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Decoding HbA1c Test for Blood Sugar

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Defining “HbA1c”

The HbA1c assay is the gold-standard measurement of chronic glycemia and measures the amount of glucose that binds to hemoglobin over a period of 3 months.

The HbA1c Test is often prescribed as a must-do blood test for pre-diabetic, type 1 diabetic or type 2 diabetic or even non-diabetics. So what exactly is HbA1c? How does this measure work?  How will it help you manage your diabetes better? All this and more info on the HbA1c counter and teach yourself how best you can interpret your blood test results.

HbA1c Blood Sugar Test


In the abbreviation “HbA1c”, ‘Hb’ refers to hemoglobin while 'A1c' is a specific subtype of hemoglobin.  Also called the Glycated/ Glycosylated Hemoglobin A Protein test, the HbA1c test gives the level of blood glucose estimated over a period of time (ideally 3 months or 8-10 weeks), The correct format of HbA1c is HbA1c but for convenience it is mentioned as HbA1c. Unlike the customary finger-prick blood test which reads blood glucose at a specific point in time, the HbA1c gives us a long range value. This reading of blood glucose is unaffected by immediate or short-term fluctuations in blood sugar and reflects how well glucose levels have been maintained over the specific period.

Insulin Injections for Diabetes - Slideshow Quiz on Diabetes

HbA1c test improves the effectiveness of diabetes treatment by tablets or insulin injection or both. It is a good guiding test by which the patient can understand how best he has controlled his condition and take further necessary corrective action.

The HbA1c test range should be as follows -

• A non-diabetic should have an A1c result between 4% and 6%.

• In Diabetics - A1c level should be 6.5% (47 mmol/mol) or higher.

• In Pre-diabetes (increased risk of developing diabetes in the future): A1c is 5.7%  to  6.4%  (39 - 46 mmol/mol)

In most diabetic individuals the blood glucose level is higher and results in a higher HbA1c level. This higher level also reflects the possible level of damage to tissues due to glycation and hence diabetic complications.
The normal recommended HbA1c readings for diabetics should fall within the reference range of  6.5 to 7%. What this really implies is that for every 100 red blood cells, 6-7 cells have glucose attached to them.

In the long term the importance of the HbA1c test can be understood from the fact that if well controlled, it lowers the possibility of vascular complications that can be traced back to diabetes.

diabetes control chart

How often should one test with HbA1c

If someone is first diagnosed with diabetes or if the control of diabetes is not good then Hb A1c is usually ordered more frequently.

The American Diabetes Association recommends testing HbA1c  at least twice a year.

Usually the test is conducted less often if diabetes is well controlled but most physicians would subject their patients to have the test 2 to 4 times each year.  

When should HbA1c Not be Used as a test to detect Diabetes control-
• Pregnant women 
• Recent severe bleeding 
• Recent blood transfusions 
• Chronic kidney disease 
• Chronic liver disease
• Iron-deficiency anemia 
• Anemia due to Vitamin B12 deficiency 
• Hemoglobin variants like sickle cell hemoglobin (hemoglobin S)
Many epidemiological studies and clinical trials (UK Prospective Diabetes Study and the Diabetes Control and Complications Trial) have now established the importance of the the relationship between HbA1c levels and risk for long-term diabetes complications. Today worldwide, HbA1c targets for diabetes management are used as the means to delay or prevent the development of complications.

"Medicine might Be winning the battle of glucose control, but is Losing the war against diabetes"
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HbA1c Test can be a good measurement for diabetes, however genetic variations play important role in Diabetes. For example, genetic polymorphisms and mutations have been linked with Maturity onset of diabetes of young (MODY). There are about 15 genes associated with MODY, which were, till-date wrongly diagnosed as Type-1 diabetes. MODY donot require any medicines. Gene therapy and dietary changes alone can cure MODY diabetes. In patients diagnosed with type-2 diabetes, a genetic testing is recommended to find the best treatment for diabetes according to their genetic make-up. Certain dietary and life-style changes can even cure the disbetes completely in some individuals, but others may not be cured at-all from type-2 diabetes. Hence it is now recommended for comprehensive genetic testing for all patients with type-2 diabetes and MODY-type diabetes...
avinash1005 Wednesday, December 18, 2013
There is big gap regarding declaring a person as Pre-Diabetic and Diabetic based on 1] Fasting and PP sugar levels 2) HbA1c levels. Many patients with with Fasting sugar less than 100 mg/dl and PP sugar less than 140 mg/dl show HbA1c level in the range of 6 % 0r 6.1 %. A person with Fasting sugar less than 100 mg/dl and PP sugar less than 140 mg/dl is considered Non Diabetic. On the other hand a person with HbA1c level between 5.7 % to 6.4 % is considered as Pre-diabetic. Two comments posted below on this website also confirm this discrepancy. For example Comment posted on 12/16/2013 [yesterday) showing Fasting and PP level as 109 and 139 ( only Pre-Diabetic range) but HbA1c as 9.4 which is very high and is severe Diabetic range. Similarly comment posted on 08/06/2012 stating that blood sugar fasting in last 6 months was 100 and 91 and pp as 122 and 102 Recently I did Hb1ac test and it gave 6.1. On the basis Fasting and PP levels the person would be non -Diabetic. in Reply just below that comment Dr Marks has declared the person as Pre-diabetic. SC Gupta
Gupta1952 Tuesday, December 17, 2013
my fasting glucose level 109, pp 139, hba1c range 9.4, i am not taking any medicine as of now, do i require medication
zydusovraman Monday, December 16, 2013
Hi have been diagnosed type 1 for 2weeks and my hba1c result came back as 99. Does this mean I have been diabetic for a while and not known ?
paul83 Monday, September 23, 2013
I was diagnosed diabetic 2 in July,2011. Fasting was 299, PP 326 and Hba1c 10.6 !! I was administered Meformin 500 mg twice a day.With all other precautions on diet and exercise I could bring down the HbA1c to 5.9 in Aug,2012. I quit medicine to see the HbA1c behavior. Diet control and 70 minutes evening walk continues. During the Non-medicine period my glucometer reading of fasting was always in the range 100-85 but sometimes PP went upto 190. Anyways, after August 27th when HbA1c read 5.9 I again got tested for HbA1c today [3rd Dec.2012] and the reading is again 5.9 with mean as 122.6 Am I right in quitting medicine ? Does 5.9 suggest that I better control diabetes with diet control and evening walk only. Thanks
vijayshubh Monday, December 03, 2012
I have been getting my blood sugar tested every six months because of family history. I run /cycle 5 to 6 time a week and otherwise have a desk job.I am 44 yrs old. I feel unease after 2 hrs of taking food in the morning after excersie but after taking food I am ok. My blood sugar fasting in last 6 months was 100 and 91 and pp as 122 and 102 Recently I did Hb1ac test and it gave 6.1. Can I be predibatic pls suggest Thanks
suratrunner Monday, August 06, 2012
Yes, at 6.1 this is a pre diabetic level. From 5.7-6.3 is pre diabetes. At 6.4 you are diabetic. Keep up the excercise, but you must watch your carbohydrate consumption. Bread, rice, pasta potatoes fruit juice and more than 2 fruits a day will keep you in this state. Increase salads and non starchy vegetables as well as lean proteins and you will improve. Dr. Marks
Lmarks1000 Friday, August 24, 2012
What should be the reference range of HbA1c in Ist, IInd and IIIrd Trimester of pregnancy????????
dr.meera Sunday, April 01, 2012
Can having a lot of sugary foods as at Cristmas time raise the levels seen on HbA1c test? Rafe
Rafael Sunday, February 20, 2011
I will be much benefitted if I know whether I have to go for the test in empty stomock or after taking food. Since I am going for this test periodically I want to know this.
ramasamy43 Saturday, July 24, 2010
HbA1c test measure the average level of glucose during last 3 months.Hence you can go both with empty stomach or after taking food.
Gupta1952 Tuesday, December 17, 2013
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