How Is The A1c Test Used To Diagnose Type 2 Diabetes And Prediabetes
Health care professionals can use the A1C test alone or in combination with other diabetes tests to diagnose type 2 diabetes and prediabetes. You dont have to fast before having your blood drawn for an A1C test, which means that blood can be drawn for the test at any time of the day.
If you dont have symptoms but the A1C test shows you have diabetes or prediabetes, you should have a repeat test on a different day using the A1C test or one of the other diabetes tests to confirm the diagnosis.2
Is A1c Age Dependent
The reasons A1c changes with aging because RBC numbers change with aging.1. There might be a change in the way how RBCs are made from stem cells.2. Compromise between RBC production and clearance.3. All RBC contribute to the measured level of HbA1c. Although older RBCs are supposed to be exposed more to plasma glucose, younger ones are more in numbers. .4. The changed RBC numbers contribute to changed A1c.The clinicians have not yet accepted the natural enhanced change in A1c with older adults.
What The Numbers Mean
The A1C test measures how much glucose is attached to the hemoglobin in your blood. The results are reported as percentages. To diagnose diabetes with an A1C test, physicians use the following scale:
- Normal: below 5 percent
- Prediabetes: 5.7 to 6.4 percent
- Diabetes: 6.5 percent or higher
It’s recommended that diabetics maintain an A1C level below 7 percent to prevent complications.
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Are Some Canadians At Higher Risk For Elevated Blood Sugar Levels Than Others
You may have a higher risk for elevated blood sugars and type 2 diabetes if you:
- Are 40 or years of age or older
- Have a close relative with diabetes
- Are of African, Arab, Asian, Hispanic, Indigenous or South Asian descent
- Are overweight
- Have been diagnosed with prediabetes
Some medical conditions can also increase your risk of type 2 diabetes, such as:
- High blood pressure or cholesterol levels
- Polycystic ovary syndrome
- Psychiatric disorders
- Sleep apnea
What Does The A1c Test Measure
When sugar enters your bloodstream, it attaches to hemoglobin, a protein in your red blood cells. Everybody has some sugar attached to their hemoglobin, but people with higher blood sugar levels have more. The A1C test measures the percentage of your red blood cells that have sugar-coated hemoglobin.
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Take Advantage Of Tech
There are lots of apps out there to help patients manage their diabetes. What may work for one person may not work for anothertry out a few to find a good fit. You may want to talk to your doctor about getting a continuous glucose monitor to help you track your progress. These tiny sensors, which are inserted under the skin, are a great way to see your glucose levels in real timesome can even send your results to your tablet or smartphone.
Make Sure You Receive Diabetes Self
Many health care organizations offer diabetes education, which your doctor can refer you to and is covered by most insurance plans. Diabetes education is recommended when you are first diagnosed with diabetes, before and during pregnancy with diabetes, and any time your blood sugars are poorly controlled. People who receive diabetes education learn important information, such as lifestyle and medication tips, which helps them successfully take control of their diabetes.
Anyone in the MedStar Health system can access the MedStar Diabetes Institutes Diabetes Self-Management Education program through their own primary care provider. Furthermore, people with type 2 diabetes and an A1C of 9 percent or higher, can participate in our three-month Diabetes Boot Camp upon a referral from your provider, which helps patients lower their A1C by an average of 3 percent. Protocol for the program can be found here.
For those with type 2 diabetes, have you spoken with your doctor about your specific average blood sugar level goal?
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But What Do These Results Mean For You
For you, a person with type 1 diabetes, lowering your A1C by 1 per cent means a 45 per cent less risk you will develop the chronic complications of diabetes! Thats 45 per cent for each 1 per cent lower! The closer to normal the A1C is the better!The results also mean that an A1C of < 7 per cent will also be good for you if you already have some signs of chronic complications. For example, kidney and eye disease may stay stable for years!At the end of the original DCCT trial, all the people in the conventional group changed to intensive therapy and their A1C lowered. Then both groups went back to their usual diabetes care teams, coming back to the study centre for a once yearly assessment.This same group of volunteers has remained in the DCCT follow up study called Epidemiology of Diabetes Interventions & Complications since 1993. Now thats commitment to a research study!Over time the A1C of the original intensive therapy and the former conventional therapy groups evened out at an average of 8%, but the benefits of intensive therapy remained much to everyones surprise. And for the first time, the benefits of good control on heart/cardiovascular disease were clearly shown.
How The Test Works
The sugar in your blood is called glucose. When glucose builds up in your blood, it binds to the hemoglobin in your red blood cells. The A1c test measures how much glucose is bound.
Red blood cells live for about 3 months, so the test shows the average level of glucose in your blood for the past 3 months.
If your glucose levels have been high over recent weeks, your hemoglobin A1c test will be higher.
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Type 2 Diabetes Remission
Remission is when a person with type 2 diabetes has healthy blood glucose levels for the long-term, without taking any diabetes medications. Were working with international experts to agree this, but our researchers used an HbA1c level of 48mmol/mol or less to define remission.
Type 2 diabetes is still a serious condition. It can be lifelong and get worse over time for many, but it doesnt have to be like this for everyone. This can be life-changing. Find out more about type 2 diabetes remission.
What Does An A1c Of 69 Mean
An A1C of 6.9 means that you have diabetes.
The A1c test measures blood sugar over the last three months by looking at the percentage of hemoglobin saturated with sugar. An A1c of 6.9 means that 6.9% of the hemoglobin in your blood are saturated with sugar.
You may already be experiencing symptoms of diabetes, which include increased thirst, frequent urination, general fatigue and blurred vision.
Diabetes is a serious condition. Left untreated diabetes can lead to heart disease, stroke, nerve damage, blindness, kidney disease and amputation.
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How Is Hemoglobin A1c Measured
The test for hemoglobin A1c depends on the chemical charge on the molecule of HbA1c, which differs from the charges on the other components of hemoglobin. The molecule of HbA1c also differs in size from the other components. HbA1c may be separated by charge and size from the other hemoglobin A components in blood by a procedure called high pressure liquid chromatography . HPLC separates mixtures into its various components by adding the mixtures to special liquids and passing them under pressure through columns filled with a material that separates the mixture into its different component molecules.
HbA1c testing is done on a blood sample. Because HbA1c is not affected by short-term fluctuations in blood glucose concentrations, for example, due to meals, blood can be drawn for HbA1c testing without regard to when food was eaten. Fasting for the blood test is not necessary.
As mentioned previously, normal levels of HbA1c are less than 6%, so a measurement over 6% is considered high. For many people with type 1 and type 2 diabetes, the goal is to keep the HbA1c levels under 7%, since keeping levels below 7% has been shown to delay the complications of diabetes.
Many laboratories report a calculated eAG along with every HbA1c results. This is a correlation of the HbA1c levels with the average blood sugar level. For example, a HbA1c measurement of 7% corresponds to an eAG measurement of 154 mg/dl.
What Is A Dangerous Level Of A1c
When levels rise to 9.0, the risk of kidney and eye damage and neuropathy increases. Some people who are newly diagnosed could have levels over 9.0. Lifestyle changes and possibly medication can lower levels quickly. For someone who has long-standing diabetes, levels rise above 9.0 could signal the need for a change in their treatment plan.
Some labs estimate average blood glucose , which corresponds to home glucose meter readings , allowing patients to understand the results better.
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Large Trial Compared Usual Tools For Assessing For Diabetes In Adults
The researchers looked at data from 9,000 adults, ages 20 years and older, from the 2005-2014 National Health and Nutrition Examination Survey . The information collected by the research team included body weight and blood test results.
Based on the fasting blood glucose test and the OGTT, 765 patients were diagnosed as having type 2 diabetes . However, only about 27% of these individuals were classified as having diabetes based on their A1c levels, which is how Dr. Villacreses and her team determined that nearly three-quarters of those at risk for diabetes were not aware that they had this chronic disease, and therefore were not receiving treatment.1
“Most worrisome, 73 % of patients would have missed out on early intervention and treatment,” she tells EndocrineWeb. While the A1c test is convenient, ”we recommend that we do not rely solely on this number,” Dr. Villacreses says.
The guidelines for diagnosis and treatment of type 2 diabetes from the American Diabetes Association already advise against relying solely on A1c,3 she says. While the American Diabetes Association guidelines specify that diabetes can be diagnosed based on fasting plasma glucose , the OGTT, or the A1c, our findings confirm that reliance on A1c remains the least reliable method for assessing diabetes risk.
How Long Does It Take A Vegan Diet To Lower Blood Sugar
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What Are All The Classes Of Diabetes Drugs
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A1c Results And What The Numbers Mean
| Diagnosis* | |
|---|---|
| Diabetes | 6.5 percent or above |
When using the A1C test for diagnosis, your doctor will send your blood sample taken from a vein to a lab that uses an NGSP-certified method. The NGSP, formerly called the National Glycohemoglobin Standardization Program, certifies that makers of A1C tests provide results that are consistent and comparable with those used in the Diabetes Control and Complications Trial.
Blood samples analyzed in a doctors office or clinic, known as point-of-care tests, should not be used for diagnosis.
The A1C test should not be used to diagnose type 1 diabetes, gestational diabetes, or cystic fibrosis-related diabetes. The A1C test may give false results in people with certain conditions.
Having prediabetes is a risk factor for developing type 2 diabetes. Within the prediabetes A1C range of 5.7 to 6.4 percent, the higher the A1C, the greater the risk of diabetes.
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How Often Do You Need The Test
Your doctor probably will have you take the A1c test as soon as youâre diagnosed with diabetes. Youâll also have the test if your doctor thinks you may get diabetes. The test will set a baseline level so you can see how well youâre controlling your blood sugar.
How often youâll need the test after that depends on several things, like:
- The type of diabetes you have
- Your blood sugar control
- Your treatment plan
Youâll probably get tested once a year if you have prediabetes, which means you have a strong chance of developing diabetes.
You may get tested twice each year if you have type 2 diabetes, you don’t use insulin, and your blood sugar level is usually in your target range.
You could get it three or four times each year if you have type 1 diabetes.
You may also need the test more often if your diabetes plan changes or if you start a new medicine.
Itâs not a fasting test. You can take it any time of day, before or after eating.
People with diseases affecting hemoglobin, such as anemia, may get misleading results with this test. Other things that can affect the results of the hemoglobin A1c include supplements, such as vitamins C and E, and high cholesterol levels. Kidney disease and liver disease may also affect the test.
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Follow Your Treatment Plan
Successful management of chronic conditions is all about making a plan and sticking to it. Work with your doctor to set goals for your health and create a plan that will work for you. It you have a hard time following your plan, you may want to write it down or post your goals in a place where you will see them frequently. The NIDDK offers a diabetes planning worksheet to help you get started.
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What Foods Help Lower Your A1c
Here are seven foods that Powers says can help keep your blood sugar in check and make you happy and healthy to boot. Raw, Cooked, or Roasted Vegetables. These add color, flavor, and texture to a meal. Greens. Flavorful, Low -calorie Drinks. Melon or Berries. Whole-grain, Higher-fiber Foods. A Little Fat. Protein.
Blood Glucose Levels Move Up And Down
Your results can vary because of natural changes in your blood glucose level. For example, your blood glucose level moves up and down when you eat or exercise. Sickness and stress also can affect your blood glucose test results. A1C tests are less likely to be affected by short-term changes than FPG or OGTT tests.
The following chart shows how multiple blood glucose measurements over 4 days compare with an A1C measurement.
Blood Glucose Measurements Compared with A1C Measurements over 4 Days
The straight black line shows an A1C measurement of 7.0 percent. The blue line shows an example of how blood glucose test results might look from self-monitoring four times a day over a 4-day period.
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Why The Acp Guidelines Have Sparked Some Controversy
Reaction to the ACPs new guidelines has been mixed.
Utpal Pajvani, MD, PhD, an endocrinologist and assistant professor at Columbia University Medical Center in New York City, praises the recommendation to personalize A1C targets, as well as the guideline to account for patients preferences and their potential burden and cost of medication. He adds that the recommendation for not making elderly patients A1C targets too stringent has a great deal of logic to it, considering the risk for hypoglycemia.
But other parts of the guidelines give Dr. Pajvani pause. Pajvani says shifting the A1C target to between 7 and 8 percent, as well as de-intensifying therapy for patients below 6.5 percent, are recommendations that the ACP took from past trials of patients with long-standing type 2 diabetes who also had heart disease, meaning that the findings might not be relevant for all people with type 2 diabetes, specifically those who dont have heart disease.
Pajvani says that one big blind spot in the new guidelines involves the fact that they dont take into consideration the fact that a lot of treatments endocrinologists use help minimize hypoglycemia and weight gain, and have proven benefits on heart disease, for instance.
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Pajvani maintains the opposite view.