In June 2009 the American Diabetes Association (ADA), International Diabetes Federation (IDF), and European Association for the Study Of Diabetes (EASD) began recommending diabetes A1C diagnosis testing. While the A1C for diagnosis of diabetes is not the only test that should be administered by doctors, the committee’s recommendation reflects the A1C test’s ability to provide a different perspective on blood glucose management and average levels. This is because A1C values vary less than fasting plasma glucose (FPG) as patients do not need to fast and A1C values have also been correlated with the risk of developing retinopathy. The downside of the A1C test is its price; it is more expensive than other tests. The ADA noted that the price is prohibitive, particularly in the developing world. Additionally, A1C is inaccurate in cases of severely low hemoglobin levels caused by chronic anemia, hemolytic anemia, and other forms, which are prevalent in some developing countries. While there are point of care (POC) and at home test kits available, in order to use A1C to diagnose diabetes the test must be sent to a certified lab that meets the appropriate standards as POC tests have been shown to have variation.
Hemoglobin A1C and Diabetes
Diagnosis of diabetes, using any test, dependent on the condition of hyperglycemia caused by either a defect in insulin secretion, insulin action, or both. While FPG and at home tests measure the presence of glucose in the blood, the A1C test measures the presence of glycated hemoglobin (HbA1C). Hemoglobin is a protein found in red blood cells. The most common form is Hemoglobin A. Excess blood sugar hooks to and combines with Hemoglobin A, making it glycated and creating hemoglobin A1C molecules. The glucose stays attached to the hemoglobin for the duration of the cell’s lifespan (120 days). Thus, when an A1C test is done it measure the percentage of glycated hemoglobin present during the cells lifespan, giving an average amount.
What Is A1C In Diabetes
In diabetics A1C levels reflect an average excess of blood glucose. The international committee’s A1C percentage for diagnosis of diabetes is 6.5% or greater, reflecting the increased risk of retinopathy and other organ damage. Individuals with normoglycemia, or normal levels of blood glucose, have A1C levels in the 4% to 6% range. The maintenance goal for diabetics is an A1C level of <7%. The ADA recommends a minimum of twice yearly testing to ensure a proper treatment plan is in place, allowing doctor’s to modify treatment if levels get too high. While A1C is important for diagnosis and maintenance, patients should continue to check their daily glucose levels for proper monitoring.
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