What Is An A1c Test?
By Zachary T. Bloomgarden, MD, FACE When a person with diabetes sees an endocrinologist [en-doh-cri-NA-lo-jist], they soon learn about a test called hemoglobin A1C, or HbA1c, or, simply, A1c. The A1C, they are told, should be as low as possible (the American Association of Clinical Endocrinologists [AACE] recommends a level of 6.5% or less). A person with diabetes may also learn that an A1C of 6.5% is a benchmark for diagnosing diabetes. What is A1C? Is it truly useful? What does it mean as a benchmark of diabetes control? A1C represents the attachment of glucose (sugar) to hemoglobin (the oxygen-carrying protein in our red blood cells). The red blood cells need glucose for their metabolism. When the hemoglobin in the red blood cell meets glucose, glucose slowly (over days and weeks) attaches to an amino acid on the hemoglobin. At this time, a person’s A1C level would show the amount of glucose that the red blood cells have been exposed to over time. Since the average life of a red blood cell is 3 to 4 months, the A1C shows an average blood sugar level, not just at the time the blood test was done, but during the long period leading up to that time. Normally, when a person does not have diabetes, their blood sugar is below 100 mg/dL before meals, and it rarely rises over 120-130 mg/dL after meals. In these circumstances, the A1C is around 5%. This means that 5% of the hemoglobin molecules in that person’s millions of red blood cells have glucose attached. In mild diabetes (with a fasting blood glucose just over 125 mg/dL or the blood sugar 2 hours after an oral glucose tolerance test around 200 mg/dL), the A1C will be over 6%. So, 6% of their hemoglobin molecules have glucose attached. At 7%, 8%, and 10% the blood glucose levels during the day become higher, and so, Continue reading >>
Glycohemoglobin (hba1c, A1c)
A A A Test Overview Glycohemoglobin (A1c) is a blood test that checks the amount of sugar (glucose) bound to the hemoglobin in the red blood cells. When hemoglobin and glucose bond, a coat of sugar forms on the hemoglobin. That coat gets thicker when there's more sugar in the blood. A1c tests measure how thick that coat has been over the past 3 months, which is how long a red blood cell lives. People who have diabetes or other conditions that increase their blood glucose levels have more glycohemoglobin than normal. An A1c test can be used to diagnose prediabetes or diabetes. The A1c test checks the long-term control of blood glucose levels in people with diabetes. Most doctors think checking an A1c level is the best way to check how well a person is controlling his or her diabetes. A home blood glucose test measures the level of blood glucose only at that moment. Blood glucose levels change during the day for many reasons, including medicine, diet, exercise, and the level of insulin in the blood. It is useful for a person who has diabetes to have information about the long-term control of blood sugar levels. The A1c test result does not change with any recent changes in diet, exercise, or medicines. Glucose binds to hemoglobin in red blood cells at a steady rate. Since red blood cells last 3 to 4 months, the A1c test shows how much glucose is in the plasma part of blood. This test shows how well your diabetes has been controlled in the last 2 to 3 months and whether your diabetes treatment plan needs to be changed. The A1c test can also help your doctor see how big your risk is of developing problems from diabetes, such as kidney failure, vision problems, and leg or foot numbness. Keeping your A1c level in your target range can lower your chance for problems. Why It Is Continue reading >>
Consistency Of Hemoglobin A1c Testing And Cardiovascular Outcomes In Medicare Patients With Diabetes
Abstract Background Annual hemoglobin A1c testing is recommended for patients with diabetes mellitus. However, it is unknown how consistently patients with diabetes mellitus receive hemoglobin A1c testing over time, or whether testing consistency is associated with adverse cardiovascular outcomes. Methods and Results We identified 1 574 415 Medicare patients (2002–2012) with diabetes mellitus over the age of 65. We followed each patient for a minimum of 3 years to determine their consistency in hemoglobin A1C testing, using 3 categories: low (testing in 0 or 1 of 3 years), medium (testing in 2 of 3 years), and high (testing in all 3 years). In unweighted and inverse propensity‐weighted cohorts, we examined associations between testing consistency and major adverse cardiovascular events, defined as death, myocardial infarction, stroke, amputation, or the need for leg revascularization. Overall, 70.2% of patients received high‐consistency testing, 17.6% of patients received medium‐consistency testing, and 12.2% of patients received low‐consistency testing. When compared to high‐consistency testing, low‐consistency testing was associated with a higher risk of adverse cardiovascular events or death in unweighted analyses (hazard ratio [HR]=1.21; 95% CI, 1.20–1.23; P<0.001), inverse propensity‐weighted analyses (HR=1.16; 95% CI, 1.15–1.17; P<0.001), and weighted analyses limited to patients who had at least 4 physician visits annually (HR=1.15; 95% CI, 1.15–1.16; P<0.001). Less‐consistent testing was associated with worse results for each cardiovascular outcome and in analyses using all years as the exposure. Conclusions Consistent annual hemoglobin A1c testing is associated with fewer adverse cardiovascular outcomes in this observational cohort of Me Continue reading >>
- A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
- A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
- Medication Adherence and Improved Outcomes Among Patients With Type 2 Diabetes
Diabetes, Cholesterol, Bp: Normal Is No Longer Normal
Pre-diabetes On 10 June 2014 there were global headlines about a ‘condition’ called pre-diabetes. From the Mail telling us that “A third of adults have ‘borderline’ diabetes – but most don’t know: Rising tide of obesity means number who have ‘pre-diabetes‘ has trebled since 2006″ to the Huffington Post proclaiming “Most People In England Have Borderline Diabetes, New Study Reveals“. One third was never most people when I did proportions, but anyway. Here is the summary of the study and findings from a journal web site and here is the original (full) article. A quick review of the article should have made the media far more challenging, instead of just taking the press release headlines: 1) The study used data already gathered for Health Survey England (HSE), which started in 1991. The number of adults involved in the HSE, from whom blood samples were taken, was 7,455 in 2003; 6,347 in 2006 and 1,951 in 2009. I can’t find the numbers for 2011, but they are likely to be small if the trajectory continues. There are over 40 million adults in England. Using 2009 as a guide, projections on this concept of ‘pre-diabetes’ have been made based on 0.0048% of the population. I can’t get my head around such numbers. 2) People were diagnosed with pre-diabetes if they had glycated haemoglobin (an indicator of blood sugar levels) between 5.7% and 6.4%. This is the US guideline for ‘pre-diabetes’. The UK guideline is 6.0-6.4%. This would have over-predicted the idea of having a pre-condition. 3) The introduction to the full article in the BMJ is worth a read. The introduction notes that England set up a scheme to offer people aged between 40 and 74 a health check to try to pick up blood glucose concerns (and other things). Then it admits that “the Continue reading >>
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Hemoglobin A1c
On This Site Tests: Glucose Tests; Urine Albumin; Urine Albumin/Creatinine Ratio; Fructosamine Conditions: Diabetes In the News: Screening, Diet and Exercise Key Factors in Task Force's New Diabetes Guidelines (2015), Task Force Updates Recommendations for Screening for Pre-Diabetes and Diabetes in Adults (2014), New Report Finds that Diabetes is on the Rise (2014) Elsewhere On The Web American Diabetes Association: Diabetes Basics American Diabetes Association: Risk Test American Association of Diabetes Educators Centers for Disease Control and Prevention: Diabetes Public Health Resource National Diabetes Information Clearinghouse: Prevent diabetes problems - Keep your diabetes under control National Institute of Diabetes and Digestive and Kidney Diseases: Diabetes A to Z National Glycohemoglobin Standardization Program American Diabetes Association – DiabetesPro, estimated Average Glucose, eAG Ask a Laboratory Scientist Your questions will be answered by a laboratory scientist as part of a voluntary service provided by one of our partners, the American Society for Clinical Laboratory Science (ASCLS). Click on the Contact a Scientist button below to be re-directed to the ASCLS site to complete a request form. If your question relates to this web site and not to a specific lab test, please submit it via our Contact Us page instead. Thank you. Continue reading >>
Check Your Hemoglobin A1c I.q.
(The following is reprinted courtesy of the National Institute of Diabetes and Digestive and Kidney Diseases, a division of the U.S. National Institutes of Health.) Find out how much you know about the Hemoglobin A1c test (also called HbA1c). Mark each statement true (T) or false (F). Then see how you did by checking the correct answers and explanations, found below. 1. A Hemoglobin A1c test measures the average amount of sugar in your blood over the last three months. T F 2. It's important to know your Hemoglobin A1c number. T F 3. All people with diabetes need to have a Hemoglobin A1c test. T F 4. The Hemoglobin A1c goal for people with diabetes is less than 7 percent. T F 5. Most people can tell what their blood sugar levels are simply by how they feel. T F 6. You can have a "touch of sugar" but don't have to do anything about it. T F 7. You can do something about high blood sugar. T F 8. A Hemoglobin A1c number over 8 percent is a sign that one or more parts of your treatment plan needs to be changed. T F 9. A Hemoglobin A1c test should be done about once a year. T F 10. There's no proof that lowering your Hemoglobin A1c number can reduce your chances of getting serious eye, kidney, and nerve disease. T F Answers to the HEMOGLOBIN A1c I.Q. QUIZ: 1. TRUE: The Hemoglobin A1c test shows the average amount of sugar in your blood over the last three months. It is a simple lab test done by your health care provider. The Hemoglobin A1c is the best test to find out if your blood sugar is under control. 2. TRUE: If you know your Hemoglobin A1c number, you will know if your blood sugar is under control. A high number is a sign you should work with your health care provider to change your treatment plan. A good test result is a sign your treatment plan is working and your bloo Continue reading >>
Your Average Blood Sugar: Why It Really Matters
If there was a blood test that could give you valuable information about a major, yet reversible risk factor for Alzheimer’s disease and age related dementia, would you want to take it? What if that same blood test could also give you information about your risk of heart disease, high blood pressure, diabetes, vision loss, cancer and how fast you can expect your body to age? What if the test was really cheap? Now, what if you knew that what you were going to have to do to reverse your risk of all these conditions was going to be personally challenging, maybe even really hard, would you still want to take the test? Something to think about, isn’t it? The test I’m talking about does exist. It’s a simple little test that’s run all the time. It’s full implications are rarely considered, however. The test It’s called “hemoglobin A1c” and is sometimes referred to simply as the “A1c” test. In essence, it measures the amount of sugar that has become stuck to the hemoglobin in your red blood cells (hemoglobin is the component in blood that carries oxygen). Because red blood cells live for about 3 to 4 months, the test is usually used to estimate an “average blood sugar” for the previous 3 months. The more sugar floating around in your blood on a daily basis, the higher you A1c value will be. In conventional medicine the test is used to diagnose and monitor treatment goals for diabetics. The implications of a person’s A1c value run much deeper, however. Sugar within the body doesn’t just stick to hemoglobin. It sticks to many tissues that are made of proteins and fats (this accounts for most tissues in your body by the way) and can bind directly to DNA. The compounds formed by this process are called advanced glycation end products or “AGEs” for Continue reading >>
The Association Between 25-hydroxyvitamin D And Hemoglobin A1c Levels In Patients With Type 2 Diabetes And Stage 1–5 Chronic Kidney Disease
Copyright © 2014 Farshad Kajbaf et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Aim. To examine the relationship between plasma 25-hydroxyvitamin D (25(OH)D) levels and blood hemoglobin A1c (HbA1c) levels in diabetic patients at various stages of chronic kidney disease (CKD). Methods. We screened for data collected between 2003 and 2012. The correlation between 25(OH)D and HbA1c levels was studied in patients categorized according to the severity of CKD and their vitamin D status. A multivariate linear regression model was used to determine whether 25(OH)D and HbA1c levels were independently associated after adjustment for a number of covariates (including erythrocyte metformin levels). Results. We identified 542 reports from 245 patients. The mean HbA1c value was % in vitamin D sufficiency, % in insufficiency, and % in deficiency (). There was a negative correlation between 25(OH)D and HbA1c levels for the population as a whole (, ) and in the CKD severity subgroups (, and , for CKD stages 1–3 and 4-5, resp.). In the multivariate analysis, the 25(OH)D level was the only factor associated with HbA1c (). Conclusion. 25(OH)D levels were negatively correlated with HbA1c levels independently of study covariates. 1. Introduction In addition to the pivotal role of vitamin D in calcium/phosphorus homeostasis and bone physiology [1, 2], several lines of evidence suggest that vitamin D status may also have a significant role in glucose homeostasis in general [3] and on pathophysiology and progression of metabolic syndrome and Type 2 diabetes in particular [4]. Studies in animals and humans sugges Continue reading >>
- Predictors of Chronic Kidney Disease In Type 1 Diabetes
- A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
- A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes
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 >>
- Home blood glucose test: How to test for diabetes at home
- Diabetes and the A1C Test: What Does It Tell You?
- Postprandial Blood Glucose Is a Stronger Predictor of Cardiovascular Events Than Fasting Blood Glucose in Type 2 Diabetes Mellitus, Particularly in Women: Lessons from the San Luigi Gonzaga Diabetes Study
Should The Target A1c Level Be Less Than 7 Percent? No: The Case For Modest Glycemic Control In Patients With Type 2 Diabetes
HENRY C. BARRY, MD, MS, Michigan State University College of Human Medicine, East Lansing, Michigan Am Fam Physician. 2012 Dec 15;86(12):online. Related editorial: Should the Target A1C Level Be Less Than 7 Percent? Yes: This Should Be the Target for Most Patients. This is one in a series of pro/con editorials discussing controversial issues in family medicine. Between firmly held beliefs in tight glycemic control and the available empiric data lies a wide chasm. In a review of 13 randomized controlled trials (RCTs) comparing tight control versus usual care in patients with type 2 diabetes mellitus, overall, tight control did not improve all-cause mortality, cardiovascular mortality, or total myocardial infarctions.1 There was a decrease in the rate of nonfatal myocardial infarctions, but between 117 and 150 patients would have to be treated for five years to prevent one myocardial event. If you omit two poor-quality studies, the benefit for any outcome disappears, except for less progression to microalbuminuria. However, only 15 to 52 patients would need to be treated per year with tight control to cause one severe episode of hypoglycemia. Several arguments in favor of tight control come to mind, such as the need to preserve islet cells, the association between glycemic control and complications, and the use of highly selected populations in the above studies. However, none of those arguments hold up. Early preservation of islet cell function, the world's greatest glucose monitoring and management system, is arguably the key to avoiding complications. Yet in spite of this interesting hypothesis, the outcomes of patients with screen-detected diabetes treated intensively are no different than those of patients treated with usual care.2 In a study commonly used to justify Continue reading >>
Is A Lower A1c Level Better Or Worse?
It seems logical that the lower our blood glucose levels are the better we will be. Most of us have always assumed that lower blood glucose levels would protect us better from the complications of diabetes. In fact, during the past two decades several studies showed a linear relationship between blood glucose, as measured by A1C levels, and worsened health. But now, several recent A1C studies have shown a J-shaped relationships, in which at the lower end some bad things happen, at the center things are better, and at the top end things are terrible. While linear relationships are the rule in observational studies, U-shaped and J-shaped curves aren’t uncommon, and some authors lump both of these shapes as U-shaped. All of the studies relating A1C levels and ill health — the earlier ones and the recent ones alike — are observational. They study correlations, which aren’t proof, because other confounding factors that the researchers didn’t take into account could have been the problem. 5.4-5.6 Seems Safest The first of these newer studies showing that a very low A1C level is unhealthier than a higher one came out in the February 2015 issue of Diabetes Care. This analysis of the German National Health Interview and Examination Survey 1998 that studied about 6,300 people for about 12 years indicated that people with an A1C level of 5.4 to 5.6 had the lowest risk of excess mortality. Because this result puzzled me so much, I asked Dr. Richard K. Bernstein for his reaction. “These A1c measurements were made years ago in Germany,” he replied, “before international agreement on how it would be measured. The modern elution method would likely give considerably different results. It is even possible that several different methods were being used at different sites Continue reading >>
5 Tips For Preserving Your Vision
Whether you have type 1 or type 2 diabetes, you run the risk of developing diabetic retinopathy, which accounts for 12,000 to 24,000 new cases of blindness each year. But you don’t have to become one of these scary statistics if you keep tight control over your blood glucose (sugar), and follow these simple preventive measures. Monitor changes in your vision. This can be done both during your yearly visit to your eye care professional, and also at home. Make a note of vision on a daily basis--that way if anything out of the ordinary arises, you’ll be able to identify it immediately. If you are new to diabetes, you will have some vision abnormalities as glucose is regulated by treatment (pills or insulin, or both), but if you notice blurred vision and you have had diabetes for a length of time, it might be a signal you need to keep tighter control of your glucose levels. Keep your A1C level under 7%. A1C is a test you have during a visit to your endocrinologist to determine how well-controlled your diabetes has been during the previous 2-3 months. For most people, if your A1C is under 7%, it means you’re doing a good job keeping the amount of sugar in your blood in your target range. Keeping your blood glucose in this target range means less damage to the delicate blood vessels around your eyes. Control blood pressure. People with diabetes have a greater chance of having high blood pressure, which can cause eye blood vessel damage. The combination of high blood pressure and the presence of too much glucose can wreak havoc on your vision. Keep your blood pressure at 130/80 or under, and you’ll decrease the chances of vision impairment. Get your eyes checked. This means visiting your eye care professional each year, and having a dilated eye exam. The Beetham Eye In 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 >>
A Hemoglobin A1c Of Greater Than 5% Can Be A Predictor Of Incident Diabetes
The incidence of diabetes progressively and significantly increased among patients with an HbA1c greater than 5.0%…. Several studies have suggested that HbA1c levels may predict incident diabetes. With new recommendations for use of HbA1c in diagnosing diabetes, many patients with HbA1c results below the diagnostic threshold will be identified. Clinicians will need to categorize risk for a subsequent diabetic diagnosis in such patients. The objective of this study was to determine the ability of HbA1c to predict the incidence of a diabetic diagnosis. For this study they performed a historical cohort study using electronic medical record data from two Department of Veterans Affairs Medical Centers. Patients (12,589) were identified with a baseline HbA1c <6.5% between January 2000 and December 2001 and without a diagnosis of diabetes. Patients (12,375) had at least one subsequent follow-up visit. These patients were tracked for 8 years for a subsequent diagnosis of diabetes. The results showed that during an average follow-up of 4.4 years, 3,329 (26.9%) developed diabetes. HbA1c ≥5.0% carried a significant risk for developing diabetes during follow-up. When compared with the reference group (HbA1c <4.5%), HbA1c increments of 0.5% between 5.0 and 6.4% had adjusted odds ratios of 1.70 (5.0–5.4%), 4.87 (5.5–5.9%), and 16.06 (6.0–6.4%) (P < 0.0001). Estimates of hazard ratios similarly showed significant increases for HbA1c ≥5.0%. A risk model for incident diabetes within 5 years was developed and validated using HbA1c, age, BMI, and systolic blood pressure. The results showed that baseline HbA1c was significantly predictive of the subsequent development of a diagnosis of diabetes over an 8-year period. The risk of developing diabetes increased progressively at Hb Continue reading >>
- Postprandial Blood Glucose Is a Stronger Predictor of Cardiovascular Events Than Fasting Blood Glucose in Type 2 Diabetes Mellitus, Particularly in Women: Lessons from the San Luigi Gonzaga Diabetes Study
- Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)*
- Relation of total sugars, fructose and sucrose with incident type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies
Hemoglobin A1c
Hemoglobin A1c (HbA1c) refers to a minor population of HbA that has been modified by attachment of glucose to the N-terminal amino acid of the beta globin chain. Since erythrocytes are freely permeable to glucose, the attachment occurs continually over the entire lifespan of the erythrocyte and is dependent on glucose concentration and the duration of exposure of the erythrocyte to blood glucose. HbA1c is a weighted average of blood glucose levels during the preceding 120 days, which is the average life span of red blood cells. A large change in mean blood glucose can increase HbA1c levels within 1-2 weeks. Sudden changes in HbA1c may occur because recent changes in blood glucose levels contribute relatively more to the final HbA1c levels than earlier events. For instance, mean blood glucose levels in the 30 days immediately preceding blood sampling contribute 50% to the HbA1c level, whereas glucose levels in the preceding 90-120 day period contribute only 10%. Thus, it does not take 120 days to detect a clinically meaningful change in HbA1c following a significant change in mean plasma glucose level. Hemoglobin A1c Methods Methods for analysis of HbA1c can essentially be divided into 2 categories depending on whether they measure HbA1c based upon charge or structure. The most common charge-based method utilizes cation-exchange high pressure liquid chromatography (HPLC). In this method, different hemoglobin molecules (eg, HbA, HbA2, HbF) are eluted from the column at different times following exposure to buffers of increasing ionic strength, depending on their charge. HbA1c is less positively charged than HbA and does not bind as tightly to the negatively charged resin. Therefore, it elutes more rapidly than HbA. The quantity of each Hb fraction in the eluate is quantit Continue reading >>
