What is HbA1c?
When you look through your blood report, you may find a term called HbA1c or glycated hemoglobin. This is a common test performed in individuals with diabetes. But what exactly is HbA1c?
The blood that flows throughout the body contains an iron rich protein called hemoglobin. Hemoglobin is responsible for carrying oxygen to all the vital tissues and structures to enable them to function normally. Hemoglobin can also carry glucose as well. When it carries glucose, it is called glycated hemoglobin.
A glycated hemoglobin report, or an HbA1c report gives the Doctor an idea as to what the individuals blood sugar control has been over a period of three months. In other words, the HBA1C value is representative of the average blood glucose control over three months.
How does HbA1c estimate average blood glucose level?
Let us take an example. Let us say that your fasting blood glucose has been running between 110 to 130 mg/dL and your post-prandial blood glucose (taken two hours after a meal) is running between 160 to 180 mg/dL.
These values will tell you what the sugars are on the day of the test but do not tell you how they have been over the last few months.
This is particularly important if you have not been monitoring your sugars at home.
A glycated hemoglobin value will tell you how good your blood sugar control has been over the last three months.
The red blood cells that contain hemoglobin have a lifespan of around 12 weeks (three months). So as long as the red blood cells are alive, glucose will continue to be attached to them.
When measuring HbA1c, the red blood cells that have been alive for the last 12 weeks i.e. three months will be assessed. The glucose values obtained from analyzing these cells will give you an average blood glucose value over three months. This is the HbA1c.
What is HbA1c?
HbA1c is an estimate of average blood glucose levels over a period of 3 months.
What is the ideal HbA1c value?
In individuals who do not suffer from diabetes, the HbA1c value is less than 6%. In those who suffer from prediabetes, the values range between 6% to 6.5%.
A diagnosis of diabetes is made when the HbA1c values are over 6.5%.
In those who have been suffering from diabetes and are taking medication, a ‘target’ HbA1c value may have to be achieved in order to have good control. These days, it is recommended that the HbA1c levels be maintained at less than 7% with medication.
However, clinical studies have shown that very tight control of blood sugars may not be beneficial in the long run, especially in those who have complications of diabetes and other medical conditions associated with diabetes. Therefore, certain clinicians are satisfied if the HbA1c levels are under 7.5%.
If your blood reports demonstrate a high HbA1c level, you may be asked to make changes to your medication and lifestyle in order to bring down this value.
What are the advantages of checking HbA1c?
There are a number of different advantages.
1. HbA1c provides a better assessment of blood glucose control over a long period of time.
2. Assessment of HbA1c values are standardized across laboratories and hence values anywhere are quite accurate.
3. Fasting sample is not necessary.
4. It is a useful test in not only diagnosing diabetes but also monitoring progress and treatment.
Often, just checking HbA1c value is not enough and usually a fasting blood glucose and postprandial blood glucose estimation is also made.
What are the benefits of lowering HbA1c?
Clinical studies have shown that by reducing the HbA1C value by 1%, you reduce your risk of diabetes related complications by nearly 25%. These complications include diabetic retinopathy, diabetic neuropathy and kidney disease from diabetes.
But that’s not all.
Bringing down your A1c as recommended by your doctor can significantly reduce your chances of developing heart disease, heart failure, cataracts and even amputations from vascular disease. A Swedish research study found that reducing HbA1c values by less than 1% can reduce the risk of death within five years by 50%.
HbA1c and Pregnancy
In women who are planning to get pregnant, the HbA1c levels in those who have diabetes must be maintained at less than 6.1%, according to the NICE guidelines for diabetes in pregnancy. If the values are above 10%, it is advised to avoid becoming pregnant until the blood glucose is better controlled. Make sure you speak to your doctor regarding this for further advice.
During pregnancy, the values of HbA1c if you suffer from diabetes must be maintained less than 6.1% (similar to the values to be maintained when planning pregnancy). This applies only during the first trimester. In the second and the third trimester, blood glucose values will need to be monitored and glycated hemoglobin is not a useful test.
What if the pregnancy is unplanned? In a unplanned pregnancies, make sure you follow your doctor’s advice and bring down your blood glucose values and glycated hemoglobin values less than 6.1% as soon as possible.
After delivery in the post pregnancy period, the A1c values can be maintained at less than 6.5%.
Testing for HbA1c
HbA1c can be easily tested through a simple blood test. Unlike fasting blood glucose values that need to be tested on an empty stomach, HbA1c can be checked at any time of the day.
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