Beyond Blood Sugar: Testing A1c
More people need to know about the test for A1c -- or glycated hemoglobin -- that has revolutionized diabetes care.
The Benefits continued...
"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.
But exactly where you should be on that scale is debated and the recommendations for target A1c levels vary. For instance, the American Diabetes Association recently changed its recommended A1c from under 8% to 7% or below. 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. Treatment almost always includes behavioral techniques, such as weight loss and exercise, and may include medications to lower blood sugar levels.
But it's important to know that not everyone can reach these goals. "I've been delighted with the number of patients I have with A1c levels in the low 6% area," says Paul Jellinger, MD, past president of the American Association of Endocrinologists. "But in some patients who have unstable blood sugar levels, you're content with 7.2% or 7.4%, since that's the best you can do."
Goldstein is somewhat doubtful of the new, lower targets. "I agree that people should strive for the lowest A1c possible," he says, "but most patients can't achieve either the ADA or the AACE goals with current therapies because they're so low. And I think that you have to be careful not to set a goal that most people can't attain."
So what's the upshot? Get your A1c tested regularly and consult with your doctor about what target you should set. In general, aim for below 6.5% or 7%, but understand that it may not always be possible to get there.
Doing it Yourself
At least one at-home test kit for A1c levels has been developed, and more are probably on the way. While it may be somewhat more convenient than trudging into the doctor's office, Goldstein and Kaufman are a little skeptical of their usefulness.