|
Beyond Blood Sugar: The Hemoglobin A1c Test
WebMD University
What's your A1c? If you have diabetes and you don't know the answer, you should.
"The A1c [or glycated hemoglobin or HbA1c] is critical in the management of both type 1 and type 2 diabetes," says Fran Kaufman, MD, past president of the American Diabetes Association. "It's a wonderful test."
Kaufman, who is also division head of endocrinology at the Children's Hospital Los Angeles, is not alone in her glowing assessment of the A1c. "The A1c test has been a revolutionary change in diabetes management," says David E. Goldstein, MD, chairman of the NGSP steering committee, the organization that developed standards for A1c testing.
Despite enthusiastic reception by experts, the benefits of A1c testing are still not apparent to everyone. Not enough people with diabetes have their A1c tested regularly, and even when they do, many don't understand the results. In a survey conducted by the American Association of Diabetes Educators, only 24% of people with diabetes knew their A1c levels. Given the severe and life-threatening risks of diabetes — such as heart disease and stroke — that number is disturbingly low.
The Significance
Everyone with diabetes is familiar with the standard, fasting blood-glucose test that is used to indicate your current blood sugar levels. The fasting test is the warhorse of diabetes management, and it helps you and your doctor see how your treatment is going.
But while the fasting test remains an important part of diabetes treatment, its weakness is that it is an indication of your glucose level only at the moment you take the test. A fasting blood sugar doesn't tell you anything about your blood-sugar levels the rest of the time.
The hemoglobin A1c test — usually called the A1c — fills this gap by testing your blood sugar in a different way. As your body processes blood sugar, small amounts of glucose naturally bond with hemoglobin, a protein in the red blood cells. What's significant is that the amount of glucose that combines with the hemoglobin is directly proportional to the total amount of glucose currently in your system.
As a result, the hemoglobin bonded with glucose (glycated hemoglobin, or A1c) can be used as an overall record of glucose levels for as long as the individual red blood cell lives, which is about two to three months. While a fasting test gives you an indication only of current glucose levels, the A1c gives you the big picture of what your average levels are over this whole two- to three-month period.
The Benefits
Getting a reading of overall blood glucose, instead of relying only on a series of fasting readings, has made a big difference in diabetes management.
Goldstein says that fasting-glucose tests alone were not a very good indicator of how well a person was doing in controlling his or her blood sugars. He says that he and other experts used to be surprised by patients who appeared to have good glycemic control — based on fasting sugars — but who would then suddenly develop serious complications.
"By checking the A1c, we don't see surprises like that anymore," Goldstein tells WebMD. "When we monitor people in the long term, we don't see people with great A1c levels developing classic complications of diabetes."
The test itself is simple and quick, and thanks to the work of the NGSP (formerly the National Glycohemoglobin Standardization Program), more than 90% of all A1c tests are now standardized, meaning that the results from different labs should be comparable. Experts are not yet sure how often people with diabetes need to have their A1c tested, but the American Diabetes Association settled on a range of two to four times per year based on current evidence.
How Low Should It Be?
Experts agree that a normal A1c for someone without diabetes is between 4%-6%; anything above that should be considered a sign of diabetes.
Exactly where you should be on that scale is debated, and the recommendations for target A1c levels vary.
For instance, the American Diabetes Association recommends an A1c of below 7%. Meanwhile, the American Association of Clinical Endocrinologists (AACE) recommends an even lower number of less than 6.5%.
All of these different numbers might leave you a bit confused. However, the general rule is that the closer to a normal A1c a person can get, the better, provided that the glucose control is not so strict — or tight, in medical terminology — that it induces hypoglycemia, a level of blood sugar that is too low.
Your target levels should be set by your diabetes health team. Be sure to ask your doctors and health professionals what your A1c level should be.
What's the upshot? Get your A1c tested regularly and consult with your doctor about what target you should set.
Edited by Brunilda Nazario, MD, WebMD, April 2006.
SOURCE: WebMD Feature: "Beyond Blood Sugar: Testing A1c."
|
WebMD does not provide medical advice, diagnosis or treatment. See additional information.
Print This Page
Email a Friend
