What Is HbA1c?

HbA1c is also called glycated hemoglobin. It is formed when hemoglobin, the oxygen-carrying protein in red blood cells, is chemically linked to glucose or another sugar.

Introduction

Hemoglobin A1c, or HbA1c, is a crucial biomarker in the diagnosis and management of diabetes. It offers insights into your average blood glucose levels over the past 2-3 months.

But is that the only reason your doctor ordered this test? Read on to find out more about the significance of HbA1c, the testing process, and its implications for diabetes management. 
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Understanding HbA1c

This process is concentration-dependent, non-enzymatic, and irreversible, and it occurs continuously over the lifespan of red blood cells. That is, the more glucose you have in your blood, the greater the chance that it glycates, increasing the percentage of glycated hemoglobin proteins. And once glucose sticks to hemoglobin A, it remains stuck for approximately 120 days. Hence, it provides a reliable measure of your average blood glucose levels over the preceding 8-12 weeks.

The National Glycohemoglobin Standardization Program has played a pivotal role in improving the measurement of HbA1c, ensuring its accuracy and reliability in clinical practice.<a href="#accordion">[1]</a> 
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Now that you know what the HbA1c test is and its significance in healthcare, let&rsquo;s move on to identify why doctors prefer it so much.&nbsp;

<ul>
	<li>The HbA1c test helps doctors diagnose prediabetes, type 1 and type 2 diabetes.</li>
	<li>It allows both you and your doctor to monitor and manage blood sugar levels.</li>
	<li>Additionally, HbA1c is being investigated as an adjunct test for fasting plasma glucose to identify subjects at risk of metabolic syndrome in certain populations.<a href="#accordion">[2]</a> 
	&nbsp;</li>
</ul>

Perhaps your doctor wanted to see the bigger picture &mdash; an average of your blood glucose. More like a screening measure as part of your annual medical exam to see if your glucose is a potential problem.

Or, maybe, it&rsquo;s because you&rsquo;ve really been careless and not checking your glucose levels regularly like your doctor had advised you to.

So, you settle on the HbA1c test this time. No special preparations, no fasting. You can show up for the test at any time of the day, and you can get the results in 24 hours. 
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During the test, a lab technician will take a blood sample from your arm (preferably your non-dominant one). They will clean the area with an alcohol swab and insert a small needle into the vein. You may feel a little sting at the time, but there is no risk. The sample will then be sent to a lab for analysis.

Post-test, if there is some bleeding at the injection site, the technician will put a band-aid over it. If you don&rsquo;t feel nauseous, you&rsquo;re allowed to leave as soon as the blood is drawn. Or, if you want, you can wait for a couple of minutes to first recover and then go home and resume normal activities. 
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Here comes the scary part &ndash; the follow-up to your previous visit to the doctor. 
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The results of an HbA1c test are pivotal in evaluating the risk of diabetes-related complications and guiding treatment decisions.

The reference ranges to screen or diagnose prediabetes and diabetes are:<a href="#accordion">[3]</a>

<ul>
	<li>Normal -&nbsp;Less than 5.7%</li>
	<li>Prediabetes -&nbsp;Between 5.7% and 6.4%</li>
	<li>Diabetes -&nbsp;6.5% or higher 
	&nbsp;</li>
</ul>

If the HbA1c is meant to monitor diabetes control, your doctor may refer to one of the following recommended target levels:

<ul>
	<li>American Association Of Clinical Endocrinologists (AACE) -&nbsp;6.5% or below</li>
	<li>American Diabetes Association (ADA) -&nbsp;Less than 7% for the majority of non-pregnant adults without significant hypoglycemia 
	&nbsp;</li>
</ul>

Conclusion

In conclusion, HbA1c plays a fundamental role in the diagnosis and management of diabetes. Its significance extends beyond glycemic control, encompassing the assessment of treatment outcomes, risk stratification for diabetes-related complications, and its potential utility in identifying subjects at risk of metabolic syndrome. 
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Key Takeaways

<ul>
	<li>HbA1c is a simple blood test that offers reliable insights into an individual&#39;s average blood glucose levels over the past 2-3 months.</li>
	<li>The accurate measurement of HbA1c is crucial for clinical decision-making, highlighting its indispensable role in diabetes management.&nbsp;</li>
</ul>

[1] Little, R., Rohlfing, C., & Sacks, D. (2019). The national glycohemoglobin standardization program: over 20 years of improving hemoglobin a1c measurement. Clinical Chemistry, 65(7), 839-848.

[2] Piloya, T., Mungai, L., Moran, A., Yauch, L., Christakis, N., Zhang, L., … & Chalew, S. (2023). Can hba1c alone be safely used to guide insulin therapy in african youth with type 1 diabetes?. Pediatric Diabetes, 2023, 1-7.