Factors That Interfere With Hba1c Test Results
Information for physicians and patients regarding HbS, HbC, HbE and HbD traits More about hemoglobin variants and HbA1c can also be found at the NIDDK web site: Sickle Cell Trait and Other Hemoglobinopathies and Diabetes: Important Information for Physicians For People of African, Mediterranean, or Southeast Asian Heritage: Important Information about Diabetes Blood Tests Factors that Interfere with HbA1c Measurement: Genetic variants (e.g. HbS trait, HbC trait), elevated fetal hemoglobin (HbF) and chemically modified derivatives of hemoglobin (e.g. carbamylated Hb in patients with renal failure) can affect the accuracy of HbA1c measurements. The effects vary depending on the specific Hb variant or derivative and the specific HbA1c method. Table 1 contains information for most of the commonly used current HbA1c methods for the four most common Hb variants, elevated HbF and carbamylated Hb. Interferences from less common Hb variants and derivatives are discussed in Bry, et al [1]. All entries in Table 1 are based on published information. In addition, if a product insert indicates clearly that there is inference from a particular factor, then the interference is entered as “yes” and the product insert is cited. When selecting an assay method, laboratories should take into consideration characteristics of the patient population served, (e.g. high prevalence of hemoglobinopathies or renal failure). Factors that affect interpretation of HbA1c Results: Any condition that shortens erythrocyte survival or decreases mean erythrocyte age (e.g., recovery from acute blood loss, hemolytic anemia) will falsely lower HbA1c test results regardless of the assay method used [2]. HbA1c results from patients with HbSS, HbCC, and HbSC must be interpreted with caution given the patholog Continue reading >>
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 >>
Glycated Hemoglobin
Glycated hemoglobin (hemoglobin A1c, HbA1c, A1C, or Hb1c; sometimes also referred to as being Hb1c or HGBA1C) is a form of hemoglobin that is measured primarily to identify the three-month average plasma glucose concentration. The test is limited to a three-month average because the lifespan of a red blood cell is four months (120 days). However, since RBCs do not all undergo lysis at the same time, HbA1C is taken as a limited measure of 3 months. It is formed in a non-enzymatic glycation pathway by hemoglobin's exposure to plasma glucose. HbA1c is a measure of the beta-N-1-deoxy fructosyl component of hemoglobin.[1] The origin of the naming derives from Hemoglobin type A being separated on cation exchange chromatography. The first fraction to separate, probably considered to be pure Hemoglobin A, was designated HbA0, the following fractions were designated HbA1a, HbA1b, and HbA1c, respective of their order of elution. There have subsequently been many more sub fractions as separation techniques have improved.[2] Normal levels of glucose produce a normal amount of glycated hemoglobin. As the average amount of plasma glucose increases, the fraction of glycated hemoglobin increases in a predictable way. This serves as a marker for average blood glucose levels over the previous three months before the measurement as this is the lifespan of red blood cells. In diabetes mellitus, higher amounts of glycated hemoglobin, indicating poorer control of blood glucose levels, have been associated with cardiovascular disease, nephropathy, neuropathy, and retinopathy. A trial on a group of patients with Type 1 diabetes found that monitoring by caregivers of HbA1c led to changes in diabetes treatment and improvement of metabolic control compared to monitoring only of blood or urine glu Continue reading >>
Diabetes And The Significance Of The A1c Test: Part 2 In A Series
Audrey Demmitt, RN, BSN, is a nurse diabetic educator, VisionAware Peer Advisor, AFB Career Connect mentor, and author of the VisionAware multi-part blog series on diabetes and diabetes education. At age 25, Audrey was diagnosed with retinitis pigmentosa and continued to work as a nurse for 30 years with her visual impairment. She has worked as an Adjustment to Blindness Counselor and Diabetic Educator for Vision Rehabilitation Services of Georgia and as a school nurse providing in-service training for school staff and developing care plans for newly-diagnosed students and their families. In Part 1 of her series, Audrey discussed how diabetes education can help lower your blood sugars and reduce the risk of diabetic retinopathy. In this week's Part 2, Audrey emphasizes the significance of the A1c test in the effective diagnosis, treatment, and management of diabetes. As Audrey says, "By making daily efforts to stick to your treatment plan and making healthy lifestyle changes, you can achieve your A1c goal, avoid long-term complications, and live well with diabetes." How Diabetes Is Diagnosed When teaching people with diabetes, I encourage them to "know their numbers" and use them to better manage their diabetes. Let's take a look at the A1c and why it is an important number. Diabetes is a complex condition to diagnose and manage. In the early stages, there are no symptoms and in the long term, there can be devastating effects on every system in the body. Prevention, early detection, and vigilant management are key factors in reducing diabetes complications, such as blindness and blood vessel disease. The A1c blood test, also known as glycated hemoglobin, hemoglobin A1c, and HbA1c, is the primary tool used to diagnose diabetes and pre-diabetes and to monitor blood glucos 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. Because red blood cells in the human body survive for 8-12 weeks before renewal, measuring glycated haemoglobin (or HbA1c) can be used to reflect average blood glucose levels over that duration, providing a useful longer-term gauge of blood glucose control. If your blood sugar levels have been high in recent weeks, your HbA1c will also be greater. HbA1c targets The HbA1c target for people with diabetes to aim for is: 48 mmol/mol (6.5%) Note that this is a general target and people with diabetes should be given an individual target to aim towards by their health team. An individual HbA1c should take into account Continue reading >>
What Your Doctor Doesn't Know About Glucose Testing.
Blood sugar management is important for preventing everything from hypoglycemia to full blown diabetes. However, monitoring blood glucose is rarely as straightforward as it seems. In this article we’ll discuss the current gold standard for measuring a person’s blood sugar. We’ll share some problems with the most popular tests. And we’ll review the best ways to interpret your results. (Even if your doctor doesn’t know how). [Note: We’ve also prepared an audio recording of this article for you to listen to. So, if you’d rather listen to the piece, click here.] ++ Homeostasis is a fancy scientific word for “body balance”. Essentially, our bodies must keep internal levels of thousands of chemicals in check. Or else health can go awry. One of the most important homeostatic systems in our body is our blood sugar management system. When blood sugar is kept at a healthy range, we feel healthy, strong, energetic. On the other hand, unbalanced blood sugars put us at risk for problems ranging from reactive hypoglycemia to insulin resistance to full blown diabetes. But estimating blood sugar levels can be tricky. First, these levels change throughout the day, and with meals and exercise. So, unless you’re monitoring blood sugar levels continuously, every second of every day, it’s hard to get a complete picture of your glucose health. Second, the convenient glucose meters that many Type 1 diabetics use only give us a snapshot instead of a movie. They don’t show us how patients regulate blood sugars over time. And that may be the most important information of all when it comes to disease prevention. That’s why doctors and scientists have become obsessed with finding a test that measures blood glucose balance across days, weeks, or months. In other words, a t Continue reading >>
Why Doesn’t My Average Blood Glucose Match My A1c?!
So, you test your meter for accuracy and everything looks good. You take your average BG and convert it to A1C using a table, calculator, or equation you find online. Then, you get your blood work done and learn that your actual A1C is… Not even close! What’s the deal? As it turns out, the relationship between average BG and A1C isn’t as clear as most of us think. After doing some research, I came across a couple reasons why someone’s actual A1C may be higher or lower than expected… But before we get into that, let’s briefly go over why A1C is used to approximate average glucose over ~3 months: As glucose enters your blood, it attaches to a protein in your red blood cells called “hemoglobin.” Hemoglobin is the same protein that carries oxygen in your bloodstream, and it is what gives blood its red color A1C measures the total amount of glucose that has attached to your hemoglobin over the lifespan of your red blood cells (typically ~3 months). OK, now that we’ve got the science down, here’s why your average BG and lab-measured A1C values might not match up: 1. BG meter average does not usually reflect the average over a full 24 hours This reason is pretty obvious. If you are not on a CGM, it’s tough to get a full picture of your average blood glucose throughout the day. We generally test much more during the day than at night, and nighttime glucose values may be very different from daytime values. We also tend to test more often before eating (when glucose is typically lower), and less often after meals (when glucose is typically higher). So, for most people, BG meter average doesn’t accurately reflect average blood glucose over a full 24 hours. A1C, on the other hand, does. If you want your BG meter average to better reflect your A1C values, che Continue reading >>
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What's A "normal" A1c? When Is It Misleading?
By Adithi Gandhi and Jeemin Kwon Why we use A1c, what values are recommended, and what impacts A1c – everything from anemia to vitamins Want more information just like this? Hemoglobin A1c (“HbA1c” or just “A1c”) is the standard for measuring blood sugar management in people with diabetes. A1c reflects average blood sugars over 2 to 3 months, and through studies like DCCT and UKPDS, higher A1c levels have been shown to be associated with the risk of certain diabetes complications (eye, kidney, and nerve disease). For every 1% decrease in A1c, there is significant pretection against those complications. However, as an average over a period of months, A1c cannot capture critical information such as time spent in a target range (70-180 mg/dl) and hypoglycemia (less than 70 mg/dl). This article describes why A1c is used in the first place, as well as factors that can lead to misleadingly high or low values. In a follow-up piece, we will discuss time-in-range, hypoglycemia, hyperglycemia, blood sugar variability, and how to measure and interpret them. Click to jump down to a section: What tools are available if an A1c test is not accurate or sufficient? What is A1c and why is it used? A1c estimates a person’s average blood sugar levels over a 2 to 3-month span. It is the best measure we have of how well blood glucose is controlled and an indicator of diabetes management. Though A1c doesn’t provide day-to-day information, keeping A1c low has been proven to lower the risk of “microvascular” complications like kidney disease (nephropathy), vision loss (retinopathy), and nerve damage (neuropathy). The relationship between A1c and “macrovascular” complications like heart disease is harder to show in clinical trials, but having high blood sugar is a major ris Continue reading >>
High A1c With Normal Glucose Readings
I recently saw the following question: My granddaughter’s HgbA1c was elevated to 10. Her glucose readings have been normal. Why does she have this elevated reading? My reply: It seems obvious at first glance that either the elevated HgbA1c is wrong, or the glucose readings are misleading. I’ll assume that your granddaughter has a diagnosis of diabetes, and that the glucose readings you describe are being done by her with a home glucose meter, rather than being done in a commercial laboratory. You don’t describe her as being a child, teen, or adult, but the issues are mostly age-independent. As you are aware, the glycosylated hemoglobin test (called by various acronyms including HgbA1c and A1C) has a normal range well below your granddaughter’s value of 10. In people without diabetes, the value is usually about 5; for people with diabetes, most endocrinologists would want to see the value below 7. So, based on her value of 10, one would assume there should be lots of elevated blood glucose readings. There are a few rare conditions where there can be elevated A1C levels with normal glucose levels (with or without diabetes): most of these are due to genetic hemoglobin variants. See a document from the NIH, Sickle Cell Trait and Other Hemoglobinopathies and Diabetes: Important Information for Physicians for more information on this. If this is the case with your granddaughter, the A1C will always be high with some lab methods, but with other lab assay methods, the problem can be bypassed: her physician should discuss this with the laboratory’s director. If your granddaughter has a definite diagnosis of diabetes and all her blood glucose readings are normal, then there’s the possibility that either her meter is malfunctioning, or that she doesn’t know how to do Continue reading >>
Normal, High, And Low Hemoglobin A1c Levels
On the other hand, as the RBC circulates, it combines its HbA1 with some of the glucose in the bloodstream to form glycohemoglobin (GHb). The amount of GHb depends on the amount of glucose available in the bloodstream over the RBC’s 120-day life span. Therefore determination of the GHb value reflects the average blood sugar level for the 100- to 120-day period before the test. The more glucose the RBC is exposed to, the greater the GHb percentage. One important advantage of this test is that the sample can be drawn at any time, because it is not affected by short-term variations (e.g., food intake, exercise, stress, hypoglycemic agents, patient cooperation). It is also possible for very high short-term blood glucose levels to cause an elevation of GHb. Usually, however, the degree of glucose elevation results not from a transient high level but from a persistent, moderate elevation over the entire life of the RBC. 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
- Hemoglobin A1c (HbA1c) Test for Diabetes
The Normal A1c Level
Wow Richard, 70 lbs? I have lost 24 lbs from low carb diet due to SIBO. It also helped my AC1 go down three points from 6.2 and my cholesterol is lower, which surprised me. I can’t afford to lose anymore weight because I was small to begin with. I had noticed much bigger people in the UK over the last 5 years compared to 15-20. Was quite shocking. I thought we had the patent on obesity! I am not diabetic that I know of but I had weird symptoms… Thirst that continued all day and night. My husband called me a camel. Dry eyes, rashes, strange dark discolouration on arm, under the arm to the side, some circulation issues and blurred vision. Eye specialist could not figure out why. Sores in the mouth also. I had observed about three weeks into super low carbs (30 Gms carb/day) that athlete’s foot symptom, sores in mouth and rashes were clearing up. So, lowering carbs for SIBO actually turned out for the best. By the way, I love your final paragraph. Research is what led me to SIBO diagnosis, and I then told the GI what to look for! He was barking up the wrong tree for months. Said I needed to eat more carbs so I don’t lose weight. Well, carbs fed the bacterial overgrowth!!! Dang fool. On Saturday, June 23, 2012, Diabetes Developments wrote: There is a new comment on the post “The Normal A1C Level”. Author: Richard Comment: I think part of the problem is that doctors are trained over many years to treat with pills, not with food. We continue to do what we are trained to do no matter what. I do believe they want to help us but don’t have the nutritional knowledge because that is not their expertise. When you have a hammer, etc. Nutritionist are no better unless they are those involved in research. They just peddle the messages they are told to. Then again, why wo Continue reading >>
- What Is a Normal Blood Sugar Level?
- 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
High Blood Sugar Causes Brain Changes That Raise Depression Risk
Newswise — CHICAGO, IL — Researchers have found a possible biological reason why people with diabetes are prone to depression. A new study shows that high blood glucose (sugar) levels in patients with Type 1 diabetes increase the levels of a brain neurotransmitter associated with depression, and alter the connections between regions of the brain that control emotions. The results will be presented Sunday at the joint meeting of the International Society of Endocrinology and the Endocrine Society: ICE/ENDO 2014 in Chicago. “It was traditionally thought that patients with Type 1 or Type 2 diabetes have higher rates of depression than their nondiabetic peers because of the increased stress of managing a complex chronic disease,” said study co-investigators Nicolas Bolo, PhD, from Beth Israel-Deaconess Medical Center, and Donald Simonson, MD, MPH, ScD from Brigham and Women’s Hospital, both in Boston. “Our results suggest that high blood glucose levels may predispose patients with Type 1 diabetes to depression through biological mechanisms in the brain.” The researchers studied 19 adults who were not depressed: eight with Type 1 diabetes (three men and five women, with an average age of 26) and 11 healthy controls (six men and five women, whose average age was 29). They used a type of magnetic resonance imaging (MRI), called functional MRI, to measure brain activity, as well as magnetic resonance spectroscopy to measure the level of glutamate, a brain neurotransmitter linked to depression at high levels. Subjects underwent brain imaging when their blood sugar level was normal (90 to 110 milligrams per deciliter, or mg/dL) and after a continuous infusion of glucose, which moderately elevated their blood sugar (180 to 200 mg/dL). Bolo explained how acutely raisi Continue reading >>
Symptoms, Diagnosis & Monitoring Of Diabetes
According to the latest American Heart Association's Heart Disease and Stroke Statistics, about 8 million people 18 years and older in the United States have type 2 diabetes and do not know it. Often type 1 diabetes remains undiagnosed until symptoms become severe and hospitalization is required. Left untreated, diabetes can cause a number of health complications. That's why it's so important to both know what warning signs to look for and to see a health care provider regularly for routine wellness screenings. Symptoms In incidences of prediabetes, there are no symptoms. People may not be aware that they have type 1 or type 2 diabetes because they have no symptoms or because the symptoms are so mild that they go unnoticed for quite some time. However, some individuals do experience warning signs, so it's important to be familiar with them. Prediabetes Type 1 Diabetes Type 2 Diabetes No symptoms Increased or extreme thirst Increased thirst Increased appetite Increased appetite Increased fatigue Fatigue Increased or frequent urination Increased urination, especially at night Unusual weight loss Weight loss Blurred vision Blurred vision Fruity odor or breath Sores that do not heal In some cases, no symptoms In some cases, no symptoms If you have any of these symptoms, see your health care provider right away. Diabetes can only be diagnosed by your healthcare provider. Who should be tested for prediabetes and diabetes? The U.S. Department of Health and Human Services recommends that you should be tested if you are: If your blood glucose levels are in normal range, testing should be done about every three years. If you have prediabetes, you should be checked for diabetes every one to two years after diagnosis. Tests for Diagnosing Prediabetes and Diabetes There are three ty Continue reading >>
The Effects Of Elevated Hemoglobin A1c In Patients With Type 2 Diabetes Mellitus On Dental Implants
Implant stability increased significantly from baseline through all follow-up times for each HbA1c group (P ≤ .0045) (Figure 1). The mean baseline ISQs were not significantly different between the HbA1c groups (P = .1585). In the group with an HbA1c of 5.9 percent or lower, the mean ISQs at three, six and 12 months after loading were higher than the ISQ at implant loading (P = .0604); in addition, the results showed no differences in mean ISQ values at three, six and 12 months after loading (P = .8909). Similarly, for participants with an HbA1c level of between 6.0 and 8.0 percent, the mean ISQs at three, six and 12 months after loading were higher than the ISQ at implant loading (P = .0192), with no differences between the mean ISQ values at three, six and 12 months after loading (P = .7115). Implant integration was delayed in the group with poorly controlled diabetes compared with that in the other two groups. In the former group, the mean ISQs at six and 12 months after loading were higher than the mean ISQs at implant loading and three months after loading (P = .0337). We found no difference between the mean ISQ values at implant loading and three months after loading (P = .4515) or between the mean ISQ values at six and 12 months after loading (P = .7296). To evaluate the effects of HbA1c as a continuous variable at each time point, we identified the implant in each patient for which the ISQ was lowest (that is, the more poorly performing implant). In Figure 2, we present scatter diagrams of ISQs for the more poorly performing implant relative to the patient's HbA1c level at baseline. No association between ISQs and HbA1c levels is evident over this one-year postloading period. Our evaluation of ISQ levels over time allowed an assessment of the integration—or h Continue reading >>
Bringing Down Your Blood Sugar Levels: Why It's Important
Play Video Play Mute Current Time 0:00 / Duration Time 0:00 Loaded: 0% 0:00 Progress: 0% 0:00 Progress: 0% Stream TypeLIVE Remaining Time -0:00 Playback Rate 1 Chapters Chapters descriptions off, selected Descriptions subtitles off, selected Subtitles captions settings, opens captions settings dialog captions off, selected Captions Audio Track Fullscreen This is a modal window. Caption Settings Dialog Beginning of dialog window. Escape will cancel and close the window. TextColorWhiteBlackRedGreenBlueYellowMagentaCyanTransparencyOpaqueSemi-TransparentBackgroundColorBlackWhiteRedGreenBlueYellowMagentaCyanTransparencyOpaqueSemi-TransparentTransparentWindowColorBlackWhiteRedGreenBlueYellowMagentaCyanTransparencyTransparentSemi-TransparentOpaque Font Size50%75%100%125%150%175%200%300%400% Text Edge StyleNoneRaisedDepressedUniformDropshadow Font FamilyProportional Sans-SerifMonospace Sans-SerifProportional SerifMonospace SerifCasualScriptSmall Caps DefaultsDone If you suffer from a form of diabetes requiring daily injections of the hormone insulin as well as multiple daily blood sugar checks, it's important to know how to bring down blood sugar levels. Michael Heile MD, a family medicine doctor with The Family Medical Group, tells Local 12's Liz Bonis that those daily checks are critical to knowing how what you're eating balances with medication. But, you also need to know a number called your hemoglobin A1c. Dr. Heile says a hemoglobin A1c test is most accurate when taken as part of a blood draw and normal levels are critical to immediate good health for most people. “It tells us what their average blood sugar is for the last two to three months," Dr. Heile explains. Normal levels are usually under 5.7, but many people who do not have diabetes are in the 4s. Why Should I L Continue reading >>
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