You've probably heard doctors say, "You need to get an A1C test." Or if someone in your family has diabetes, you've probably heard about this A1C test. What exactly is this A1C test? What can we learn from it? Today, we'll talk about this A1C test in a simple way that you can understand.
What is the A1C test?
Simply put, the A1C test is a test that measures your blood sugar, or ``Glucose'', levels over the past three months. The results are given as a percentage. The higher the percentage, the higher your blood sugar levels are.
Doctors use the A1C test for several main reasons:
- Identify the stage before diabetes (`(Prediabetes)`). That is, a stage close to developing diabetes.
- Find out exactly if you have type 2 diabetes.
- If you have type 2 diabetes or type 1 diabetes, it's important to understand how well your treatment plan is working. Your A1C level can help you and your doctor decide if you need to make changes to your treatment plan.
How is the A1C test done?
Doctors test A1C in two ways:
- Most often, a small amount of blood is drawn from a vein and sent to a lab for testing. This is the most common method. This is called a ``Phlebotomist'' drawing blood.
- The other method is to take a drop of blood from your fingertip and test it. This can give you results in a few minutes. However, this method is only used to see how your treatment is going, and is not used to diagnose a new disease.
A test using a vein is usually more accurate than a finger prick test.
What are other names for the A1C test?
This A1C test is called by several other names. You may also hear these names:
- Hemoglobin A1C `(Hemoglobin A1C)`
- HbA1c `(HbA1c)`
- Glycated hemoglobin
- Glycohemoglobin test `(Glycohemoglobin test)`
What is blood sugar (Glucose)?
Our bodies get this `(Glucose)` or sugar mainly from the carbohydrates in the foods we eat. This is the main source of energy for our body's cells. Our blood carries this `(Glucose)` to the cells throughout the body.
Many processes in our bodies help keep blood sugar levels within a certain range. The most important role in this is played by the hormone ``Insulin``, which is produced by our pancreas.
If your blood sugar levels are consistently high (hyperglycemia), which means your A1C is also high, it often means you have diabetes. Diabetes occurs when the pancreas doesn't produce enough insulin, or when the amount of insulin it produces isn't enough, or when the body can't use insulin properly.
When do I need an A1C test?
If you have diabetes, you should have an A1C test at least twice a year to see how well your treatment plan is working. Your doctor will tell you exactly how often you should have this done.
If you haven't been diagnosed with diabetes, but have the following symptoms, a doctor may order an A1C test:
- Constant excessive thirst (`(Polydipsia)`)
- Excessive urination
- Blurred vision
- Feeling tired all the time (`(Fatigue)`)
Also, if you are at risk for developing type 2 diabetes (`(Type 2 Diabetes)`), you can also have an A1C test to see if you have it. Risk factors include:
- Having a family member with type 2 diabetes.
- If you have previously had gestational diabetes.
- Obesity.
- Lack of physical activity or exercise.
- Being over 35 years of age.
How is A1C calculated?
The A1C test is based on something called hemoglobin . Hemoglobin is the part of our red blood cells that carries oxygen throughout the body. When there is glucose in your blood, it sticks to this hemoglobin. This is called glycation . The more glucose in your blood, the more this sticking increases. And, this sticking can last for about three months – which is about the average lifespan of a red blood cell.
The A1C test measures the average amount of glucose that is attached to hemoglobin over time. Because it measures blood sugar levels over time, the A1C test can tell us more about your health than a single blood sugar test.
Do I need to fast before an A1C test?
No. You do not need to fast before taking an A1C test.
What happens when you do an A1C test?
Here's what you can expect from an A1C test, which involves taking blood from a vein:
- While you are sitting in a chair, a phlebotomist (person who draws blood) will look for a vein in your arm that is easy to draw blood from. Most often, the blood is drawn from the inside of your arm, just behind your elbow.
- Once a vein is found, the area is cleaned and disinfected.
- Then a small needle is inserted into the vein and a blood sample is taken. This may feel like a slight prick.
- After inserting the needle, a little blood is collected in a test tube.
- Once enough blood has been collected for the test, the needle is removed and the bleeding is stopped by applying pressure to the area with a piece of cotton or gauze.
- Finally, put a plaster on the spot and you're done.
During an A1C test, which is done by taking blood from a finger, the following things happen:
- A doctor asks you which finger to take blood from.
- Your fingertips will be wiped with alcohol and a small puncture will be made with a small needle called a ``Lancet'' (this is usually in a small plastic device).
- They will squeeze your fingertip, extract a drop of blood, and collect it in a small plastic container.
- After enough blood is taken for the test, you will be given a piece of cotton or gauze to hold onto your fingertip to stop the bleeding.
- Results can usually be obtained in a few minutes.
Are there any risks to the A1C test?
Blood tests are a very common and necessary part of medical testing. The risks of both types of A1C tests are very low. You may experience some bruising or soreness where the blood is drawn or where your finger is pricked, but this will quickly heal.
What does my A1C value mean?
The results of an A1C test are given as a percentage. This number tells you how much of the hemoglobin protein is glycated, meaning it's attached to glucose. The higher the percentage, the higher your blood sugar levels have been over the past few months.
A1C levels for diagnosis are as follows:
- If it is less than 5.7%, it means you do not have diabetes. (Healthy level)
- If it is between 5.7% and 6.4%, it is considered prediabetes. This means that diabetes is close to developing.
- A level of 6.5% or higher usually indicates either Type 2 Diabetes or Type 1 Diabetes.
If you already have diabetes, your A1C result shows how well your treatment plan has worked over the past three months. This treatment may include pills, insulin injections, frequent blood sugar testing, and lifestyle changes (such as diet and exercise). Based on your A1C value, you and your doctor can decide if any changes to your treatment plan are needed.
The most important thing to remember is that your A1C (if you have diabetes) is just an average of your blood sugar levels over a period of several months. It is not a sign of your health or the final decision on whether you are living a healthy life. Remember that your A1C can change throughout your life, and there are things you can do to manage your diabetes and improve your A1C levels, if needed.
What are A1C and estimated normal glucose (eAG)?
Some labs give the A1C result as a percentage, along with a corresponding estimated average glucose (eAG) value.
The `(eAG)` calculation converts the A1C percentage to the same units (milligrams per deciliter - mg/dL or millimoles per liter - mmol/L) that you use with your home glucose meter. Just as your A1C is an average, the `(eAG)` is a single value that shows your average blood sugar level over the past three months.
For example, an A1C of 7% is equal to `(eAG)` 154 mg/dL (8.6 mmol/L). An A1C of 9% is equal to `(eAG)` 212 mg/dL (11.8 mmol/L).
What is a normal A1C value?
For someone without diabetes, a normal A1C value is less than 5.7%.
What is considered "normal" and healthy for people with diabetes depends on your goals and your access to diabetes management medications and equipment. You and your doctor will work together to determine your target A1C range. This may change throughout your life.
In general, the American Diabetes Association recommends that most adults with diabetes aim for an A1C of 7% or less .
Your A1C target may be higher than 7% in these situations:
- If life expectancy is limited.
- If you have frequent episodes of severe low blood sugar (`(Hypoglycemia)`) or are unaware of such episodes (`(Hypoglycemia unawareness)`).
- If you have severe complications from diabetes (such as chronic kidney disease, nerve damage, or cardiovascular disease).
On the other hand, for women with type 1 diabetes during pregnancy, doctors generally recommend keeping A1C levels at 6.5% or lower throughout pregnancy. This is done to reduce health risks to the fetus and prevent excessive fetal growth (fetal macrosomia).
What is a dangerous level of A1C?
As your A1C level increases, especially if it remains high for many years, you are more likely to develop complications such as:
- Eye disorders (`(Retinopathy)`)
- Kidney problems (`(Nephropathy)`)
- Neuropathy
- Stomach dysfunction (Gastroparesis)
- Heart disease
- Stroke
Research has shown that people with diabetes can reduce their risk of developing diabetes complications by maintaining A1C levels below 7% .
But remember, other factors, such as genetic factors and how long you have had diabetes, can also affect the development of diabetes complications.
Is the A1C test really accurate?
Some factors can affect the accuracy of A1C tests, including:
- Genetic factors, for example, hemoglobin variants
- Other medical conditions
- Some medications and nutritional supplements
- Errors during collection, transportation, or processing of samples for testing
These factors can cause your result to be either ``falsely low`` or ``falsely high``. Many of these factors are caused by variations in the lifespan and health of your red blood cells.
Hemoglobin Variants and A1C Results
Hemoglobin variants can affect the results of some A1C tests.
The type of hemoglobin in your blood is determined by what you inherit from your genes. There are different types. The most common is hemoglobin A. Other, less common types of hemoglobin are called hemoglobin variants.
Having a hemoglobin variant does not increase your risk of developing diabetes, but it can affect A1C results. Labs have different ways to test A1C on blood with a hemoglobin variant.
Some of the most commonly seen varieties are:
- Hemoglobin C trait : This is most common among black people, people of West African descent, and people from South and Central America, the Caribbean, and Europe.
- Hemoglobin D trait : This is common among people living in China, India, Turkey, Brazil, and some parts of Europe.
- Hemoglobin E trait : This is common among Asian Americans, especially those of Southeast Asian descent.
- Hemoglobin S trait : This is more common among blacks and Hispanic Americans.
A blood test can identify hemoglobin variants. If you think you may have a hemoglobin variant that could affect your A1C results, talk to your doctor.
Reasons why your A1C may be lower than it actually is
These conditions and situations can cause your A1C result to be lower than your actual level:
- Excessive alcohol use (`(Alcohol use disorder)`)
- Blood transfusion
- Chronic kidney failure (`(Chronic kidney failure)`)
- Erythropoietin-stimulating agents (ESAs)
- Excessive bleeding (`(Hemorrhage)`)
- Living at a high altitude
- Taking iron supplements
- Cirrhosis of the liver (`(Cirrhosis of the liver)`)
- Pregnancy
- Sickle cell anemia (`(Sickle cell anemia)`)
- Spherocytosis and hemolytic anemia (`(Spherocytosis and hemolytic anemia)`)
Reasons why A1C values may be higher than they actually are
These conditions and situations can cause your A1C result to be higher than it actually is:
- Anemia, for example iron deficiency anemia, anemia caused by infection, or anemia caused by cancer.
- Some medications, such as immunosuppressant medications and protease inhibitors.
- Increased triglycerides in the blood (`(Hypertriglyceridemia)`)
- Organ transplantation
- Thalassemia (`(Thalassemia)`)
- Vitamin B12 deficiency (`(Vitamin B12 deficiency)`)
Can diabetes be cured even if A1C levels are high?
Yes, you can. Just because you have a high A1C (above 6.5%) doesn't mean you have diabetes. Some medications, such as steroids, or other factors, such as illness, can temporarily increase your blood sugar levels. Other conditions, such as anemia, can make your A1C result appear higher than it actually is. There is also a chance that the test may be inaccurate.
Doctors use more than one test to diagnose diabetes. For example, you may be asked to do a fasting blood glucose test or an A1C test. However, your doctor will carefully review your results and discuss them with you.
Does A1C accurately tell you about diabetes management?
For decades, doctors and people with diabetes have used the A1C test primarily to measure how well their treatment is working.
However, especially for people with type 1 diabetes, blood sugar levels can fluctuate greatly over days, weeks, and months. Therefore, A1C is based on a mean and does not always give an accurate picture of management.
For example, consider this: Someone's blood sugar levels are constantly fluctuating, but their A1C may be 7%. Another person's blood sugar levels are consistently around 154 mg/dL, and their A1C may also be 7%.
Recently, with the introduction of continuous glucose monitoring (CGM) devices , doctors and people with diabetes have found that Time in Range (TIR) provides a more useful and accurate picture of diabetes management.
The TIR is the amount of time your blood sugar level is within the recommended target range. The TIR is measured as a percentage. Blood sugar target ranges can vary from person to person, but a typical target range is between 70 and 180 mg/dL. For most adults with type 1 or type 2 diabetes, doctors recommend trying to keep the TIR above 70% (about 17 hours out of a 24-hour day).
With `(CGM)` and `(TIR)`, doctors and people with diabetes can see how often their blood sugar levels are high or low. This helps them tailor their treatment regimens more accurately.
Finally, you have to say...
It can be disconcerting when your A1C results are not as expected or higher than expected. But remember, a high A1C doesn't necessarily mean you have diabetes. There are many factors that can cause the results to be inaccurate. Your doctor will tell you if you need more testing. Don't be afraid to ask your doctor questions. They are there to help you.
If you have diabetes, it's important to remember that your A1C is only a temporary average of your blood sugar levels. There are things you can do to improve your A1C levels. If you're feeling overwhelmed about managing your diabetes, talk to your doctor. Together, you can create a plan to manage your diabetes and reach your A1C goals.
` A1C, HbA1c, diabetes, blood sugar, glucose, hemoglobin, diabetes test
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