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.
Tests For Gestational Diabetes
Gestational diabetes is diagnosed using blood tests. Youll probably be tested between 24 and 28 weeks of pregnancy. If your risk is higher for getting gestational diabetes , your doctor may test you earlier. Blood sugar thats higher than normal early in your pregnancy may indicate you have type 1 or type 2 diabetes rather than gestational diabetes.
Finally: A1c Is Also Defined As Estimated Average Glucose Or Eag
Another term you may come across when finding out your A1C is eAG. Your doctor might report your A1C results as eAG. eAG is similar to what you see when monitoring your blood sugar at home on your meter. However, because you are more likely to check your blood sugar in the morning and before meals, your meter readings will likely be lower than your eAG.
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High Risk For Hypoglycemia Or Presence Of Hypoglycemia Unawareness
Noninsulin-dependent medications such as metformin, SGLT2 inhibitors, GLP-1 receptor agonists, or DPP-4 inhibitors are preferred for patients who are prone to hypoglycemia or have hypoglycemia unawareness. Insulin secretagogues should be avoided. If insulin is needed, levemir and degludec have a lower incidence of hypoglycemia than glargine or NPH .
What Can Affect Your A1c Results
Anyone whos had diabetes for any length of time knows that A1C tests havent been reliable until recently. In the past, many different types of A1C tests gave different results depending on the lab that analyzed them. But the National Glycohemoglobin Standardization Program has helped improve the accuracy of these tests.
Manufacturers of A1C tests now have to prove that their tests are consistent with those used in a major diabetes study. Accurate home test kits are also now available for purchase.
But accuracy is relative when it comes to A1C or even blood glucose tests. The A1C test result can be up to half a percent higher or lower than the actual percentage. That means if your A1C is 6, it might indicate a range from 5.5 to 6.5.
Some people may have a blood glucose test that indicates diabetes but their A1C is normal, or vice versa. Before confirming a diagnosis of diabetes, your doctor should repeat the test that was abnormal on a different day. This isnt necessary in the presence of unequivocal symptoms of diabetes and a random sugar over 200 mg/dl.
Some people may get false results if they have kidney failure, liver disease, or severe anemia. Ethnicity can also influence the test. People of African, Mediterranean, or Southeast Asian descent may have a
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Hemoglobin A1c Not Reliable In Diagnosing Type 2 Diabetes
With Maria Mercedes Chang Villacreses, MD, and Elena Christofides, MD, FACE
The test that doctors most often rely on to detect a persons risk for prediabetes and type 2 diabetesthe hemoglobin A1c blood testtoo often delivers a poor reading, thereby missing the diagnosis in nearly three out of four at-risk individuals,1 according to research presented at the Endocrine Society meeting in New Orleans, Louisiana.
The investigators compared the accuracy of the A1c test with the other screening method used to assess patients risk of diabetesthe oral glucose tolerance test to arrive at this startling conclusion.1
The common use of the hemoglobin A1c test to screen for prediabetes and type 2 diabetes should be skipped in place of more reliable tests. Photo: 123rf
“The A1c missed almost 73% of the people with diabetes in comparison to the oral glucose tolerance test,” says Maria Mercedes Chang Villacreses, MD, a clinical endocrinology fellow at the City of Hope Diabetes and Metabolism Research Institute in Duarte, California, who introduced the findings at the annual meeting of the Endocrine Society but are considered preliminary until published in a peer-reviewed medical journal.
Since the fasting blood test requires a person to fast, the OGTT measures the body’s response to sugar it requires a person to fast overnight. First, blood is taken, then the person drinks a sugary drink. Blood is taken again two hours later.
What Is An A1c Blood Test
The A1C test is a common blood test that measures the amount of glucose in the blood. The A1C blood test goes by many other names, including A1C, HbA1C, glycated hemoglobin, glycosylated hemoglobin or hemoglobin A1C. Hemoglobin is a protein found in the red blood cells that carries oxygen to the cells. Glucose attaches to hemoglobin in your blood cells, and the A1C test measures the amount of hemoglobin with attached glucose.
The test results reflect your average blood sugar over the past 2-3 months. As your red blood cells have a lifespan of around 3 months, this is why the test gives us an average of what has been going on in your blood for the past few months.
The higher your A1C level, the greater your risk of developing diabetes, and the poorer your blood sugar control if you already have diabetes.
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Making Sense Of The Numbers
There are charts available that tell you your estimated average glucose value, based on your A1c test result. For instance, if your A1c comes back at 8%, that may not mean a whole lot to you. The eAG translates the A1C into what our average glucose would read on our monitor if we checked blood sugar all day, every day, for the previous 2-3 months. So, and 8% A1C is an estimated blood glucose average of 183mg/dl. Milligrams per deciliter is the unit of measurement used in our blood sugar monitor. One thing that the A1C test does not account for is daily variability. For example, Bobs blood sugar could range from 50-300 on a regular basis and Marys blood sugar could range from 120-250 on a regular basis, but they both could actually end up with the same A1C. That wide variability is being studied in more detail because many health experts wonder if variability in your daily blood sugars matter just as much, or more, than what your estimated average blood sugar is. Regardless, studies have shown us that if your A1c is 7% or lower, youre risk for certain complications related to diabetes is lower.
|A1C Test Result %|
If you didnt have a chart to show the conversion from A1c to estimated average glucose , you could use the following calculation: 28.7 x HbA1c 46.7 = eAG . But, my guess is that you wont commit that calculation to memory, so the next time you are wondering what a 7.2% A1C equates to, you can easily find many conversion charts on the internet.
A1c Differences In Ethnic Populations And Children
In the ADAG study, there were no significant differences among racial and ethnic groups in the regression lines between A1C and mean glucose, although the study was underpowered to detect a difference and there was a trend toward a difference between the African and African American and the non-Hispanic White cohorts, with higher A1C values observed in Africans and African Americans compared with non-Hispanic Whites for a given mean glucose. Other studies have also demonstrated higher A1C levels in African Americans than in Whites at a given mean glucose concentration .
A1C assays are available that do not demonstrate a statistically significant difference in individuals with hemoglobin variants. Other assays have statistically significant interference, but the difference is not clinically significant. Use of an assay with such statistically significant interference may explain a report that for any level of mean glycemia, African Americans heterozygous for the common hemoglobin variant HbS had lower A1C by about 0.3 percentage points when compared with those without the trait . Another genetic variant, X-linked glucose-6-phosphate dehydrogenase G202A, carried by 11% of African Americans, was associated with a decrease in A1C of about 0.8% in hemizygous men and 0.7% in homozygous women compared with those without the trait .
Zachary T. Bloomgarden Achieving Glycemic Goals in Type 2 Diabetes. Diabetes Care 1 January 2007 30 : 174180.
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How Often Should I Have The Hemoglobin A1c Test
How often you need the hemoglobin A1C test depends on your specific treatment plan and how well you are managing your blood sugar levels. Many doctors recommend the A1C test:1
- 1 time per year if you have prediabetes
- 2 times per year if you have type 2 diabetes, do not use insulin, and your blood sugar levels are usually within your target range
- 4 times per year if you have type 2 diabetes, you use insulin, or you have trouble keeping your blood sugar levels within your target range
Start An Exercise Plan You Enjoy And Do It Regularly
Find something you enjoy doing that gets your body moving take your dog for a walk, play a sport with a friend, or ride a stationary bike indoors or a regular bike outdoors.
A good goal is to get 150 minutes of moderate exercise per week, recommends Jordana Turkel, a registered dietitian and certified diabetes educator at Park Avenue Endocrinology and Nutrition in New York City. This is also what the ADA recommends. Different types of exercise can lower your A1C by making the body more sensitive to insulin, Turkel says. She encourages her patients not to go more than two days in a row without exercising, and to aim for two days of strength training.
Be sure to check with your healthcare provider before embarking on an exercise plan, though. He or she can come up with an individualized plan for you.
And if you monitor your blood sugar daily, check it before and after exercise. As the Joslin Diabetes Center at Harvard Medical School explains, exercise can cause your blood sugar to rise, as more is released from the liver, and blood sugar to fall, due to increase insulin sensitivity. Fluctuations in your blood sugar levels can result if you arent careful. This is particularly important if you are on insulin or another diabetes medication that causes insulin secretion, such as include sulfonylureas, such as Amaryl , and glinides, such as Prandin and Starlix .
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Hba1c Is Your Average Blood Glucose Levels For The Last Two To Three Months If You Have Diabetes An Ideal Hba1c Level Is 48mmol/mol Or Below
If you’re at risk of developing type 2 diabetes, your target HbA1c level should be below 42mmol/mol .
On this page well go through what HbA1c means, and why aiming for your target level is so important. Well also explain the HbA1c test in more detail, and show you what you can do to lower your HbA1c levels if theyre too high. Plus, you can use our HbA1c converter tool if youre looking to find out your level in % or mmol/mol.
How Often Do You Measure A1c
Your doctor will want to see what your A1C results is 2-4 times a year, and will typically order this lab with other important labs when its time for your blood draw. You can buy at home A1c test kits at your local pharmacy for approximately $20-$40. The kits in this price range usually include 2 tests and you can see the results in about 5 minutes. It is possible to see a significant change in your A1C in a one month time period, but the test typically isnt done too often because red blood cells only turnover about every 120 days. On the plus side, if you have made some changes in the month prior to going to visit your doctor, those positive changes in the last 30 days are going to make more of an impact on your result than what you did 2 months ago.
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What Does This Mean For People Wondering About Their Diabetes Risk
For individuals who havent received a diagnosis of diabetes, Dr. Villacreses says, one important lesson from these fidings is that ”you should not feel 100% reassured if your A1c number is less than 6.5% that you are do not have diabetes. A test result that is greater than 6.4% defines the beginning of diabetes, so you may have prediabetes or have already progressed to type 2 diabetes.
The sooner you receive a diagnosis regarding your diabetes status, the earlier treatment can begin. This is important because by understanding your risks, and making the necessary lifestyle changes, you can prevent prediabetes from progressing or even reverse the type 2 diabetes.
In addition, she says, patients should feel comfortable asking their doctor about the choice of tests and indicate your desire to skip the A1c, and have one of the other more reliable screening methods, while more time consuming, to determine if you are at risk for pre-diabetes or diabetes.
Dr. Villacreses has received research funding and speaking fees from a variety of pharmaceutical companies but none that pose a conflict in this research. Dr. Christofides has no relevant financial disclosures.
How Is The A1c Test Performed
An A1c is a blood test and requires a blood draw. The sample of blood is often sent to a lab for testing. In some settings, you may be able to get a point-of-care test. This gives results in real time that you can discuss with your healthcare provider immediately. Your healthcare staff will prick your fingertip and collect a few drops of blood on a test strip. This will then be inserted into a machine in the office. After a few minutes, it will print out an A1c result.
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What Does An A1c Of 67 Mean
An A1C of 6.7 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 6.7 means that 6.7% 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.
Know Your Family History
Did your mother, grandfather, or other close relative have a stroke or heart attack? Check out your family tree to get clues about your medical future. Having family members with heart disease makes you more likely to follow the same path. And if one or more relatives had a heart attack before age 50, your chances of heart disease could be even higher. Learning your family history can give you incentives to take care of your health.
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So What Do The Numbers Mean
When it comes to the numbers, there’s no one-size-fits-all target. A1C target levels can vary by each person’s age and other factors, and your target may be different from someone else’s. The goal for most adults with diabetes is an A1C that is less than 7%.
A1C test results are reported as a percentage. The higher the percentage, the higher your blood sugar levels over the past two to three months. The A1C test can also be used for diagnosis, based on the following guidelines:
- If your A1C level is between 5.7 and less than 6.5%, your levels have been in the prediabetes range.
- If you have an A1C level of 6.5% or higher, your levels were in the diabetes range.
Random Blood Sugar Test
This measures your blood sugar at the time youre tested. You can take this test at any time and dont need to fast first. A blood sugar level of 200 mg/dL or higher indicates you have diabetes.
|140 mg/dL or below||N/A|
*Results for gestational diabetes can differ. Ask your health care provider what your results mean if youre being tested for gestational diabetes.Source: American Diabetes Association
If your doctor thinks you have type 1 diabetes, your blood may also tested for autoantibodies that are often present in type 1 diabetes but not in type 2 diabetes. You may have your urine tested for ketones , which also indicate type 1 diabetes instead of type 2 diabetes.
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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.
Best To Avoid Reliance On A1c In Making An Initial Diagnosis Of Diabetes
The shortcomings of the A1c test are known, says Elena Christofides, MD, FACE, an endocrinologist and CEO of Endocrinology Associates, in Columbus, Ohio, upon reviewing the study for EndocrineWeb.
While she takes issue with some of the researchers statistical methods, such as how they grouped those with an abnormal glucose tolerance test together with those with a full-blown diabetes for the analysis, she says they are not the first to conclude that the A1c test is not a great tool to capture diabetes diagnoses accurately for most individuals.
When the ADA guidelines were in development,3 Dr. Christofides tells EndocrineWeb, ”there were significant arguments back and forth about even permitting the continued use of the HbA1c testdue to the fact that it would indeed miss a number of individuals. That is why the use of the A1c is still being used but the OGTT is still thought to be the more definitive test.”
“The guidelines also state that if the A1c is normal and there is still a suspicion of prediabetes or diabetes, doctors are advised to do the OGTT anyway,” she says. So an A1c can be done so long as you are then advised to have another test to check your blood sugar levels if there is any concern regarding your risks.
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