What Is A High A1c
A1C results show the percent of glucose and hemoglobin bound together in your bloodstream. For example, a 5% A1C indicates five out of every 100 hemoglobins are glycated. The higher your A1C, the greater the risk of developing complications.
The A1C ranges for normal, prediabetes, and diabetes are:
- Normal: Less than 5.7%
- Prediabetes: 5.7% to 6.4%
- Diabetes: 6.5% or higher
Talk to your healthcare provider if your A1C is in the prediabetic range. Prediabetes is a risk factor for type 2 diabetes. A diet change, increased activity, and moderate weight loss can help improve blood sugar control to prevent diabetes.
What Is A Hba1c Test
The hemoglobin A1c test measures the amount of blood sugar attached to your hemoglobin. Hemoglobin is the part of your red blood cells that carries oxygen from your lungs to the rest of your body. It is an important blood test that gives a good indication of how well your diabetes is being controlled.
You can check these average blood sugar levels yourself, but youll have to buy a kit, whereas your healthcare professional will do it for free. Its different from a finger-prick test, which is a snapshot of your blood sugar levels at a particular time, on a particular day.
You find out your HbA1c level by getting a blood test by a doctor or nurse. Your healthcare team will arrange this for you, but chase it up with your GP if you havent had one for a few months.
Most people will have the test every three to six months. But you may need it more often if youre planning for a baby, your treatment has recently changed, or youre having problems managing your blood sugar levels.
And some people will need the test less often, usually later on during pregnancy. Or need a different test altogether, like with some types of anaemia. A fructosamine test can be used instead, but its very rare.
An HbA1c test is also used to diagnose diabetes, and to keep an eye on your levels if youre at risk of developing diabetes .
The test is sometimes called haemoglobin A1c or just A1c.
Diabetes Tracking And Treatment
- Follow your diabetes treatment plan: Understand the treatment plan before leaving the healthcare providers office and discuss barriers that could prevent you from following the program. Attend all follow-up visits.
- Consistently take prescribed medications: If a healthcare provider has prescribed medications to reduce blood sugar levels, take them regularly. Some people only take medication when they arent feeling well, but these medications dont work unless taken consistently.
- Monitor and track blood sugar: Regular blood sugar monitoring is the most important step in diabetes management, according to the CDC. Healthcare providers can inform patients of different types of meters and help patients find the best one for them. Providers can also tell patients how often to check their blood sugar and what their target blood sugar range is.Keep a log of your blood sugar levels to look for patterns and triggers for blood sugar spikes and lows. If you wear a continuous glucose monitor, you can use the data. Learning what causes blood sugar to rise or decrease can help you create a plan to keep it consistent.
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What To Do If Your A1c Is 66
An A1c of 6.6 falls into the diabetic range between 6.5 and 10.0.
Reducing an A1c of 6.6 will take a combination of medication and lifestyle modifications. Seek medical advice to gain control of your blood sugar and avoid further damage to critical organs.
Keep an eye on your blood sugar by testing at home. Its easier than ever and there are a variety of affordable blood glucose monitors available.
Diabetes is manageable but only if you stick to a plan and monitor your progress with the help of your doctor.
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A1c Tests Can Be Affected By Changes In Red Blood Cells Or Hemoglobin
Conditions that change the life span of red blood cells, such as recent blood loss, sickle cell disease, erythropoietin treatment, hemodialysis, or transfusion, can change A1C levels.
A falsely high A1C result can occur in people who are very low in iron for example, those with iron-deficiency anemia. Other causes of false A1C results include kidney failure or liver disease.
If youre of African, Mediterranean, or Southeast Asian descent or have family members with sickle cell anemia or a thalassemia, an A1C test can be unreliable for diagnosing or monitoring diabetes and prediabetes. People in these groups may have a different type of hemoglobin, known as a hemoglobin variant, which can interfere with some A1C tests. Most people with a hemoglobin variant have no symptoms and may not know that they carry this type of hemoglobin. Health care professionals may suspect interferencea falsely high or low resultwhen your A1C and blood glucose test results dont match.
Not all A1C tests are unreliable for people with a hemoglobin variant. People with false results from one type of A1C test may need a different type of A1C test to measure their average blood glucose level. The NGSP provides information for health care professionals about which A1C tests are appropriate to use for specific hemoglobin variants.
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What Is A1c And Why Is It Used
A1C estimates a persons average blood sugar levels over a 2 to 3-month span. It is one measure we have of how well blood glucose is controlled and an indicator of diabetes management.
Though A1C doesnt provide day-to-day information, lower A1Cs are correlated with a lower risk of microvascular complications, such as kidney disease , vision loss , and nerve damage . Similarly, higher A1Cs can lead to “macrovascular” complications, such as heart disease.
A1C is usually measured in a lab with routine blood work, or with a countertop machine in a doctors office using a fingerstick.
A1C measures the relative percentage of glycated hemoglobin, which refers to red blood cells called hemoglobin with sugar attached to it. If a person consistently has higher blood glucose levels, A1C levels go up because more red blood cells are coated with sugar. The test is representative of a 2 to 3-month average because once a red blood cell becomes coated with sugar, the link is irreversible. It is only when the red blood cell is “recycled” that the sugar coating disappears.
Is A Hemoglobin A1c Test Better Than Other Available Blood Sugar Tests
If you have diabetes, the A1C test is the best way to check your average blood sugar levels over a three-month period, to gauge whether or not you are managing your condition effectively.
There are other blood tests that may be used to diagnose pre-diabetes or diabetes, including:
- A fasting blood sugar test, for which you must fast overnight before having your blood drawn
- A glucose tolerance test, for which you must drink a sweet liquid containing glucose, then wait in the doctors office for a set time period before having your blood drawn
- A random blood sugar test, which doesnt require any special preparation, but it only screens for diabetes.
Doctors may use one or more of these tests to diagnose pre-diabetes or diabetes. Although the A1C test is effective, people with certain health conditions may not get accurate results from it. Thus, another test should be used to confirm a diabetes or pre-diabetes diagnosis in those cases.
Hemoglobin A1C test results may not be accurate when people have health conditions such as:
- Sickle cell anemia
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Navigating The Targets For Hba1c
With more than 100 million U.S. adults living with diabetes and prediabetes,¹ the value of education and treatment for this condition cannot be overstated. The health and economic costs of managing, rather than improving, the complications associated with diabetes necessitate a careful look at the treatment options that are available for this disease.
Summary of Recommendations from the ACP Guidance Statement:âµ
- Clinicians should personalize goals for glycemic control
- Aim to achieve HbA1c 7â8% in most patients
- De-intensify pharmacologic therapy when HbA1c < 6.5%
- Avoid targeting HbA1c level in certain patient populations
The ACP determined that the risks associated with intensive medication therapy aimed at achieving tight HbA1c control were greater than the benefits, asserting that the evidence did not support enough of an improvement in outcomes for patients with an HbA1c of less than 7% versus 7â8%. The statement cited concerns with intensive pharmacologic treatment as it relates to adverse events, medication costs and patient burden, as well as the risk-benefit analysis based upon a patientâs health status.âµ According to the ACP, their guidance statement is consistent with the recommendations of the Institute for Clinical Systems Improvement guideline from 2014 wherein a recommendation for > 7% â < 8% was provided in order to manage the potential complications of intensive medication therapy.â¶
Ask Your Doctor Or Diabetes Educator About New Ways To Monitor And Treat Diabetes
Checking your own blood sugar levels with a fingerstick is becoming easier, as researchers continue to develop new ways to do so. Some of the latest innovations include:
- The FreeStyle Libre: This is the first blood glucose meter that can read your blood sugar levels by waving the meter over an adhesive patch that sticks to your arm, rather than pricking your finger to get a drop of blood. This device records your blood sugar level every five minutes and shows you a graph of the results on its screen.
- New medications: Several new classes of medications have come out relatively recently and can help people with type 2 diabetes maintain their target blood sugar levels. Some of these newer medications also provide protection against cardiovascular and kidney complications that can arise because of diabetes.
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What Is A Hemoglobin A1c Test
A hemoglobin A1C test is a blood test that shows what your average blood sugar level was over the past two to three months.
Glucose is a type of sugar in your blood that comes from the foods you eat. Your cells use glucose for energy. A hormone called insulin helps glucose get into your cells. If you have diabetes your body doesn’t make enough insulin, or your cells don’t use it well. As a result, glucose can’t get into your cells, so your blood sugar levels increase.
Glucose in your blood sticks to hemoglobin, a protein in your red blood cells. As your blood glucose levels increase, more of your hemoglobin will be coated with glucose. An A1C test measures the percentage of your red blood cells that have glucose-coated hemoglobin.
An A1C test can show your average glucose level for the past three months because:
- Glucose sticks to hemoglobin for as long as the red blood cells are alive.
- Red blood cells live about three months.
High A1C levels are a sign of high blood glucose from diabetes. Diabetes can cause serious health problems, including heart disease, kidney disease, and nerve damage. But with treatment and lifestyle changes, you can control your blood glucose levels.
Other names: HbA1C, A1C, glycohemoglobin, glycated hemoglobin, glycosylated hemoglobin
Maintain A Moderate Weight
Eating a balanced diet and exercising can help you reach or maintain a moderate weight.
You can work with a doctor or dietitian to determine how many calories to eat each day. If they recommend that you lose weight, ask them how much weight you should try to lose per week to reach your goal.
Restrictive diets and extreme workout plans are not sustainable or realistic for long-term maintenance. Theyre often unhealthy as well. A doctor or dietitian can recommend a plan to help you lose weight at a reasonable rate.
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Can Other Blood Glucose Tests Be Used To Diagnose Type 2 Diabetes And Prediabetes
Yes. Health care professionals also use the fasting plasma glucose test and the OGTT to diagnose type 2 diabetes and prediabetes. For these blood glucose tests used to diagnose diabetes, you must fast at least 8 hours before you have your blood drawn. If you have symptoms of diabetes, your doctor may use the random plasma glucose test, which doesnt require fasting. In some cases, health care professionals use the A1C test to help confirm the results of another blood glucose test.
Setting Goals For A1c Levels
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. Someone who has had untreated diabetes for a long time might have a level above 8%.
If you have diabetes and your level is above your target, your doctor may change your treatment plan to get your level down.
A combination of diet, exercise, and medication can bring your levels down.
People with diabetes should have an A1c test every 3 months to make sure their blood sugar is in their target range. If your diabetes is under good control, you may be able to wait longer between the blood tests. But experts recommend checking at least two times a year.
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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New Recommendations For Hba1c Targets For Type 2 Diabetes: Warranted Or Short
Hemoglobin A1c has been a standard test of long-term average blood glucose control for patients with type 2 diabetes for more than a decade, and blood levels above accepted thresholds are used to diagnose both pre-diabetes and diabetes . While it is uniformly accepted that higher HbA1c levels are associated with greater risk of complications from diabetes, as well as the incidence of other diseases, the targets for reducing this biomarker in people with existing diabetes remain open to debate. In particular, aggressive pharmaceutical therapy increases both side effects and costs, which need to be considered when assessing the net benefits accrued from meeting specific HbA1c targets.
Recently the American College of Physicians published less stringent treatment goals than those advocated by the American Diabetes Association , resulting in an open debate between these two trusted medical organizations. As you might expect, this is of considerable interest to us at Virta as we strive to help our patients achieve even lower HbA1c values than either of these organizations recommend.
In other words, the method used to get to a specific HbA1c level will significantly affect the resulting risk-benefit ratio, and thus the appropriate targets will differ depending on the chosen method of treatment. So here, in detail, is how we at Virta justify setting an HbA1c target reflecting better blood glucose control than what is advocated by either the ACP or the ADA.
How Precise Is The A1c Test
When repeated, the A1C test result can be slightly higher or lower than the first measurement. This means, for example, an A1C reported as 6.8 percent on one test could be reported in a range from 6.4 to 7.2 percent on a repeat test from the same blood sample.3 In the past, this range was larger but new, stricter quality-control standards mean more precise A1C test results.
Health care professionals can visit www.ngsp.org to find information about the precision of the A1C test used by their lab.
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Making The Case For Early Treatment
Weight gain can set off hormonal and metabolic changes in the body. These changes trigger insulin resistance, which is the inability of most cells to use insulin effectively to move glucose from the blood into the cells to use as energy. The beta cells in the pancreas that produce insulin subsequently go into overdrive. They overproduce insulin with the goal of maintaining normal glucose levels. The result? An abundance of insulin that cant be used effectively because most of the bodys cells are insulin resistant.
Eventually, glucose levels in the blood may rise high enough to result in either prediabetes or type 2 diabetes. If prediabetes is diagnosed, glucose levels may continue to rise high enough for a diagnosis of type 2 diabetes. Dont let the pre in prediabetes lull you into inaction, says Perry.
She also notes that high glucose levels in prediabetes and type 2 diabetes are a big driver for future heart, kidney, eye, and brain damage. The weight gain also causes high blood pressure and abnormal lipid levels , which also increase the risk for heart and blood vessel disease.
Unfortunately, most people are unaware that these changes are occurring because the weight gain happens with few other signs and symptoms over many years. Plus, health care providers dont often raise a caution flag as they should and encourage immediate action other than weight loss. Millions of people spend years with prediabetes that may then progress to type 2 diabetes.
What Is It Used For
An A1C test may be used to screen for or diagnose:
- Type 2 diabetes. With type 2 diabetes your blood glucose gets too high because your body doesn’t make enough insulin to move blood sugar from your bloodstream into your cells, or because your cells stop responding to insulin.
- Prediabetes. Prediabetes means that your blood glucose levels are higher than normal, but not high enough to diagnosed as diabetes. Lifestyle changes, such as healthy eating and exercise, may help delay or prevent prediabetes from becoming type 2 diabetes.
If you have diabetes or prediabetes, an A1C test can help monitor your condition and check how well you’ve been able to control your blood sugar levels.
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