What Is a Good A1c Reading for a Diabetic
Past Adithi Gandhi and Jeemin Kwon
Why we use A1c, what values are recommended, and what impacts A1c – everything from anemia to vitamins
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Hemoglobin A1c ("HbA1c" or just "A1c") is the standard for measuring claret sugar management in people with diabetes. A1c reflects boilerplate blood sugars over 2 to three months, and through studies like DCCT and UKPDS, higher A1c levels have been shown to be associated with the risk of certain diabetes complications (heart, kidney, and nerve disease). For every 1% decrease in A1c, there is significant pretection against those complications.
Nonetheless, equally an average over a period of months, A1c cannot capture critical information such equally time spent in a target range (lxx-180 mg/dl) and hypoglycemia (less than 70 mg/dl).
This article describes why A1c is used in the get-go place, as well as factors that can lead to misleadingly high or low values. In a follow-up slice, we will talk over time-in-range, hypoglycemia, hyperglycemia, blood saccharide variability, and how to measure and interpret them.
Click to spring down to a section:
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What is A1c and why is it used?
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What are "normal" A1c levels for people who don't take diabetes?
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What is an A1c goal for those with diabetes?
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How does age affect A1c?
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Where is A1c misleading or potentially inaccurate?
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What tools are available if an A1c test is non accurate or sufficient?
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What's important to keep in mind virtually A1c?
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Conditions and factors that bear upon A1c
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 all-time measure we have of how well blood glucose is controlled and an indicator of diabetes management.
Though A1c doesn't provide day-to-day data, keeping A1c low has been proven to lower the hazard 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, only having high blood sugar is a major take a chance gene for heart disease.
A1c is normally measured in a lab with routine blood piece of work, or with a countertop motorcar in a md's part (and some pharmacies) using a fingerstick.
A1c measures the quantity of "glycated hemoglobin," which refers to sugar fastened to a red blood cell protein called hemoglobin. The number is reported as a percent of the total hemoglobin in the blood. If a person consistently has higher blood glucose levels over time, A1c levels become upwards considering more cherry blood cells are coated with sugar. The exam is representative of a two to 3-month average because once a red blood jail cell becomes coated with carbohydrate, the link is irreversible. Information technology is only when the red blood cell is "recycled" (happens every two to 3 months) that the saccharide coating disappears.
What are "normal" A1c levels for people who don't have diabetes?
By and large, high A1c values bespeak high average blood sugar levels and that a person might be at take a chance for or may have diabetes. The American Diabetes Association (ADA) has established the following cutoffs:
| A1c Level | What It Means |
| Less than five.7% | Normal (minimal Risk for Type 2 Diabetes) |
| v.seven% to half-dozen.4% | "Prediabetes," meaning at risk for developing type 2 diabetes |
| 6.5% or greater | Diagnosed diabetes |
Make sure you go a regular A1c exam, peculiarly if you think y'all might be at take a chance for diabetes.
What is an A1c goal for those with diagnosed diabetes?
An A1c of less than 6.5% or 7% is the goal for many people with diabetes. Since each person with diabetes is unique, all the same, healthcare providers are recommended to set individual A1c goals. For instance, goals may differ depending on age and other health conditions.
How does age affect A1c?
A1c is a measure out of diabetes management, so your A1c won't naturally shift as you get older. However, as you age your diabetes management strategies and A1c goals may modify – for example, younger people may exist more focused on reducing long-term health complications, while older people may concentrate on avoiding astringent lows. Talk with your healthcare professional if you're curious well-nigh how your historic period may touch your A1c levels.
Where is A1c misleading or potentially inaccurate?
Much progress has been made in standardizing and improving the accuracy of the A1c examination thanks to the National Glycohemoglobin Standardization Program (NGSP). Results from a non-NGSP certified lab may not be as reliable. Depending on the auto, a single A1c test tin have up to a 0.5% margin of mistake, which ways the "true" value might exist 0.5% higher or lower than the measured A1c. For example, if a lab report shows an A1c value of 7.0%, the actual A1c value might range from half-dozen.5% and 7.v%.
A1c is based on a person's red blood cell turnover (the lifespan of a red claret cell) and the quantity of sugar attached to each cell. Certain weather condition, such equally kidney illness, hemoglobin variants, certain types of anemia, and certain drugs and vitamins, affect ruby claret cell turnover, leading to misleading A1c values. Click hither to jump down to a list of factors that impact A1c.
According to Dr. Irl Hirsch, in a typical diabetes practice, an estimated xiv%-25% of A1c measurements are misleading.
The relationship between A1c values and average claret carbohydrate levels tin can also vary markedly from person to person. In studies using continuous glucose monitoring (CGM), 24/7 blood sugar levels can be compared to a measured A1c. These studies reveal considerable variation from person to person. For example, an 8% A1c value in one person could reflect an average claret saccharide of 140 mg/dl, while in some other information technology could be 220 mg/dl. This variation relates to individual differences in how red blood cells and claret sugars bind or the lifespan of red blood cells.
"An A1c of 8% tin represent to an average claret sugar of 140 mg/dl in one person, while in some other information technology could exist 220 mg/dl."
For looking at an individual's glucose values, CGM is a better tool for measuring average sugar levels, fourth dimension-in-range, and hypoglycemia. Learn more in our previous across A1c article here.
What tools are available if an A1c test is not accurate or sufficient?
Besides A1c tests, the most common measures of blood sugar are the oral glucose tolerance examination (OGTT), CGM, andself-monitored blood glucose tests.
The OGTT is a diagnostic tool diabetes and prediabetes, assessing a person's response to consuming a fixed amount of sugar. After taking the sugar drink, blood sugar levels are measured two hours later. Below 140 mg/dl is considered "normal," betwixt 140 mg/dl and 200 mg/dl points to prediabetes or dumb glucose tolerance, and above 200 mg/dl indicates diabetes. It is not useful for tracking diabetes management.
For those with established diabetes, CGM has the reward of monitoring claret saccharide levels consistently throughout the solar day (every 5-xv minutes), providing more detailed insight into time spent in-range, low blood sugars, and loftier blood sugars. Examples of CGM include:
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Abbott FreeStyle Libre (existent-time) and Freestyle Libre Pro (blinded)
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Dexcom G5 (real-time)
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Medtronic Enlite (existent-time) and Guardian Sensor iii (existent-time) and iPro2 (blinded)
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Senseonics implantable Eversense CGM (real-fourth dimension)
If CGM is non available, taking frequent fingersticks with a blood glucose meter – when waking upward, before and afterward meals, and earlier bed – can also betoken when blood sugar levels are going low, high, and staying in range.
What's important to keep in mind about A1c?
If you lot have diabetes, it's also important to take the perspective that A1c is not a "class" on diabetes direction, but rather a helpful measurement tool that you and your healthcare providers tin utilise to guide decisions and assess the risk of complications.
Not-glycemic factors that tin can bear upon A1c:
While there are many unsuspecting factors that can touch on A1c, the data in the table beneath is non meant to invalidate the A1c exam. Rather, knowing how certain conditions and factors can change A1c levels is a key part of using A1c every bit one mensurate of diabetes management.
Many of the conditions that bear upon A1c results are related to changes in the turnover of red blood cells, and thus notably, types of anemia. Correction of anemia by treatment can too affect A1c results.
| Status | What is the impact on A1c? | How to exam for this condition |
|---|---|---|
| Untreated anemia due to:
| Untreated anemia tin misleadingly increase A1c values due to decreased production of red blood cells. (If anemia is treated, A1c can go down.) | To test for anemia, inquire your healthcare provider about taking a complete blood count (CBC) test. |
| Asplenia: decreased spleen function | The spleen is involved in the product and removal of red blood cells. Decreased spleen role, which may be caused by surgical removal, congenital disorders, or other claret disorders such as sickle jail cell affliction. This may pb to misleadingly increased A1c. | Asplenia can be identified by MRI, echocardiogram, chest 10-ray, or a screening examination. |
| Blood loss and blood transfusions | The body'south response to recent blood loss (create more blood cells) or claret transfusion can misleadingly lower A1c, but the next A1c exam should return to a more representative reading. | Permit your healthcare provider know if yous have recently received a blood transfusion. |
| Cirrhosis of the liver: chronic liver damage that leads to scarring | Cirrhosis, in addition to affecting response to glucose-lowering medications – including insulin – may misleadingly lower A1c values. | Ask your healthcare provider about a liver examination. |
| Genetic blood disorders
| Depending on the abnormal form of hemoglobin, hemoglobinopathy can result in either increased or decreased A1c values. Thalassemia can misleadingly lower A1c values due to early devastation of red blood cells. | Tell your healthcare provider if you take any known family members that accept had thalassemia, and ask for a Consummate Blood Count test. |
| Hemolysis: rapid devastation of red blood cells | Hemolysis may misleadingly lower A1c values due to the shortened blood-red blood cell lifespan. This status may be caused by an inappropriate immune response and artificial heart valves. | Inquire your healthcare provider near taking a Complete Blood Count (CBC) test. |
| Untreated hypothyroidism: depression levels of thyroid hormone | Hypothyroidism may misleadingly increase A1c, while treatment with thyroid hormone can lower A1c. | Inquire your healthcare provider nearly taking claret tests that measure the level of thyroid-stimulating hormone, which helps determine if there are thyroid gland problems. |
| Pregnancy | Decreased red claret cell lifespan and increase in ruby claret cell production may misleadingly lower A1c values in both early and belatedly pregnancy. | Ask near taking an oral glucose tolerance test, which is used to diagnose gestational diabetes. A mutual do for pregnant people with diabetes is to employ CGM. To learn more nearly managing diabetes during pregnancy, click here. |
| Uremia: high levels of waste (normally filtered by kidneys) in the blood | Untreated uremia may misleadingly increase A1c values. Dialysis is used to treat uremia – in this instance, A1c is not a suitable test. | Inquire your healthcare provider most taking a blood examination to detect uremia or aberrant kidney role. |
| Medications | Medications that may misleadingly increase A1c include:
Medications that may misleadingly lower A1c include:
| Ever talk over appropriate apply of opioids for pain and their possible issue on A1c as well. Tell your healthcare provider if you are taking whatever of these medications prior to your A1c test. |
Source: https://diatribe.org/whats-normal-a1c-when-it-misleading
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