Hba1c And Monitoring Glycaemia
This article forms part of our ‘Tests and results’ series for 2012, which aims to provide information about common tests that general practitioners order regularly. It considers areas such as indications, what to tell the patient, what the test can and cannot tell you, and interpretation of results. Proteins in the body chemically react with glucose and become glycosylated. HbA1c is glycosylated haemoglobin and reflects the average blood glucose over the lifespan of the red blood cells containing it. HbA1c is regarded as the gold standard for assessing glycaemic control. HbA1c is also known as A1c, glycohaemoglobin and glycated haemoglobin. When should HbA1c be ordered? HbA1c reflects average glycaemia over the preceding 6–8 weeks. The test is subsidised by Medicare up to four times in a 12 month period.1 In some patients, HbA1c may be measured more frequently than 3 monthly to closely monitor glycaemic control (eg. in pregnancy when up to six tests in a 12 month period can be subsidised).1 The Service Incentive Program for diabetes care requires at least one HbA1c measurement per year. It is suggested that HbA1c is done every 6 months if meeting target, or every 3 months if targets are not being met or if therapy has changed.2 Self blood glucose monitoring (BGM) and HbA1c complement each other: BGM informs the patient about blood glucose at any particular time (eg. when the patient feels hypoglycaemic) and informs the patient and doctor about the glycaemic pattern over the 24 hour cycle and guides the timing and level of lifestyle intervention and hypoglycaemic therapy. What do I tell my patient? HbA1c is tested using venous blood, taken at any time of day and without any preparation such as fasting. In the paediatric setting, a finger-prick capillary sample can Continue reading >>
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Use Of Glycated Haemoglobin (hba1c) In The Diagnosis Of Diabetes Mellitus: Abbreviated Report Of A Who Consultation.
HbA1c can be used as a diagnostic test for diabetes providing that stringent quality assurance tests are in place and assays are standardised to criteria aligned to the international reference values, and there are no conditions present which preclude its accurate measurement. An HbA1c of 6.5% is recommended as the cut point for diagnosing diabetes. A value of less than 6.5% does not exclude diabetes diagnosed using glucose tests. Quality of evidence assessed by GRADE: moderate Strength of recommendation based on GRADE criteria: conditional Glycated haemoglobin (HbA1c) was initially identified as an “unusual” haemoglobin in patients with diabetes over 40 years ago (12). After that discovery, numerous small studies were conducted correlating it to glucose measurements resulting in the idea that HbA1c could be used as an objective measure of glycaemic control. The A1C-Derived Average Glucose (ADAG) study included 643 participants representing a range of A1C levels. It established a validated relationship between A1C and average glucose across a range of diabetes types and patient populations (13). HbA1c was introduced into clinical use in the 1980s and subsequently has become a cornerstone of clinical practice (14). HbA1c reflects average plasma glucose over the previous eight to 12 weeks (15). It can be performed at any time of the day and does not require any special preparation such as fasting. These properties have made it the preferred test for assessing glycaemic control in people with diabetes. More recently, there has been substantial interest in using it as a diagnostic test for diabetes and as a screening test for persons at high risk of diabetes (16). Owing in large part to the inconvenience of measuring fasting plasma glucose levels or performing an OGTT, Continue reading >>
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What Is Hba1c And A Normal Hba1c Range? Explained In Plain English
Those with type 1 or type 2 diabetes may have seen it before, but what is a normal HbA1c range? This article explores what your HbA1c reading should be and how you can improve it. What is HbA1c (Hemoglobin A1c)? HbA1c is a marker that can determine your average blood sugar (glucose) levels over the previous 3-months (1). That means it can be used to assess the quality of your diabetes management, as well as to diagnose pre-diabetes and diabetes. Sometimes HbA1c is also called glycated hemoglobin, hemoglobin A1c or just A1c. The ‘Hb’ refers to hemoglobin, a part of red blood cells that carry oxygen throughout your body. ‘A1c’ refers to a minor part of hemoglobin that sugar molecules attach to. The amount of sugar attached is directly proportional to the amount of sugar in your blood at a given time, so this reading is used to accurately reflect average blood sugar levels. If you’ve had high blood sugar levels in the past month or so, your HbA1c levels will be higher too. Summary: HbA1c is a marker that reflects your average blood sugar levels in the previous 3 months. It’s also called glycated hemoglobin, hemoglobin A1c or just A1c. Normal HbA1c Range The HbA1c test is measured as either a percentage or in mmol/mol. Below I’ve listed what is considered a normal HbA1c range, and what values would be considered outside of normal (pre-diabetic or diabetic): HbA1c range for normal (non-diabetic) adults: Below 6.0%, or below 42 mmol/mol HbA1c range for pre-diabetes: 6.0% to 6.4%, or 42 to 47 mmol/mol HbA1c range for diabetes: 6.5% or above, or 48 mmol/mol or above. Target ranges are also shown below in this table: HbA1c % mmol/mol Normal Below 6.0% Below 42 mmol/mol Pre-diabetes 6.0% to 6.4% 42 to 47 mmol/mol Diabetes 6.5% or above 48 mmol/mol or above Normal Hb Continue reading >>
Cutoff Point Of Hba1c For Diagnosis Of Diabetes Mellitus In Chinese Individuals
Cutoff Point of HbA1c for Diagnosis of Diabetes Mellitus in Chinese Individuals Affiliation: Graduate School, Dalian Medical University, Dalian, China Affiliation: Department of Endocrinology, Dalian Municipal Central Hospital Affiliated Of Dalian Medical University, Dalian, China Affiliation: Department of Endocrinology, Dalian Municipal Central Hospital Affiliated Of Dalian Medical University, Dalian, China Affiliation: Department of Endocrinology, Dalian Municipal Central Hospital Affiliated Of Dalian Medical University, Dalian, China Affiliation: Department of Endocrinology, Dalian Municipal Central Hospital Affiliated Of Dalian Medical University, Dalian, China Affiliation: Department of Endocrinology, Dalian Municipal Central Hospital Affiliated Of Dalian Medical University, Dalian, China Affiliation: Department of Endocrinology, Dalian Municipal Central Hospital Affiliated Of Dalian Medical University, Dalian, China Affiliation: Department of Endocrinology, Dalian Municipal Central Hospital Affiliated Of Dalian Medical University, Dalian, China Affiliation: Department of Endocrinology, Dalian Municipal Central Hospital Affiliated Of Dalian Medical University, Dalian, China The purpose of the present study was to find the optimal threshold of glycated hemoglobin (HbA1c) for diagnosis of diabetes mellitus in Chinese individuals. A total of 8 391 subjects (including 2 133 men and 6 258 women) aged 4090 years with gradable retinal photographs were recruited. The relationship between HbA1c and diabetic retinopathy (DR) was examined. Receiver operating characteristic (ROC) curves were used to find the optimal threshold of HbA1c in screening DR and diagnosing diabetes. HbA1c values in patients with DR were significantly higher than in those with no DR. The ROC curve fo Continue reading >>
Hemoglobin A1c Test (hba1c)
Hemoglobin A1c, often abbreviated HbA1c, is a form of hemoglobin (a blood pigment that carries oxygen) that is bound to glucose. The blood test for HbA1c level is routinely performed in people with type 1 and type 2 diabetes mellitus. Blood HbA1c levels are reflective of how well diabetes is controlled. The normal range for level for hemoglobin A1c is less than 6%. HbA1c also is known as glycosylated, or glycated hemoglobin. HbA1c levels are reflective of blood glucose levels over the past six to eight weeks and do not reflect daily ups and downs of blood glucose. High HbA1c levels indicate poorer control of diabetes than levels in the normal range. HbA1c is typically measured to determine how well a type 1 or type 2 diabetes treatment plan (including medications, exercise, or dietary changes) is working. How Is Hemoglobin A1c Measured? The test for hemoglobin A1c depends on the chemical (electrical) charge on the molecule of HbA1c, which differs from the charges on the other components of hemoglobin. The molecule of HbA1c also differs in size from the other components. HbA1c may be separated by charge and size from the other hemoglobin A components in blood by a procedure called high pressure (or performance) liquid chromatography (HPLC). HPLC separates mixtures (for example, blood) into its various components by adding the mixtures to special liquids and passing them under pressure through columns filled with a material that separates the mixture into its different component molecules. HbA1c testing is done on a blood sample. Because HbA1c is not affected by short-term fluctuations in blood glucose concentrations, for example, due to meals, blood can be drawn for HbA1c testing without regard to when food was eaten. Fasting for the blood test is not necessary. What Are Continue reading >>
Understanding The New Hba1c Units For The Diagnosis Of Type 2 Diabetes
In the absence of overt symptoms of hyperglycaemia, the diagnosis of diabetes has been based on plasma glucose concentrations that are associated with an increased risk of its specific microvascular complications, in particular retinopathy.1,2 The precise criteria have always been determined by consensus among experts and are based principally on several large observational cohort studies. The criteria have been repeatedly modified over time as more high quality data have become available. Most recently many international diabetes societies have adopted the measurement of glycated haemoglobin (HbA1c) as a legitimate diagnostic test for the diagnosis of diabetes using a “cut point” for the diagnosis of ≥6.5%.3–5 Recently there has been a change in the reporting units for HbA1c from percent to mmol/mol that has been driven by the International Federation of Clinical Chemistry (IFCC) and is linked to the standardisation of routine assays for HbA1c to a new reference method.6 The validity of the process has been accepted by many international diabetes societies (American Diabetes Association, Canadian Diabetes Society, European Association for the Study of Diabetes and International Diabetes Federation) as well as by the New Zealand Society for the Study of Diabetes (NZSSD).7 A NZSSD Working Party, made up of members representing clinicians, academics, laboratory staff, general practitioners and population health experts, has developed and now published a new position statement for the diagnosis of diabetes.7 This article explains the changes in use of HbA1c recommended in that statement and expands on the evidence behind these modifications. New units All methods used to measure HbA1c in New Zealand are now standardised through traceability to the IFCC reference me Continue reading >>
Predictors Of Hba1c Over 4 Years In People With Type 2 Diabetes Starting Insulin Therapies: The Credit Study
Highlights • We identified factors predictive of HbA1c in people with T2DM starting insulin. • Multivariable backward regression analysis selected variables associated with HbA1c. • HbA1c over 4 years was mainly determined by the HbA1c before starting therapy. • At 4 years, current insulin dose was the characteristic most strongly associated with concurrent HbA1c. Abstract To identify factors associated with glucose control, as measured by HbA1c over 4 years, in people with type 2 diabetes starting insulin therapy. CREDIT, an observational cohort study, collected data semi-annually over 4 years, on people with type 2 diabetes starting any insulin, in 311 centres in 12 countries; 2803 people had data on HbA1c during follow-up. Multivariable backward regression analysis selected characteristics associated with glycaemic control from a limited number of candidate variables. Before starting insulin therapy, HbA1c was 9.3% (78 mmol/mol) and decreased to 7.6% (60 mmol/mol) after 1 year, and changed little after that. Insulin dose increased from 0.21 U/kg to 0.36 U/kg at 1 year, and then by 0.10 U/kg over the next 3 years. Body weight increased by 2.0 kg in the first year and increased little thereafter. Poorer glycaemic control over the 4 years was mainly determined by the HbA1c before starting therapy, after accounting for the other statistically significant associated variables in multivariable analysis: higher BMI, younger age, longer diabetes duration, more glucose-lowering drugs, using basal insulin alone, higher insulin dose and female sex. At 4 years, a higher current insulin dose was the characteristic most strongly associated with a higher concurrent HbA1c. HbA1c at the start of insulin therapy was the characteristic most predictive of later HbA1c, after acco Continue reading >>
Diabetes Care
*Additional exclusion criteria are required for this indicator, which will result in a different eligible population from all other indicators. This indicator is only reported for the commercial and Medicaid product lines. Diabetes is a complex group of diseases marked by high blood glucose (blood sugar) due to the bodys inability to make or use insulin. Left unmanaged, diabetes can lead to serious complications, including heart disease, stroke, hypertension, blindness, kidney disease, diseases of the nervous system, amputations and premature death.1 Proper diabetes management is essential to control blood glucose, reduce risks for complications and prolong life. With support from health care providers, patients can manage their diabetes with self-care, taking medications as instructed, eating a healthy diet, being physically active and quitting smoking.1 Centers for Disease Control and Prevention (CDC). 2014. National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services. Continue reading >>
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Hba1c Conversion Chart
The HbA1c test measures how much haemoglobin in the blood has become glycated (chemically bonded with glucose). ••••• HbA1c values have changed and are now reported as a measurement in mmols/mol instead of the percentage previously given. To make sense of the new units and compare these with old units and vice versa, use our HbA1c units converter table below. Old unit = NGSP unit = %HbA1c New unit = IFCC unit = mmol/mol HbA1c Old HbA1c New HbA1c Old HbA1c New 4.0 20 8.1 65 4.1 21 8.2 66 4.2 22 8.3 67 4.3 23 8.4 68 4.4 25 8.5 69 4.5 26 8.6 70 4.6 27 8.7 72 4.7 28 8.8 73 4.8 29 8.9 74 4.9 30 9.0 75 5.0 31 9.1 76 5.1 32 9.2 77 5.2 33 9.3 78 5.3 34 9.4 79 5.4 36 9.5 80 5.5 37 9.6 81 5.6 38 9.7 83 5.7 39 9.8 84 5.8 40 9.9 85 5.9 41 10 86 6.0 42 10.1 87 6.1 43 10.2 88 6.2 44 10.3 89 6.3 45 10.4 90 6.4 46 10.5 91 6.5 48 10.6 92 6.6 49 10.7 93 6.7 50 10.8 95 6.8 51 10.9 96 6.9 52 11.0 97 7.0 53 11.1 98 7.1 54 11.2 99 7.2 55 11.3 100 7.3 56 11.4 101 7.4 57 11.5 102 7.5 58 11.6 103 7.6 60 11.7 104 7.7 61 11.8 105 7.8 62 11.9 107 7.9 63 12.0 108 8.0 64 Sit down with your child to decide what kind of meter they would prefer out of the options available. Hypos Hypos occur when your blood glucose falls too low. PLAY A healthy diet for someone with diabetes is the same as a healthy diet for anyone else. Find out what… Living with diabetes during pregnancy can be challenging, but you can still lead a healthy life. Take control of your… Glucose testing is the process used to measure the amount of glucose in your blood and can be carried out… FreeStyle Optium Neo has a choice of tools designed to help people who use insulin. Understanding your blood glucose level is a beneficial part of diabetes self-management and can help you and your healthcare team… Continue reading >>
Table 13, Correlation Of Hba1c Levels With Mean Blood Glucose Levels (31, 34-35) - Endotext - Ncbi Bookshelf
Report of the Committee on the classification and diagnostic criteria of diabetes mellitus. [Diabetes Res Clin Pract. 2002] Report of the Committee on the classification and diagnostic criteria of diabetes mellitus. Kuzuya T, Nakagawa S, Satoh J, Kanazawa Y, Iwamoto Y, Kobayashi M, Nanjo K, Sasaki A, Seino Y, Ito C, et al. Diabetes Res Clin Pract. 2002 Jan; 55(1):65-85. Report of the committee on the classification and diagnostic criteria of diabetes mellitus. [J Diabetes Investig. 2010] Report of the committee on the classification and diagnostic criteria of diabetes mellitus. Committee of the Japan Diabetes Society on the Diagnostic Criteria of Diabetes Mellitus., Seino Y, Nanjo K, Tajima N, Kadowaki T, Kashiwagi A, Araki E, Ito C, Inagaki N, Iwamoto Y, et al. J Diabetes Investig. 2010 Oct 19; 1(5):212-28. Restoring Insulin Secretion (RISE): design of studies of -cell preservation in prediabetes and early type 2 diabetes across the life span. RISE Consortium.. Diabetes Care. 2014; 37(3):780-8. Epub 2013 Nov 5. Review [Gestational diabetes mellitus]. [Wien Klin Wochenschr. 2016] Kautzky-Willer A, Harreiter J, Bancher-Todesca D, Berger A, Repa A, Lechleitner M, Weitgasser R. Wien Klin Wochenschr. 2016 Apr; 128 Suppl 2:S103-12. Review Impaired beta-cell and alpha-cell function in African-American children with type 2 diabetes mellitus--"Flatbush diabetes". Banerji MA. J Pediatr Endocrinol Metab. 2002 Apr; 15 Suppl 1:493-501. Continue reading >>
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New Hba1c Measurements
What are the traditional HbA1c units and why change? Print reference table new measurements Traditionally HbA1c was reported as a percentage of total haemoglobin. The International Federation of Clinical Chemistry and Laboratory Medicine(IFCC) has established a new reference measurement system for the worldwide standardisation of HbA1c. The IFCC recommends that HbA1c concentration be reported in mmol of HbA1c per mol of haemoglobin (mmol/mol). This will make comparing HbA1c results from different laboratories and clinical research trials throughout the world much easier. These developments are supported by the international diabetes organisations and came about because the HbA1c assay systems used in both the DCCT and UKPDS trials were not specific for HbA1c and were not calibrated in the manner that is now required. What are the IFCC units and how will HbA1c be reported? The IFCC has recommended that “HbA1c” is the official test name for what has been in the past referred to as glycohaemoglobin, A1c and the unit for reporting HbA1c concentration is mmol/mol. The range of HbA1c values for people without diabetes will be 20 to 42 mmol/mol. The HbA1c values will be higher in people with diabetes depending on their degree of glycaemic or blood glucose control. For a period of time, the HbA1c (IFCC, mmol/mol) result will be accompanied by the familiar HbA1c (DCCT,%) result. This is called dual reporting. Print reference table new measurements For example a HbA1c report might read as follows: HbA1c (IFCC) 53 mmol/mol Ref. Interval (20 - 42) HbA1c (DCCT) 7.0 % Ref. Interval (4.0 – 6.0) The fact that the IFCC number is higher than the DCCT number does not mean there has been more glucose in an individual’s blood or that the diabetes was more poorly controlled. It is ju Continue reading >>
Impact Of Hba1c Measurement On Hospital Readmission Rates: Analysis Of 70,000 Clinical Database Patient Records
Impact of HbA1c Measurement on Hospital Readmission Rates: Analysis of 70,000 Clinical Database Patient Records 1Department of Computer Science, Virginia Commonwealth University, Richmond, VA 23284, USA 2Department of Health Administration, Virginia Commonwealth University, Richmond, VA 23298, USA 3Department of Biostatistics, Virginia Commonwealth University, Richmond, VA 23298, USA 4Department of Computer Science and Numerical Analysis, University of Cordoba, 14071 Cordoba, Spain 5IITiS Polish Academy of Sciences, 44-100 Gliwice, Poland 6Department of Medicine, Virginia Commonwealth University, Richmond, VA 23298, USA Received 19 November 2013; Revised 25 February 2014; Accepted 7 March 2014; Published 3 April 2014 Copyright 2014 Beata Strack 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. Management of hyperglycemia in hospitalized patients has a significant bearing on outcome, in terms of both morbidity and mortality. However, there are few national assessments of diabetes care during hospitalization which could serve as a baseline for change. This analysis of a large clinical database (74 million unique encounters corresponding to 17 million unique patients) was undertaken to provide such an assessment and to find future directions which might lead to improvements in patient safety. Almost 70,000 inpatient diabetes encounters were identified with sufficient detail for analysis. Multivariable logistic regression was used to fit the relationship between the measurement of HbA1c and early readmission while controlling for covariates such as demographics, severity and type of the disease, and typ Continue reading >>
A Comparative Study Of Fasting, Postprandial Blood Glucose And Glycated Hemoglobin For Diagnosing Diabetes Mellitus In Staff Members Of Mmimsr, Mullana, Ambala Najeeb Q, Singh J, Pandey R, Mahajan R - Med J Dy Patil Univ
Introduction: For decades, the diagnosis of diabetes mellitus was based on blood glucose criteria, either the fasting blood glucose (FBG) or a 2-h value in the 75-g oral glucose tolerance test. In 2009, an International Expert Committee that included representatives of the American Diabetes Association (ADA), International Diabetes Federation and European Association for the Study of Diabetes recommended the use of the HbA1c test to diagnose diabetes with a threshold of 6.5% and this criterion was finally adopted by ADA in 2010. Hence, the study was undertaken to evaluate the predictive efficacy of glycated hemoglobin as a diagnostic tool for diabetes mellitus and to identify individuals at risk of developing diabetes mellitus using Indian Diabetes Risk Score (IDRS). Materials and Methods: This cross-sectional study was conducted on the staff members of the Maharishi Markandeshwar Institute of Medical Science and Research, Mullana, Ambala, Haryana, India. Out of the total 800 staff members, 200 staff members were included in the study (88 faculty members, 37 staff nurses, 12 laboratory technicians, 25 clerical staff, 38 class IV) selected by systemic random sampling. Every fifth member on the list was included in the sample. After obtaining the data, it was coded and analyzed using multivariate logistic regression analysis. Receiver operating characteristics curve analysis was used to predict the sensitivity, specificity, positivity, negativity and overall accuracy of a diagnostic test. A two-tailed test P < 0.05 was considered as statistically significant. Data was analyzed using SPSS 20 (IBM, Chicago, USA). Results: Out of 200 subjects, 19.5% were labeled diabetic using FBG, 23% by postprandial blood glucose (PPBG) and 38.5% by using glycated hemoglobin according to Continue reading >>
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Hba1c Conversion Chart
The HbA1c test measures how much haemoglobin in the blood has become bonded with glucose, illustrated as yellow glucose on red blood cells in the graphic above. This gives an indication of diabetes control over the previous 2-3 months. Since June 2011, the wayHbA1cresults are reported switched from a percentage to a measurement in mmols/mol. To make sense of the new units and compare these with old units and vice versa see the table below. Clinics and labs often give results in both measurements. Many of us still use the old % measurements. For example a target of 6.5% is now 48mmol/mol A HbA1c should always be used as information only, it is only part of the picture, however the result will give an indication of how well your overall control is and let you see if there is room for improvement (there usually is!) Many things affect your HbA1c, and managing diabetes is looking at ways to managethose affects as quickly as possible to limit the length of time out of optimal range. Never ever beat yourself up, try and be positive and find one way to try and reduce it next time. There are always things that can be done and make a difference. Its interesting to note that the % HbA1c measurement does not correlate exactly to average blood glucose test results on your blood glucose meter. This table shows the differences between HbA1c and average blood glucose. An example is if your old HbA1c was 7%, it would now be reported as 53 mmol/mol, and this would be equal to an average blood glucose of 8.6 mmol/l (the results from your blood glucose meter) Continue reading >>
Guide To Hba1c
Tweet HbA1c is a term commonly used in relation to diabetes. This guide explains what HbA1c is, how it differs from blood glucose levels and how it's used for diagnosing diabetes. What is HbA1c? The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming 'glycated'. By measuring glycated haemoglobin (HbA1c), clinicians are able to get an overall picture of what our average blood sugar levels have been over a period of weeks/months. For people with diabetes this is important as the higher the HbA1c, the greater the risk of developing diabetes-related complications. HbA1c is also referred to as haemoglobin A1c or simply A1c. HbA1c refers to glycated haemoglobin (A1c), which identifies average plasma glucose concentration. How does HBA1c return an accurate average measurement of average blood glucose? When the body processes sugar, glucose in the bloodstream naturally attaches to haemoglobin. The amount of glucose that combines with this protein is directly proportional to the total amount of sugar that is in your system at that time. Tweet Type 2 diabetes mellitus is a metabolic disorder that results in hyperglycemia (high blood glucose levels) due to the body: Being ineffective at using the insulin it has produced; also known as insulin resistance and/or Being unable to produce enough insulin Type 2 diabetes is characterised by the body being unable to metabolise glucose (a simple sugar). This leads to high levels of blood glucose which over time may damage the organs of the body. From this, it can be understood that for someone with diabetes something that is food for ordinary people can become a sort of metabolic poison. This is why peop Continue reading >>
