The Evolution Of Hemoglobin A1c Targets For Youth With Type 1 Diabetes: Rationale And Supporting Evidence
Maria J. Redondo, Ingrid Libman, David M. Maahs, Sarah K. Lyons, Mindy Saraco, Jane Reusch, Henry Rodriguez, Linda A. DiMeglio The Evolution of Hemoglobin A1c Targets for Youth With Type 1 Diabetes: Rationale and Supporting Evidence. Diabetes Care 1 February 2021 44 : 301312.
How Is A1c Calculated
A1C testing relies on hemoglobin. Hemoglobin is the part of the red blood cell that carries oxygen throughout your body. When you have glucose in your blood, it sticks to hemoglobin. This is called glycation. The more glucose is in your blood, the more it sticks. And it can stay there for around three months about how long the average red blood cell lives.
The A1C test measures the average amount of glucose thats been attached to hemoglobin over time. Because the A1C test measures glucose levels over a period of time, it provides more information about blood sugar than a single blood sugar test.
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.
Read Also: How Much Is A Insulin Pen
What Is An A1c Test
The hemoglobin A1c test tells you your average level of blood sugar over the past 2 to 3 months. It’s also called HbA1c, glycated hemoglobin test, and glycohemoglobin. Itâs a lot like a baseball player’s season batting average. A single game doesn’t tell you how a player is performing in their career. And 1 day’s test results don’t give you the complete picture of how your treatment is working.
People who have diabetes need this test regularly to see if their levels are staying within range. It can tell if you need to adjust your diabetes medicines. The A1c test is also used to diagnose diabetes.
The Study Doesnt Prove A Link Between Statin Use And Diabetes Progression
One limitation of the study is the potential for diabetes progression to be detected more often among statin users simply because these patients have more frequent checkups than people who arent on statins, the study team points out.
Still, the findings offer fresh evidence of a potential risk statins pose for people with type 2 diabetes. The U.S. Food and Drug Administration in 2012 required drugmakers to add a safety warning to the labels of all statins indicating the potential of these drugs to raise blood sugar.
Overall, the risks of high cholesterol including heart attacks, strokes, and deaths from cardiovascular disease are serious enough that patients should still consider statins if their cholesterol isnt in a healthy range, regardless of the persons heart health history, says Connie Newman, MD, an adjunct professor at the New York University Grossman School of Medicine in New York City who wasnt involved in the new study.
Dont Miss: Ways To Stop Diabetes Before It Starts
Also Check: What Does High Blood Glucose Mean
Few Type 1s Meet A1c Goals Despite Treatment Innovations
T1D Exchange Registry data reveals only 17% of youth and 21% of adults are meeting A1C goals, even though more are on pumps and CGM
Recently, the T1D Exchange Clinic Network released the State of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016-2018, which is the result of a survey of more than 20,000 people exploring outcomes in A1C, hypoglycemia, continuous glucose monitor usage, and more. Alarmingly, the authors note, there is no indication that A1C levels in the registry as a whole have improved despite an increase in the use of insulin pumps and CGM. While much of the report can be seen as disheartening, there are some great takeaways CGM and insulin pump users tend to have lower A1Cs and less hypoglycemia, suggesting the need for improved access to these devices in the type 1 community.
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 bodys 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.
Also Check: How Do Continuous Glucose Monitors Work
What Does A Hemoglobin A1c Of 57% Mean
Hemoglobin A1c levels between 5.7% and 6.4% mean you have a higher change of getting of diabetes. Levels of 6.5% or higher mean you have diabetes. The target A1c level for people with diabetes is usually less than 7%. The higher the hemoglobin A1c, the higher your risk of having complications related to diabetes.
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.
Read Also: What Do You Call A Doctor Who Specializes In Diabetes
Natural Ways To Bring Hba1c Normal
Those who have higher levels of HbA1c can bring down the level of HbA1c to the normal range through medications. Apart from this, there are some natural ways as well which can bring your HbA1c normal. These include:
- Quit smoking to get haemoglobin A1c levels down.
- You should eat a balanced and healthy diet to maintain the immune system and hormonal balance.
- Exercising is another natural way to control the increased glycosylated haemoglobin levels and it helps in losing weight and lowering blood sugar which ultimately results in enhancing insulin sensitivity.
- Adopt a healthy lifestyle to keep your blood sugar levels in control.
You can easily achieve this without disturbing your daily schedule like Ms. Dheeraj Sabharwal who has been able to reduce her HbA1c level from 9.8 to 6.2 by switching on to a healthy lifestyle with the constant support and motivation of Diet Coach, Fitness Coach along with the Diabetologist. She has successfully reversed diabetes while pursuing her teaching profession and also taking care of the family.
What Is A Reasonable Target Hba1c Value For A Type 2 Diabetic Patient
Navigating the Targets for HbA1c Over the past ten years the American Diabetes Association recommendations for glycemic control have consistently targeted HbA1c values of less than 7%,² pointing to the vascular benefits of maintaining HbA1c in this range while remaining mindful of the risks of hypoglycemia.
Also Check: Why Do I Need Insulin
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.
It Is Important For You To:
- Get your A1c checked at each diabetes visit every 3 to 4 months.
- Keep track of your blood sugars and make changes to your insulin doses when needed.
- Eat healthy and count carbohydrate each time you eat or drink so you can match your insulin dose to the carbohydrate.
- Be active every day to help balance your blood sugar and lower your chance of heart disease.
- Get your blood pressure checked at each diabetes visit every 3 to 4 months.
- Get your urine checked for a protein called microalbumin. This will be done 5 years after you find out you have diabetes and then each year after that.
- Get your blood checked for cholesterol and other fats in your blood within the first year after you find out you have diabetes and every 5 years after that, as long as it is normal.
- See an eye doctor at the age of 10 or after you have had diabetes for 3 to 5 years. Then see them 1 time a year after that.
Be sure to see your diabetes doctor or nurses every 3 to 4 months. They specialize in taking care of children and adolescents with diabetes.
You May Like: Healthy Diet To Lose Weight For Diabetics
Hemoglobin A1c Patterns Of Youth With Type 1 Diabetes 10 Years Post Diagnosis From 3 Continents
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Jennifer L. Sherr, Anke Schwandt, Helen Phelan, Mark A. Clements, Reinhard W. Holl, Paul Z. Benitez-Aguirre, Kellee M. Miller, Joachim Woelfle, Thomas Dover, David M. Maahs, Elke Fröhlich-Reiterer, Maria E. Craig Hemoglobin A1c Patterns of Youth With Type 1 Diabetes 10 Years Post Diagnosis From 3 Continents. Pediatrics August 2021 148 : e2020048942. 10.1542/peds.2020-048942
Distinct hemoglobin A1c trajectories during puberty are identified in youth with established type 1 diabetes . We used data from 3 international registries to evaluate whether distinct HbA1c trajectories occur from T1D onset.
Participants were < 18 years old at diagnosis with at least 1 HbA1c measured within 12 months post diagnosis, along with 3 duration-yearaggregated HbA1c values over 10 years of follow-up. Participants from the Australasian Diabetes Data Network , the German-Austrian-Luxembourgian-Swiss diabetes prospective follow-up initiative and the US-based Type 1 Diabetes Exchange Clinic Registry were included. With group-based trajectory modeling, we identified unique HbA1c patterns from the onset of T1D.
How Is The A1c Test Used After Diagnosis Of Diabetes
Your health care professional may use the A1C test to set your treatment goals, modify therapy, and monitor your diabetes management.
Experts recommend that people with diabetes have an A1C test at least twice a year.4 Health care professionals may check your A1C more often if you arent meeting your treatment goals.4
Recommended Reading: Proliferative Diabetic Retinopathy Icd 10
How To Manage A1c Levels
If you are diagnosed with prediabetes, there are steps you can take to reduce your risk of developing diabetes, the ADA says.
Losing weight, even 10 to 15 pounds, can make a big difference in prevention. Moderate exercise also lowers blood sugar by making your body more sensitive to insulin. Done regularly, it can .
As for , aim for a diet rich in fruits, vegetables, and whole grains. Limit foods that are packaged and processed with high amounts of saturated fat, sodium, and added sugar. When reading food labels, check the ingredients list for other names for sugar, including sucrose, honey, and high fructose corn syrup.
Aim to eat complex carbohydrates that will keep you full and keep your blood sugar from rising too quickly. Examples include plain sweet potatoes, brown rice, and whole-grain pasta. Consider seeking advice from a registered dietician or searching for diabetes-friendly recipes online. Here are a few to get you started.
What Do Your A1c Results Mean
The A1C test measures the glucose in your blood by assessing the amount of whats called glycated hemoglobin. Hemoglobin is a protein within red blood cells. As glucose enters the bloodstream, it binds to hemoglobin, or glycates. The more glucose that enters the bloodstream, the higher the amount of glycated hemoglobin, Dr. Dodell says.
According to the ADA, A1C level below 5.7 percent is considered normal. An A1C between 5.7 and 6.4 percent signals prediabetes, according to the ADA. Type 2 diabetes is diagnosed when the A1C is at or over 6.5 percent. For many people with type 2 diabetes, the goal is to lower A1C levels to a healthier percentage.
Your A1C goal is specific to you. Several factors come into play, such as your age, how advanced the diabetes is, and any other heath conditions you have. A common A1C goal for people with diabetes is less than 7 percent, Dodell says. If you can keep your A1C number below your goal, you help to reduce the risk of diabetes complications, such as nerve damage and eye problems.
RELATED: A1C May Fall Short in Diagnosing Some People With Diabetes
Read Also: I Have Diabetes And My Feet Are Swollen
Risks Of Hypoglycemia With Type 1 Diabetes
In type 1 diabetes, the pancreas does not produce insulin. Insulin is a hormone that signals cells to take up sugar from the blood, thus lowering blood sugar. People with type 1 diabetes must take insulin to keep blood sugar in a healthy range.
Hypoglycemia is a common side effect of insulin therapy. People with type 1 diabetes, on average, have about two episodes of mild hypoglycemia symptoms per week. Hypoglycemia can happen regardless of your overall blood sugar control, as measured by hemoglobin A1c level. However, those with a lower target hemoglobin A1c are at a higher risk of hypoglycemic episodes.
Random Plasma Glucose Test
An RPG test is a blood test that healthcare professionals may perform any time of day when you are not fasting. It measures the sugar level in your blood at that moment in time.
An RPG result of 200 mg/dL or higher indicates diabetes, especially if youre experiencing symptoms of diabetes such as excessive thirst, hunger, or urination.
If your level is higher, a doctor will use one of the other tests listed to confirm the diagnosis.
Read Also: Is Sorbitol Safe For Diabetics
A1c Goals Missed In Most With Type 1 Diabetes: Survey
A disturbing new report on the status of the care of adults with type 1 diabetes worldwide was recently released at a major European diabetes meeting. The conclusion, according to one of the presenters, was a bad result for most people.
The report, which was based on information from an initiative called the Study of Adults Glycemia in T1D, was presented at the annual meeting of the European Association for the Study of Diabetes, held in 2019 in Barcelona. The study contained data on nearly 4,000 people aged 26 and above who had type 1 diabetes. They were from 17 countries in Europe, Asia, the Middle East and Latin America.
To get cutting-edge diabetes news, strategies for blood glucose management, nutrition tips, healthy recipes, and more delivered straight to your inbox, !
The basic statistic analyzed was hemoglobin A1C , which measures a persons average level of blood sugar control over the previous two or three months. The target for people with diabetes is an A1C of less than 7%, but according to the new report, only a quarter to a fifth of the patients were attaining that goal. According to report presenter Eric M. Renard, MD, It is a bad result for most people. There is really a need for education.
Want to learn more about type 1 diabetes? Read Type 1 Diabetes Questions and Answers,Six Type 1 Diabetes Symptoms You Need to Know and see our type 1 diabetes videos.
Signs And Symptoms Of Type 2 Diabetes
The signs and symptoms of type 2 diabetes can vary from person to person, but there are certain things to look out for.
As type 2 diabetes means the body struggles to properly get glucose from the bloodstream into the cells where it can be used for energy, one of the most common symptoms of type 2 diabetes is often feeling very tired and fatigued.
High blood sugaralso means the kidneys have to work overtime to try and filter the excess sugarout. This can lead to needing to urinate much more frequently than usual,especially at night. This increased need to pee can also cause dehydration, sopeople with type 2 diabetes may feel much thirstier than the average person.
Prolonged highlevels of blood sugar can cause damage to small blood vessels and nerves, whichcan lead to blurred vision that may become permanent vision loss if leftuntreated. This nerve damage can also impact the circulation, causing even thesmallest cuts and grazes to take weeks or even months to heal.
Also Check: Ways To Take Insulin For Type 1 Diabetes
Also Check: How Do You Get Type Ii Diabetes
How High Can An A1c Result Go
The highest A1C turns out to be a tricky piece of data to ferret out. If you try Google, you find a gazillion people talking about their own personal highest A1Cs and comparing notes with others.
Most A1C point-of-care machines cap out at a certain number, including those at-home testing A1C kits you can buy online.
At the federal clinic where Id worked for over a decade, our A1C results capped out at 14 percent. If the A1C is higher than that particularly at T2D diagnosis time the machine just reads > 14%. How much higher is anyoneguess. It could be 14.1 percent, or it could 20 percent.
If you do the math, clocking a 14 percent means youre possibly experiencing a 24-7-90 blood sugar average of 355 mg/dL.
Of course, labs can calculate higher A1Cs. Personally, the highest Ive ever seen is an A1C result in the low 20s. If your A1C was, say 21 percent, it would take a 3-month average blood sugar of 556 mg/dL.
How is that possible? If your blood sugar were in the 500s, wouldnt you go into a coma long before the 3 months were up? Those with T1D would, but those with T2D do not generally go into comas because they have insulin in their bodies all the time, even if they cant process it well enough to keep their BG at safe levels.
But that doesnt answer the question of the unfortunate individual who holds the record for highest A1C ever.