By Nadia Al-Samarrie
Know Your A1c
The A1c—sometimes referred to as the Hemoglobin A1c, glycosylated hemoglobin, glycated Hemoglobin, and HbA1c— measures your average glucose from 60 to 90 days. When you check your blood sugar with a blood glucose meter, it only tells you what your glucose level is at that moment in time. It does not accurately reflect all the highs and lows you experience, nor does it indicate the direction your blood glucose could be trending.
Blood cells form and die within 90 days. The A1c test records the memory in the blood, giving us an average reading that correlates with the percentage.
Sometimes you can get a false A1c level if you have anemia, an iron deficiency, a blood transfusion, or a plethora of other reasons.
The percentage can also vary depending on where you get your A1C checked. So, it is best to use the same lab if possible.
A1c Target Goals
The American Diabetes Association (ADA) recommends checking your A1c at least twice a year. Their recommended target A1C varies. For most adults who are not pregnant, the recommended target is <7% (53 mmol/mol).
A tighter goal of <6.5% (48 mmol/mol) is recommended for select patients, including:
• people who are newly diagnosed
• people with type 2 that is treated with lifestyle changes or metformin only
• people with a long-life expectancy
• people with no significant cardiovascular disease.
Conversely, the ADA recommends a looser A1c target of <8% (64 mmol/mol) for select people:
• People with a history of severe hypoglycemia
• people with a limited life expectancy
• people with advanced microvascular or macrovascular complications
• People diagnosed with an extensive amount of other conditions
• People who have had diabetes for a long time and who have difficulty achieving their target despite ongoing efforts
The American Association of Clinical Endocrinologists (AACE) recommends setting a target based on the person’s age, other diseases they may be living with, and how long they have had diabetes.
For most people, they recommend an A1c target of ≤6.5, but for healthier people, a tighter goal closer to normal (below 5.7%) is suggested. For people who are not as healthy, a looser A1c target is recommended.
The United Kingdom Prospective Diabetes Study (UKPDS) researched newly diagnosed patients with type 2 diabetes over a 10-year period, exploring tight glucose management through diet, type 2 medications and insulin.
The patient with tight control who was under intensive management with an A1c of 7 experienced a 25% reduction in possible damage to the eye, kidney, and nerve. Additionally, for every 1% reduction in the patient’s A1c, there was a 21% decrease in diabetes complications.
In the United States, a landmark Diabetes Control and Complications Study for people with type 1 diabetes also demonstrated that tight glucose control reduced diabetes complications.
Your A1c result corresponds with your average blood sugar. The percent stated as a number from your lab results tell you what your average blood level has been for the last 90 days.
|Percent||Average Blood Sugar Reading|
|4 Percent||68 mg/dl|
|5 Percent||97 mg/dl|
|6 Percent||126 mg/dl|
|7 Percent||154 mg/dl|
|8 Percent||183 mg/dl|
|9 Percent||212 mg/dl|
|10 Percent||240 mg/dl|
|11 Percent||269 mg/dl|
|12 Percent||298 mg/dl|
|13 Percent||326 mg/dl|
|14 Percent||355 mg/dl|
|15 Percent||384 mg/dl|
|16 Percent||413 mg/dl|
|17 Percent||442 mg/dl|
Time and Range Versus A1c
Your healthcare professional might start using the term “time and range” instead of A1c. The significance is that this new measurement looks at how long your blood sugar stays within a certain range while the A1c provides you with the average blood sugar for 90 days. Knowing how long your blood sugar stays at a certain range can help your healthcare professional fine-tune your therapy and or medication, possibly allowing you to experience fewer highs and lows in your routine care.