According to a recent survey conducted by the American Association of Diabetes Educators (AADE), 75 percent of people with type 2 diabetes do not know their Hemoglobin A1c (A1c) level. In addition, 77 percent could not name a good test result. Also, a 2000 survey published by the National Quality Control Association states that 75 percent of people with diabetes are not getting their A1cs tested.

"Tracking A1c levels helps patients know if they are in control of their diabetes," said Judith Hey-Hadavi, MD, DDS, assistant professor of clinical medicine in the department of medicine, Columbia University in New York. "It is critically important that patients be educated so that they realize the importance of taking action to stabilize their blood sugar levels and manage their diabetes in the long term."

First Off, What is the A1c and Why is it So Important?

"If you don't want to go blind, keep your A1c under 8%."

That is what John Hunt, MB, BS, FRCP, tells his patients at the University of British Columbia to stress the importance of good diabetes control.

"As soon as people see this, they ask, ‘Really? What's my A1c?'"

As glucose travels through your body, it attaches itself to your hemoglobin, which is a protein inside your red blood cells. When glucose connects itself to hemoglobin molecules, the process is called glycosylation or glycation.

When your BGs are high—even after your meter says you are back to normal—some glucose will stay attached to your red blood cells. So, the more often your body has high glucose levels, the more glucose will attach to the hemoglobin.

Red blood cells only live for about 90 to 120 days, and are then replaced by new red blood cells. Thus, when you measure the A1c level every three months, you get a quarterly average.

The A1c test (also called HbA1c, glycohemoglobin or glycated hemoglobin test) is the only test that gives a three-month average. The Diabetes Control and Complications Trial (DCCT) established the connection between A1c and complications back in 1993. The DCCT study showed that people with diabetes who keep their A1cs close to 7% or lower have a much better chance of delaying or preventing diabetes complications.

Shooting for a Goal

Rory Wilson is a 52-year-old type 1 from Cape Town, South Africa. He says that because of his busy life as the CEO of a large publishing company, he only gets an A1c test about two times per year. In addition, he tests his BGs about four times per day. Wilson is grateful for the A1c test.

"You can often delude yourself into thinking your BGs are well under daily control," he says. "The A1c is likely to give a far more truthful picture."

Rob Scono, a type 2 from Winter Haven, Florida, tests his A1c four times per year. He likes having a test that "confronts my denial and provides a clear roadmap for the next three months of self-treatment strategies."

"I struggle with eating healthy and consistent self-testing," he says. "I want a goal to shoot for even if I am having difficulties hitting the target."

Shows the Big Picture

Jennifer Howell, a type 1 from Minneapolis, Minnesota, also tests her A1c four times per year. She says it is important to have that "big" picture of diabetes control, and she feels the A1c accomplishes that for her.

"I test my blood sugar more than 10 times per day and still feel that I do not always know where I am at," says Howell. "Until continuous glucose monitoring is perfected, I will continue to rely on the overall control that the A1c provides."

Edith Frank, a type 1 insulin-pump user from Morristown, New Jersey, tests her A1cs two to three times per year.

"I really think that I need to know how well it is going over time," she says. "I need more feedback than the frequent BG testing I do every day. Every day is different, and sometimes my A1c results surprise me. When I thought I was doing well, the A1c was too high. On the other hand, my latest A1c test was much better in spite of daily BG readings that were so unstable."

The Problem with Standardization

Each A1c test tells you the same information, but the normal range can be different.

"One of the big problems with A1c testing is that from lab to lab you have variation in the number you get," says Michael Allen, chairman and CEO of Metrika, a Sunnyvale, California-based company whose at-home A1c Now test will be available this fall. Allen says this is a problem because without standardization, one lab could give you a 6% reading while another gives you an 8%.

Paul Kavanaugh of Encinitas, California, gets his A1cs tested three to four times per year. He says his doctor switched labs a while ago, and his results went from 6% to 11%.

"I was shocked, so I had them do it a second time and it was high again," says Kavanaugh. "Then I went back to the old lab, and it came in at 6.9%. The bottom line is, the new lab is basically useless to me."

"The key to it is to get everyone like the atomic clock so that every one has the exact same number from lab to lab," says Allen.

Many in the healthcare field are calling for all tests to use the same assay, with the same normal range. Toward this end, a group of leading diabetes doctors formed the National Glycohemoglobin Standardization Program (NGSP), calling for all laboratories to use an assay on the same scale as the one used in the DCCT.

"The DCCT … provided a large body of data relating glycohemoglobin values to mean blood glucose," said NGSP network coordinator Randie Little, PhD, of the University of Missouri. "Thus, the DCCT results set the stage for establishing specific diabetes treatment goals using A1c as an index of mean blood glucose."

In addition to using the same target ranges, NGSP-sanctioned methods must meet DCCT criteria for precision and accuracy. The ADA has positioned itself with the NGSP, warning people with diabetes that "data should be used with caution if the GHb assay method is not certified as traceable to the DCCT reference method."

If you get an A1c test result, make sure you know the normal range.

Involving Your Physician: To Test in the Office or at Home

With the recently FDA-approved A1c At-Home, people with diabetes will soon have the option of testing their A1cs in the comfort of their own living rooms. But, is that a good thing?

According to the November 1999 issue of Diabetes Care, researchers from the Diabetes Center in Boston, Massachussets, conducted a 12-month study on 201 people with type 1 and 2 diabetes. They discovered that, " immediate feedback of HbA1c test results at the time of patient encounters resulted in a significant improvement of glycemic control at six-month follow-up and persisted for the 12-month study."

With at-home A1c testing coming our way, is it possible that more and more people with diabetes will get this immediate feedback? Nancy Bohannon, MD, an endocrinologist at Monteagle Medical Center in San Francisco, thinks so.

"Some people will be motivated by seeing [BGs] come down when instituting changes in their regimen, without having to wait for the next official lab result in three months."

Christy Schneider, a type 1 from Washington, D.C., gets her A1cs tested two times per year. She says she will still have hers done at the lab.

"My doctor can evaluate the test results in the context of my blood-sugar recordings, and he can usually offer advice on how to improve blood sugars," she says.

Linda Radford of Rigby, Idaho, was diagnosed with type 2 diabetes this past January and she has already had two A1c tests. She likes the idea of getting to test her A1cs at home instead of at the lab.

"I know the meaning of the number as well as the doctor and would know what my average was more often if I could do it at home and save the expense of a doctor's visit," she says.

Joan Williams of Tracy, California, tests her A1cs three times per year. She would also like to test at home.

"I'm very pro-active in managing my diabetes," she says. "And it would minimize time that I have to take off from work."

Stuart Brink, MD, clinical instructor of pediatrics at Harvard Medical School and senior pediatric endocrinologist at the New England Center for Diabetes and Endocrinology, feels since so few people with diabetes actually get the recommended A1c testing, at-home testing may be a way to have the consumer get it done.

"However, I would guess that the same people who would know about the A1c are likely going to diabetes doctors routinely and are also getting frequent A1c testing," says Brink. "All this being said, anything that gets quarterly A1c testing done in a reliable, high quality fashion would be helpful."

Categories: A1c Test

Facebook MySpace Digg

Recommend this :

Not at all Somewhat Moderately Highly Very Highly

Average Rating:

You May Also Be Interested In...

Click Here To View Or Post Comments

Sep 1, 2001 -