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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

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.

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.

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