Monitoring your blood sugar levels regularly, especially if you have diabetes or are at an increased risk, is crucial for your overall health. Your doctor may suggest the HbA1c (Hb stands for hemoglobin) test to see if you have diabetes, have symptoms, or are at risk. This test measures the average amount of blood sugar (glucose) attached to hemoglobin over three months. 

The A1c test is not just a one-time thing. For people with diabetes, a regular checkup reflects how well your diabetes has been managed in the past few months. It is usually recommended every three months, but it might be performed less frequently if your blood sugar levels are under control. 

Monitoring HbA1c is important because it helps assess the risk of diabetes-related complications, such as diabetic retinopathy, diabetic kidney disease, and diabetic neuropathy. The higher the HbA1c, the greater the risk; thus, it is vital to keep an eye on it to manage diabetes and stay as healthy as possible.

What is an A1c test?

The HbA1c (or A1c) test aids in two important aspects: One, it helps assess if someone has type 2 diabetes, and two, it keeps track of how well diabetic people are managing their blood sugar.

Hemoglobin is a protein in red blood cells that carries oxygen in your body. When glucose sticks to hemoglobin, a compound called glycated hemoglobin (glucose-bound red blood cells) is formed. This glycated hemoglobin is termed as HbA1c. Common sugars, such as glucose, galactose, and fructose, naturally bond with hemoglobin in the bloodstream.

The HbA1c level of an individual is directly linked to the amount of glucose in your blood. In humans, red blood cells live for about 120 days (about four months). An HbA1c test gives an idea of the level of sugar intake in our blood over the past few months. In contrast, the conventional blood sugar test only tells the blood sugar level at the time of the test.

Why and when to test A1c levels?

Your doctor may recommend an HbA1c test if they suspect diabetes. Once diabetes is confirmed, regular HbA1c measurements are recommended for those individuals every 3–6 months. 

For individuals newly diagnosed with persistently high blood glucose levels, or when there is a change in the treatment plan, HbA1c may be measured frequently.

The US Centers for Disease Control (CDC) suggests A1c testing for diabetes and prediabetes under the following conditions:

• If you are over the age of 45, it is recommended that you undergo A1c testing. If the results are as expected, the test should be repeated every three years.
• In case the results indicate prediabetes, regular testing is typically needed once every year or two.
• If the results show diabetes, it is advisable to take an A1c test at least twice a year to monitor the condition and efficacy of treatment.

Consult your doctor to determine the required testing frequency and be aware of the steps to reduce your risk of developing diabetes.

If you are under 45, A1c testing is recommended if you:

• Have prediabetes
• Are overweight or have obesity
• Have a family history of type 2 diabetes
• Have high blood pressure or high cholesterol levels
• Have a history of heart disease or stroke
• Engage in physical activity less than three times a week
• Have experienced gestational diabetes during pregnancy or given birth to a baby weighing over nine pounds or 4 kg
• Have polycystic ovarian syndrome (PCOS)

Understanding the results

The typical A1c percentage ranges are as follows:

• Normal: below 6%
• Prediabetes: between 6% and 6.4%
• Diabetes: 6.5% or higher

Thus, you are diagnosed with diabetes when your HbA1c level is 6.5% or higher. To keep your diabetes in check, the target is to keep HbA1c below 7%. If it is below 7%, it is a sign that your diabetes is well managed. But if it goes above 7%, there is a higher risk of complications, such as eye issues, kidney problems, nerve damage, and the possibility of a heart attack or stroke.

Those with an HbA1c in the range of 5.7–6% are not precisely labeled as prediabetic, but they are at a higher risk of developing diabetes. It is a signal to take preventive measures and monitor your health.

Limitations of the A1c test

While the HbA1c test is valuable in monitoring long-term blood sugar control in individuals with diabetes, it has its limitations. Doctors often rely on a combination of tests for an accurate diabetes diagnosis. 

If your initial HbA1c result indicates higher than normal levels, your provider might suggest another A1c test or a different diabetes test, such as the conventional fasting blood glucose test or an oral glucose tolerance test (OGTT). 

It is important to note that the A1c test is not suitable for diagnosing gestational diabetes or type 1 diabetes. If you have conditions affecting your red blood cells, such as anemia or other blood disorders, the accuracy of the A1c test for diagnosing diabetes may be compromised. 

Kidney failure and liver disease can also influence A1c results. Under these circumstances, your healthcare provider might suggest alternative tests for diagnosing diabetes and prediabetes.

Learn more about the A1c test at Fortis Healthcare.

FAQs

1. What is the HbA1c test, and what does it measure?

HbA1c stands for hemoglobin A1c. The HbA1c test measures the average blood glucose levels over the past two to three months.

1. How often should individuals with diabetes undertake an HbA1c test?

The frequency of HbA1c testing might vary, but it is generally recommended every three to six months, depending on the individual’s diabetes management and healthcare provider’s advice.

1. How do I interpret the results of an HbA1c test?

HbA1c results are presented as a percentage. Generally, lower percentages indicate good blood sugar control. Your healthcare provider will guide you on your target range based on your specific health condition.

1. Are any specific preparations required before taking an HbA1c test?

In most cases, no special preparations are needed for an HbA1c test. It reflects the average blood glucose levels over an extended period, so short-term factors, like fasting, do not affect it.

1. How does HbA1c testing differ from traditional blood glucose tests?

Unlike traditional tests that show blood glucose levels at a specific moment, the HbA1c test reflects average blood glucose levels over several weeks, offering a more comprehensive view of long-term blood sugar control.

1. What should I do if my HbA1c levels are below the target range?

Consult your healthcare provider. They will rework your treatment plan, including changes in medication, diet, or lifestyle to manage your diabetes.