor may want to run the test as often as every three months if your A1C is not within your target range. What the A1C Results Mean The A1C test measures the glucose (blood sugar) in your blood by assessing the amount of what’s called glycated hemoglobin. “Hemoglobin is a protein within red blood cells. As glucose enters the bloodstream, it binds to hemoglobin, or glycates. The more glucose that enters the bloodstream, the higher the amount of glycated hemoglobin,” Dr. Dodell says. An A1C level below 5.7 percent is considered normal. An A1C between 5.7 and 6.4 perce Continue reading >>
Diabetes Control Tied To Heart Stent Outcomes
(Reuters Health) - For people with type 2 diabetes, maintaining good blood sugar control in the years after receiving a coronary artery stent is associated with a lower risk of heart attack and stroke, according to a recent study. “Although intensive glucose control had no benefit on the rate of major cardiovascular events in previous studies, our data suggest that strict glucose control after PCI (heart catheterization) can improve long-term clinical outcomes in diabetic patients,” Dr. Joo-Yong Hahn from Samsung Medical Center in Seoul told Reuters Health. Heart disease is the major cause of death among people with type 2 diabetes, Hahn’s team writes in Circulation: Cardiovascular Interventions. Although intensive blood sugar control is known to reduce damage to tiny blood vessels that are involved in many of the nerve and circulatory effects of diabetes, it’s not clear if the same is true for major arteries such as the ones that carry blood to the heart. The researchers studied 980 patients with type 2 diabetes who had undergone percutaneous cardiac intervention (PCI) to clear a blocked coronary artery and place a supportive mesh tube known as a stent. Hahn’s team followed the patients’ health for up to seven years. They looked at long-term blood sugar control using a measurement known as hemoglobin A1c (HbA1c or A1C), and used it to compare the patients’ risks of death, heart attack, repeat catheterizations and stroke over the study period. The researchers defined good control as an A1C score below 7.0 and poor control as A1C of 7.0 or higher. Then they matched patients according to other risk factors and ended up with 322 pairs of patients for comparison. In the overall group of 980 patients, the risk of all bad outcomes was 25 percent lower with good Continue reading >>
Understanding Fpg, Ppg, And A1c
When it comes to diabetes, there are a lot of numbers and initials to remember. So, maybe your health care provider has mentioned these terms to you and you weren’t exactly sure what they meant. Or, maybe they are brand new to you. Either way, understanding what FPG, PPG, and A1C mean can be very important when you are trying to reach your blood sugar goals. A1C measures how well your blood sugar has been controlled over the past 2 to 3 months. It also gives you an idea of how well your overall diabetes care plan is working. Your health care provider will be checking your A1C on a regular basis. FPG is your “fasting plasma glucose (sugar)”. This is your blood sugar when you have been “fasting” (not eating) for at least 8 hours. You may be checking this in the morning when you wake up. PPG is your “postprandial plasma glucose (sugar)”. This is your blood sugar level about 1 to 2 hours after you eat. It measures blood sugar spikes that happen after you eat. What do these numbers have in common? Your A1C tells you how well your PPG and your FPG have been controlled over the past 2 to 3 months. Or, to put it another way, A1C control=FPG control & PPG control. Why are these numbers important? To help measure how you are doing with your diabetes care, your health care provider will set a goal for what your A1C should be and will measure A1C every 2 to 3 months in most cases or at least twice a year if you are meeting your treatment goals. Your A1C gives you a good idea of your blood sugar control over time. In general, your goal is to keep your blood sugar level as close to your goal as possible. This can help reduce the risk of some diabetes-related problems, like problems with the eyes (diabetic retinopathy), and the nerves in places like the hands and feet (n Continue reading >>
Passing The A1c “test”…what Do I Need To Score?
No one quite agrees on where your A1C score should be, but we all agree on where it shouldn’t be. The scale does not look anything like the BGL numbers you are used to. For all practical purposes, it runs from 5.0 up to 14.0 where most in-house A1C machines max out. Labs can test higher, but at 14.0 your doctor will run screaming for the hills anyway, so it really doesn’t matter. At that level your blood sugar is lethal and your body is slowly dissolving, just as if you had battery acid in your veins and arteries. As a side note, many offices have in-house A1C machines that give results in six minutes. Very handy. I personally love being able to discuss the score with the patient during the visit. Other offices do a “send out.” We generally do them in-house, but if we are also running other lab tests we’ll sometimes piggyback the test onto the blood draw. Both are highly accurate and reliable. So back to your score. Scores below 6.0 are usually considered to be in the non-diabetic range. At 9.0 we cross the threshold where kidney damage starts. So we can all agree that above 9.0 you are in deep shit and the higher above 9.0 that the number is, the worse off you are because A1C tests are curvilinear. Just like Category 3 hurricanes are much worse than Category 2 storms, or like 7.3 earthquakes are much worse than 7.0s, each increase in your A1C number packs a larger punch than you’d expect. The numbers are sufficiently confusing that the ADA has introduced a new measure called eAG, for estimated average glucose. This is a formula that “translates” an A1C score into a “meter number.” It hasn’t been widely adopted yet and the jury is still out on how useful eAG is. I use it for some patients, but not for others, but I always like to have a lot of tool Continue reading >>
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 >>
The A1c Test & Diabetes
What is the A1C test? The A1C test is a blood test that provides information about a person’s average levels of blood glucose, also called blood sugar, over the past 3 months. The A1C test is sometimes called the hemoglobin A1c, HbA1c, or glycohemoglobin test. The A1C test is the primary test used for diabetes management and diabetes research. How does the A1C test work? The A1C test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen. In the body, red blood cells are constantly forming and dying, but typically they live for about 3 months. Thus, the A1C test reflects the average of a person’s blood glucose levels over the past 3 months. The A1C test result is reported as a percentage. The higher the percentage, the higher a person’s blood glucose levels have been. A normal A1C level is below 5.7 percent. Can the A1C test be used to diagnose type 2 diabetes and prediabetes? Yes. In 2009, an international expert committee recommended the A1C test as one of the tests available to help diagnose type 2 diabetes and prediabetes.1 Previously, only the traditional blood glucose tests were used to diagnose diabetes and prediabetes. Because the A1C test does not require fasting and blood can be drawn for the test at any time of day, experts are hoping its convenience will allow more people to get tested—thus, decreasing the number of people with undiagnosed diabetes. However, some medical organizations continue to recommend using blood glucose tests for diagnosis. Why should a person be tested for diabetes? Testing is especially important because early in the disease diabetes has no symptoms. Although no test is perfect, the A1C and blood glucose tests are the best tools available to diagnose diabetes—a serious and li Continue reading >>
Even A Thin Person Can Get Diabetes
Print Font: One of my most enduring childhood images is from a newspaper clipping. The grainy photograph freezes a lanky teen named Tom O'Connell launching a hook shot from his right thigh. Tucker, as he was known, led a team from tiny Merchantville High School in scoring and rebounding during an improbable run to the South Jersey Championship. New Jersey had its own version of Hoosiers in 1952, and for that one season, my father was his team's Jimmy Chitwood. More women opting for preventive mastectomy - but should they be? Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring. In February 2008, I arrive at a nursing home in the San Fernando Valley to visit the man in that photograph, a man I've neither seen nor spoken to in 20 years. Entering his room, I barely recognize the gaunt face. Where his right thigh should be sits a corduroy pant leg, gathered up and bobby-pinned. The spindly arm he extends to greet me is splotched with blood bursts. Once 6'3'' and 215 pounds, he's now a cadaverous-looking 145. The only cheerful note in the room is a balloon tied to the metal bed frame. His 73rd birthday was last week, apparently. It's a detail I had long since forgotten. Like a man looking into a foggy mirror, my father strains to recognize me. But if he is staring into his past, I might be peering into my future. I'm 6'6'' and weigh 220, with 12 percent body fat and the outline of abs above a 32-inch waist. Yet diabetes has me in its crosshairs as well. If you think being thin gives you a fr Continue reading >>
What Are The Normal A1c Levels For Children?
The A1c blood test is one of the laboratory tests used to diagnose diabetes and an important measure of average blood sugar levels in someone who has diabetes. This test determines the amount of glucose or sugar that has attached to the blood's hemoglobin -- the oxygen-carrying protein in red blood cells -- during the 3-month lifespan of these cells. Target A1c levels have been established to help healthcare providers, as well as children with diabetes and their families, understand the blood sugar goals needed to reduce the risk of the long-term complications of diabetes. While there are some situations where the A1c result may not be reliable, as a rule this test is accurate and an essential part of a child's diabetes management program. Video of the Day Normal A1c Levels Diagnostic criteria for children is similar to the guidelines used in adults, and the A1c is one of the tests used to diagnose diabetes. A1c levels are reported as a percentage, and often the estimated average glucose (eAG) -- a number calculated from the A1c reading -- is also included with the results. Using the same units as a blood glucose meter, the eAG makes understanding the A1c result a bit easier by comparing the A1c to average blood sugar levels. A normal, nondiabetic A1c level is below 5.7 percent, which reflects an eAG below 117 mg/dL. The level used to diagnose diabetes is 6.5 percent and above, which reflects an eAG of 140 mg/dL or higher. A1c levels above normal but below the diabetes range fit into a prediabetes range. Target A1c Levels Along with its role in diagnosing diabetes, the A1c test is performed between 2 and 4 times per year to estimate average blood sugar levels over the previous 3 months. This test is used to monitor the effectiveness of diabetes treatment and to determin Continue reading >>
Effort To Lower A1c Levels With Drugs Increases Death Rate In Diabetics
By Jim English While diabetes is the leading cause of kidney failure, blindness and lower limb amputations not caused by accidents or trauma, the most serious threat facing diabetic patients is death from heart attack or stroke. Eighty percent of hospitalizations for patients with diabetes are for macrovascular disorders, such as coronary disease, cerebrovascular disease and peripheral vascular disease, and 75 percent of deaths in diabetics are cardiovascular death, mostly in patients with Type 2 diabetes. To put these numbers in perspective, while a 50-year-old patient with “average” blood pressure and cholesterol levels has a 7 percent chance of experiencing a heart attack in the next 10 years, a 50-year-old diabetic patient faces up to a 50 percent chance of having a heart attack in the next ten years. ACCORD Trial Fails to Protect Diabetic Patients In 2001, the National Institutes of Health (NIH) launched a trial to lower blood glucose levels in diabetic patients to reduce their risk for heart attack, stroke, or death from cardiovascular disease. The trial, called Action to Control Cardiovascular Risk in Diabetes, or ACCORD, involved over 10,000 Type 2 diabetic patients who had either been previously diagnosed with heart disease or had two or more risk factors for heart disease when they entered the study. Participants were randomly assigned to one of two treatment groups. The first group of 5,123 participants was treated with standard drugs and insulin at levels generally approved as the standard for Type 2 diabetes. The second group, consisting of 5,128 participants, was assigned to receive a much more aggressive form of treatment involving higher doses of the standard therapy. For both groups, study clinicians were permitted to use all major classes of FDA-ap Continue reading >>
Overtreatment Of Elderly Diabetics
The last time I was directly responsible for treating diabetes was fifty years ago, when I was an intern in medicine at UCLA. In my subsequent career as a psychiatrist I was not directly responsible for diabetes care, and as an individual, I don’t have the condition. As a result, I haven’t kept up on diabetes treatment, so a June 11 article on “Diabetes Overtreatment in Elderly Individuals: Risky Business in Need of Better Management” was news to me. The opening two sentences of the American Diabetes Association’s article on “Tight Diabetes Control” make it sound as if “tight control” should be the goal of treatment: “Keeping your blood glucose levels as close to normal as possible can be a lifesaver. Tight control can prevent or slow the progress of many complications of diabetes, giving you extra years of healthy, active life.” In my uninformed state, that’s how I understood how diabetes should be managed, even for over 65ers. But I was wrong. Several paragraphs later there’s a very clear statement that elderly people with diabetes should be treated differently: “Elderly people probably should not go on tight control. Hypoglycemia [overly low blood sugar] can cause strokes and heart attacks in older people. Also, the major goal of tight control is to prevent complications many years later. Tight control is most worthwhile for healthy people who can expect to live at least 10 more years.” The American Geriatrics Society gives precise guidelines for the goal of diabetes treatment in over 65ers. The key measure of diabetes control is hemoglobin A1c. For healthy over 65ers with long life expectancy, the target should be 7.0 – 7.5%. For those with “moderate comorbidity” (so-so health) and a life expectancy of less than 10 years the targe Continue reading >>
Diabetes Simplified: A1c Testing
By Wil Dubois “Mirror, mirror, on the wall, who’s the best-controlled of all?” —what the Wicked Queen would have asked if she’d had diabetes instead of vanity issues If you’ve had diabetes for any time at all, you’ve probably heard of the A1C test. Sometimes, it’s also called the HbA1c test, the Hemoglobin A1c test, or the glycated hemoglobin test. They’re all the same thing. This is a lab test that allows your doctor, by consulting with a magic mirror, to determine how well your diabetes has been controlled, night and day, for the last three months. If that’s not black magic, I don’t know what is. Of course, as sci-fi writer Arthur C. Clarke famously said, “Any sufficiently advanced technology is indistinguishable from magic.” The A1C has become the widely accepted benchmark for diabetes control. It’s used to classify who is in control and who is not, and to quantify the risk levels of those not in-target. The higher the A1C, the greater the risk of complications. The A1C is now also used diagnostically, with A1C scores actually used to diagnose new-onset diabetes. The A1C Test: How Does It Work? Well, like I said, it’s magic: in this case, the magic of biochemistry. The test measures the average blood sugar level for the past three months. It can do this because glucose sticks to red blood cells, just like powdered sugar sticks to freshly-fried doughnut holes. The result of the test is expressed as a percentage: 6.2 percent…7.8 percent…8.3 percent…9.6 percent…12.4 percent…and so on. Most A1C scores are only expressed in tenths of a percent, but some labs report twentieths, as well, so you might see an A1C of 6.79 percent or 8.32 percent. Wait a sec. A percentage of what, exactly? The percentage of hemoglobin in the sample of red Continue reading >>
The Hemoglobin A1c Blood Test For Type 2 Diabetes
The hemoglobin A1C is a great blood test for a diabetic. You can know how well your blood sugar control has been over a few months. But this test will not replace daily glucose monitors. It has other limitations too. Still, the HbA1C blood test is my favorite of all type 2 diabetic tests. For one thing, it does not require fasting. For another, it can be done in the doctor's office with a single fingerstick just like a glucose monitor test. You get results in six minutes. Best of all, it lets you know how your blood sugar has been doing over the past two or three months. The test sounds perfect, but it is not. For diabetes management you need to know what your blood sugar levels are every day. Daily blood testing is still necessary, because a type 2 diabetic on insulin needs to know his glucose levels several times a day, not just every three months. A great HBA1C reading does not mean there have been no hyperglycemic (high blood sugar) or hypoglycemic (low blood sugar) episodes over the last few months. So the hemoglobin A1C cannot replace daily checks with your glucose monitor and good log book records. Your doctor always asks what your last daily reading was, and he likes to see your log book too. Daily readings along with the A1C give a complete picture of what is going on with your diabetes treatment. Taken together with daily readings, the hemoglobin A1C tells you if your blood sugar is staying in the range that will keep away the complications. There is more and more evidence that an A1C between 6.5 and 7 will do just that. And here's an encouraging fact. If your A1C was 9 and you lowered it to 8, there is a 20% reduction in your risk of complications. That means you do not have to be in the best range yet to see benefits from better blood sugar control. Hemoglob Continue reading >>
Epw02 - Depression 1 Epa-0023 – Diabetes And Major Depressive Disorder Interaction: No Effect Of Baseline Diabetic Control On Six Month Depression Outcomes
Prior studies have demonstrated an inter-relationship between the diagnosis of diabetes, obesity and depression. Our prior studies have shown that the diagnosis of diabetes or baseline body mass index (BMI) did not impact six month depression remission rates. Our hypothesis was that level of control of diabetes (hemoglobulin A1c < 8.0%) in depressed diabetic patients would have no effect on depression remission rates six months after diagnosis. This study was retrospective analysis of 451 diabetic primary care patients diagnosed with Major Depressive Disorder or Dysthymia with a PHQ-9 score of 10 or greater. ▪ Outcome variable was clinical remission (PHQ-9 < 5) at six months. ▪ Logistic regression modeling included the demographic variables of age, gender, marital status, the clinical variables of BMI, baseline PHQ-9 score, hemoglobin A1c level (at date of diagnosis of depression) and clinical diagnosis (recurrent or first episode of depression, or dysthymia). 78.5% (354) of depressed diabetics were in good control of diabetes (hemoglobin A1c< 8%) at enrollment. Obesity (BMI≥ 30) at baseline was not different between the controlled and uncontrolled diabetic patients at baseline (approximately 70%), p=0.36. Figure 1. Odds ratio for clinical remission (PHQ-9<5) at six months in diabetic primary care patients, by variable (N=451). Controlling for age, gender, marital status, race, clinical diagnosis and clinical site. ▪ Baseline control of diabetes was not an independent predictor for depression outcome at six months. This data suggests that poor diabetic control was not associated worsening clinical outcomes in depression management. Continue reading >>
Three Different Cutoffs Of 6.0%, 5.7%, And 5.5%.8-10 Therefore, In This Study, A1c Levels Were
2026 Glycohemoglobin (A1C), a parameter for the 2- to 3-month average endogenous exposure to glucose, has high intraindividual reproducibility and can be determined in the nonfasting state.1 The diagnostic cut points of A1C for diabetes mellitus are mainly based on the established association between A1C and microvascular disease.2 There is increasing evidence, however, that the level of A1C pre- dicts clinical cardiovascular disease (CVD) or cardiovascu- lar mortality3,4 and this association, independent of fasting glucose, is observed even at levels of A1C below the cutoff point of 6.5%.3â€“5 To date, little data are available on the association between A1C and subclinical CVD measured by coronary artery cal- cification (CAC). Studies of subclinical CVD can provide complementary information to studies of clinical CVD out- comes by allowing the understanding of early stage of CVD, whereas studies of clinical CVD events are influenced by factors related to plaque rupture and thrombosis.6 CAC scor- ing using cardiac computed tomography is a sensitive method to identify the presence of subclinical atherosclerosis7 which is associated with future risk of CVD events.8 Thus, measur- ing CAC leads to a better understanding of the relationships between potential cardiovascular risk factors and subclinical coronary artery atherosclerosis. Until now, a few studies have examined the association between A1C and CAC in asymptomatic nondiabetic popu- lation, with conflicting results.6,9 One study showed no asso- ciation between A1C and calcified plaque using computed tomography angiography,9 whereas the Multi-Ethnic Study of Atherosclerosis (MESA) study showed a significant asso- ciation between higher A1C <6.5% and the presence of CAC, although only in women.6 The association Continue reading >>