What is the ideal A1C range for diabetics. How do very low A1C levels impact health outcomes. Why do some studies show increased risks at both high and low A1C levels. What factors should be considered when setting A1C targets.

Understanding A1C and Its Importance in Diabetes Management

A1C, also known as hemoglobin A1C or HbA1c, is a critical measure of long-term blood glucose control in diabetes management. It provides an average of blood sugar levels over the past 2-3 months, offering valuable insights into how well diabetes is being managed. But what exactly constitutes the “best” A1C level? Recent research has challenged some long-held assumptions about optimal targets.

What is A1C and how is it measured?

A1C is measured through a simple blood test that determines the percentage of hemoglobin proteins in red blood cells that have glucose attached to them. The higher the percentage, the higher the average blood glucose levels have been over the past few months. For people without diabetes, a normal A1C range is typically considered to be between 4% and 5.6%.

The Evolving Understanding of Optimal A1C Levels

Historically, the prevailing wisdom in diabetes care has been “lower is better” when it comes to A1C levels. This approach was based on studies showing a linear relationship between higher A1C levels and increased risks of diabetes complications. However, recent research has begun to paint a more nuanced picture.

The J-shaped curve: Risks at both high and low A1C levels

Several recent studies have revealed a J-shaped relationship between A1C levels and health outcomes. This means that while very high A1C levels are clearly associated with increased health risks, very low levels may also carry some risks. This finding has important implications for setting A1C targets in diabetes management.

• At the lower end: Some health risks may increase
• In the middle range: Optimal health outcomes are observed
• At the higher end: Significant increase in diabetes-related complications

Key Studies Shaping Our Understanding of A1C Targets

Several influential studies have contributed to our evolving understanding of optimal A1C levels. Let’s examine some of the most significant findings:

The German National Health Interview and Examination Survey

A 2015 study published in Diabetes Care analyzed data from the German National Health Interview and Examination Survey 1998. This large-scale study followed approximately 6,300 people for about 12 years. The results indicated that individuals with an A1C level between 5.4% and 5.6% had the lowest risk of excess mortality.

A1C and dementia risk

Another recent study explored the relationship between A1C levels and the risk of developing dementia. Surprisingly, the researchers found that very low A1C levels were associated with an increased risk of dementia. This finding adds another layer of complexity to the question of optimal A1C targets.

Interpreting the Data: Causation vs. Correlation

It’s crucial to note that these studies are observational, meaning they show correlations rather than proving causation. Dr. Naveed Sattar, a professor of metabolic medicine at the University of Glasgow, emphasizes this point: “What’s the cause and what’s the result is the question. In people who have very low blood glucose levels, below guideline levels, I suspect that there are other reasons that they are sick and their A1C is low because of this and that then leads to dementia.”

Potential confounding factors

When interpreting these studies, it’s important to consider potential confounding factors that may influence the results. These could include:

• Overall health status of study participants
• Presence of other medical conditions
• Medication use
• Lifestyle factors
• Age and duration of diabetes

Current Recommendations for A1C Targets

Given the complexity of the research findings, various health organizations and experts have differing recommendations for A1C targets. Let’s explore some of these guidelines:

American Diabetes Association (ADA) recommendations

The ADA’s current “Glycemic Targets” for most people with diabetes is an A1C level below 7.0%. They suggest that some individuals may aim for more stringent goals, such as below 6.5%, if they don’t use diabetes medications that can cause hypoglycemia.

Dr. Richard K. Bernstein’s approach

On the other end of the spectrum, Dr. Richard K. Bernstein, a well-known diabetes specialist, advocates for much lower A1C levels. In his book “Dr. Bernstein’s Diabetes Solution,” he states that a “truly normal HgbA1C ranges from 4.2% to 4.6%.” He recommends this as a blood glucose goal for his patients.

Defining “Normal” A1C Levels

Determining what constitutes a “normal” A1C level is crucial for setting appropriate targets. While there is some debate, several studies have provided insights into this question:

The consensus group study

A group of prominent diabetes researchers published a study in Diabetes Care that aimed to define what A1C levels would be if diabetes were effectively cured. They determined that an A1C level of 5.6% or below, maintained for at least a year without diabetes medications or ongoing procedures, could be considered a remission or “cure” of diabetes.

Small-scale studies on non-diabetic A1C levels

Other small studies have suggested that the normal A1C range for individuals without diabetes may be between 4.7% and 5.7%. These findings help contextualize the target ranges recommended by various experts and organizations.

Practical Implications for Diabetes Management

Given the current state of research, what does this mean for individuals managing diabetes? Here are some key takeaways:

• Aim for an A1C level below 6.0% to minimize the risk of complications
• Consider targeting a range of 5.4% to 5.6% as potentially optimal
• Be cautious about pursuing extremely low A1C levels (below 5.0%)
• Work with your healthcare provider to set personalized A1C goals
• Consider factors such as age, overall health, and risk of hypoglycemia when setting targets

Strategies for Achieving and Maintaining Optimal A1C Levels

Reaching and maintaining an optimal A1C level requires a comprehensive approach to diabetes management. Here are some strategies that can help:

Dietary approaches

Many individuals have successfully lowered their A1C levels through dietary changes. A low-carbohydrate diet, for example, can be effective in reducing blood glucose fluctuations and improving overall glycemic control.

Regular monitoring

Frequent blood glucose monitoring, either through traditional fingerstick tests or continuous glucose monitoring (CGM) systems, can provide valuable data for adjusting treatment plans and maintaining optimal A1C levels.

Medication management

Working closely with your healthcare provider to optimize medication regimens can help achieve target A1C levels while minimizing the risk of hypoglycemia.

Lifestyle factors

Regular physical activity, stress management, and adequate sleep all play important roles in maintaining stable blood glucose levels and achieving optimal A1C targets.

As our understanding of optimal A1C levels continues to evolve, it’s clear that a personalized approach to diabetes management is crucial. By staying informed about the latest research and working closely with healthcare providers, individuals with diabetes can strive for A1C levels that balance the benefits of good glycemic control with the potential risks of overly aggressive treatment.

What is the Best A1C Level?

Most of us living with diabetes as well as the doctors who treat us have always assumed that lower blood glucose levels would protect us better from the complications of diabetes. In the past two decades several studies showed a linear relationship between blood glucose, as measured by A1C levels, and worsened health.

But now, several recent A1C studies have shown a J-shaped relationships, in which at the lower end some bad things happen, at the center things are better, and at the top end things are terrible. While linear relationships are the rule in observational studies, U-shaped and J-shaped curves aren’t uncommon, and some authors lump both of these shapes as U-shaped.

All of the studies relating A1C levels and ill health — the earlier ones and the recent ones alike — are observational. They study correlations, which aren’t proof, because other confounding factors that the researchers didn’t take into account could have been the problem.

5.4-5.6 Seems Safest

The first of these newer studies showing that a very low A1C level is unhealthier than a higher one came out in the February 2015 issue of Diabetes Care. This analysis of the German National Health Interview and Examination Survey 1998 that studied about 6,300 people for about 12 years indicated that people with an A1C level of 5.4 to 5.6 had the lowest risk of excess mortality.

Because this result puzzled me so much, I asked Dr. Richard K. Bernstein for his reaction.

“These A1c measurements were made years ago in Germany,” he replied, “before international agreement on how it would be measured. The modern elution method would likely give considerably different results. It is even possible that several different methods were being used at different sites during the study.”

A1C and Dementia

Even more recently, however, I came across a similar finding for a specific complication of diabetes — dementia. While the study itself, which I reported here last month, doesn’t report the finding, the author subsequently stated that “very low HbA1c levels were associated with increased risk of developing dementia. ”

What’s the cause and what’s the result is the question, Dr. Naveed Sattar commented. “In people who have very low blood glucose levels, below guideline levels, I suspect that there are other reasons that they are sick and their A1C is low because of this and that then leads to dementia,” this professor of metabolic medicine at the University of Glasgow, says.

Recommended Targets

A1C target levels are based, of course, on minimizing the complications of diabetes and take into consideration the levels that people without diabetes have. But the targets vary widely.

The latest recommendations of the American Diabetes Association in its current “Glycemic Targets” for most people is a level below 7.0 percent. The ADA adds that we may have “more stringent A1C goals such as below 6.5 percent” if we don’t take diabetes drugs that can cause hypos. The ADA doesn’t say here what they consider a normal A1C level to be.

The ADA’s recommended A1C level is one extreme. Dr. Bernstein stands at the other extreme. “A truly normal HgbA1C ranges from 4.2 percent to 4.6 percent,” he wrote in Dr. Bernstein’s Diabetes Solution (fourth edition, page 57). On several later pages of this book, Dr. Bernstein states that this should be our blood glucose goal.

Normal Levels

I haven’t been able to find any studies that support either extreme. One small study that I discussed in “The Normal A1C Level” here several years ago indicated that a normal level is probably between 4.7 and 5.7.

This study is in fact consistent with an ADA study in its journal Diabetes Care by a group of a dozen of our most well known diabetes researchers who set out to define what our A1C levels would be if we were for all intents and purposes cured of diabetes. This “consensus group” of experts defined cure as complete remission for a long enough time that the risk of recurrence is very low. Specifically, they determined that this A1C level is one in the normal range for at least a year without taking any diabetes drugs of ongoing procedures. That level, they write, is 5.6.

New Goal Levels

On a very low-carb diet we can easily bring our A1C level down to 5.6. Personally, my level has stayed close to 5.5 in dozens of tests for the last eight years on such a diet and without using any diabetes drugs. But until now I longed to bring my level below 5.0, much closer to Dr. Bernstein’s recommendation.

I wonder now, however, whether a level of about 5.5 might be the safest. While nobody knows for sure what the best A1C level is, it seems clear that it for our safety we must keep it below 6.0.

Our Review Process

What Should My A1c Goals Be?

Whether you’re noticing symptoms of blood sugar spikes becoming more frequent or you simply want to learn more about your glucose, understanding what optimal A1C levels are and what affects these levels can help you make better choices for your metabolic health. 

In this article, we’ll review what the A1C test measures, who it may be helpful for, and how you can set goals for improving your A1C level.

The A1C Test: What is it? 

HbA1C is a medical term that refers to glycated or glycosylated hemoglobin. Hemoglobin is a protein found within red blood cells, and glycated hemoglobin refers to the hemoglobin that is attached to glucose. 

The lifecycle of red blood cells spans from about 8 weeks to 12 weeks, so your A1C levels are a reflection of blood glucose levels over the past three months.

An A1C test measures the percentage of your red blood cells that have sugar-coated hemoglobin, and since it measures the average value over a three month period, it can help uncover trends in your overall glucose levels.

Why Should I Get the A1C Test?

Measuring glycated hemoglobin through the A1C test is a valuable tool in understanding the bigger picture when it comes to your body’s glycemic control. Because red blood cells live for up to three months, the A1C test can provide helpful insight into the bigger picture of your body’s glycemic control as well as metabolic health.

Whereas the finger prick method of testing your blood sugar captures a snapshot of where your glucose levels are in that exact moment, the A1C test estimates a two to three month average of your blood glucose values.

While the finger prick test may shed light on how your blood glucose levels fluctuated when you skipped breakfast that morning, for example, it won’t provide much insight into your overall glucose trends. 

Alongside the A1C test, a continuous glucose monitor can allow for real-time tracking of glucose over large windows, capturing not only the fluctuations the A1C may miss, but also the trends over time that the single finger-stick may miss.

Diagnosing Prediabetes and Type 2 Diabetes With the A1C Test

HbA1C levels are used as a diagnostic tool for diagnosing type 2 diabetes (as well as prediabetes). The A1C test is generally the preferred method of screening for and diagnosing diabetes for several reasons, including:

• It does not involve special instructions or requirements (such as fasting).  
• It can be done at any time of the day. 
• The results are not altered by acute factors such as stress or exercise.
• It is considered more convenient than the oral glucose tolerance test and the fasting plasma glucose test.   

The A1C test can also have a nearly identical sensitivity for predicting diabetic retinopathy. This means the test can be a valuable tool and effective in “picking up” how likely someone may develop diabetes-induced retinopathy. 

It’s interesting to note that in some cases the A1C test can detect glucose levels that correspond to diabetes where the fasting blood glucose test has failed to do so, and vice versa. 

Using A1C for Elevated Blood Glucose Levels

If your A1C is elevated, you’ll want to work with your doctor or a medical professional to set an A1C goal based on your individual health needs. Your doctor may specify a certain value based on where your levels currently are and advise certain lifestyle changes that may be helpful in lowering your A1C value over time.

Many lifestyle and dietary changes can take time to have any observable impact on your blood glucose levels. As you and your doctor work to improve your blood glucose levels, you may want to make sure you are regularly monitoring your A1C.

Certain medications for diabetic glycemic control have been observed to take effect in less time for some people. If you have elevated A1C levels, you may want to discuss this option further with a medical professional to determine the best options for you and your health.

Limitations of A1C

It’s also important to understand the limitations of the A1C test. For example, some conditions such as anemia can alter the turnover of your red blood cells, leading to more glucose exposure and higher A1C levels as a result.

Other factors such as certain medications, high alcohol consumption, or even blood transfusions have all been observed to falsely elevate A1C levels in some cases. Conversely, factors such as pregnancy, vitamin C, or vitamin E ingestion have been observed to cause falsely decreased A1C levels reflected in tests.

If you’re concerned about your A1C levels, you may want to consider pairing this test with other forms of glucose measuring and discuss your results with your doctor.

What are the Updated Guidelines for A1C?

According to the ADA, a diagnosis of diabetes can be made if HbA1C levels are 6.5 percent or higher. Ranges between 5.7 to 6.4 percent are considered high risk for diabetes. Individuals with HbA1c levels between 6 and 6.5 percent are considered an even higher risk, and may be advised to undergo other forms of testing by the doctor.

An A1C level below 5.7 percent is considered normal. Some practitioners may set an “optimal range”, however, there isn’t strong evidence to support any one range as being optimal at the present time. 

This is because the A1C test may be prone to certain inaccuracies, and various factors such as chronic blood loss or more serious conditions such as splenomegaly can influence the results and lead to false results. This may be one reason why, as discussed earlier, other tests can be more effective in diagnosing diabetes (although each has their own drawbacks).  

For example, some research has suggested that HbA1C levels that read between 6.0 to 6.5 percent may have a relatively higher rate of false positive or false negative readings and should be combined with other lab values for full assessment, such as a fasting glucose reading.

A1C Target: What Should my A1C Goals be? 

Your A1C goals will depend on your current A1C levels, lifestyle, and current nutritional habits. These goals are typically set by you and your doctor after discussing these factors and determining what a realistic goal should be. Your doctor may also help you determine a realistic timeline for reducing your A1C levels. 

Ideally, your goal may be to bring your A1C levels within the normal range, and ultimately work towards keeping it between 5 to 5.4 percent. 

Understanding A1C Percentages 

Your A1C is calculated using the following formulas:

• As a percentage: A1C = (Estimated average glucose(mg/dL) + 46.7) / 28. 7 
• As a measurement of mmol/mol: A1C = 10.929 * (A1C(%) – 2.15)

Check out our A1C calculator here.

A1C Goals for Those Without Diabetes 

If you’re in the very high risk group for developing diabetes (A1C levels between 6 to 6.5 percent), your initial goal may be to reduce your A1C enough to fall outside of the prediabetes threshold, which ranges from 5.7 percent to 6.4 percent.

For those that are around the upper limit between 5.5 to 5.7 percent, you may want to aim to gradually lower your levels to the optimal range of 5.4 percent or lower.

A1C Goals for Those with Diabetes

The ADA recommends that individuals with diabetes aim for an A1C level of less than 7 percent. If you’ve been diagnosed with type 2 diabetes, you should work with your doctor to implement healthy lifestyle habits that may help your blood sugar response. 

Below, we’ll take you through some evidence-backed tips that may help lower your A1C.

How can I get my A1C down quickly?

In general, there is no quick fix when it comes to lowering your A1C levels. Oftentimes, the most sustainable way to achieve normal HbA1C levels is to incorporate a variety of effective lifestyle habits, dietary changes, and in some cases medications that your doctor has prescribed for you.

Lifestyle habits that can help optimize your blood glucose levels include: 

• Walking after eating
• Getting high quality sleep 
• Reducing stress 
• Getting appropriate amounts of exercise for your health. 

Dietary changes that can help optimize your blood glucose levels:

• Incorporating more fiber (different types of fiber have different health benefits)
• Including healthy fats
• Figuring out the right macronutrient ratio for you

It may take several weeks to months for these changes to reflect in your A1C levels. 

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Glycated and glycosylated hemoglobin values: what you need to know

Contents

• 1 Glycated and glycosylated hemoglobin values ​​
  • 1.1 Hemoglobin and its values ​​
  • 1.2 What is glycated hemoglobin?
  • 1.3
  • 1.4 Glycated hemoglobin
  • 1.5 Role of glycated hemoglobin in the diagnosis of diabetes
  • 1.6 Relationship between glycated hemoglobin and blood glucose
  • 1.7 Glycated hemoglobin norms for different age groups
  • 1.8 How to increase or decrease the level of glycated hemoglobin?
  • 1. 9 What is glycosylated hemoglobin?
  • 1.10 Glycosylated hemoglobin
  • 1.11 Similarities and differences between glycated and glycated hemoglobin
  • 1.12 Importance of monitoring glycated and glycated hemoglobin
  • 1.13 Q&A:
    900 05
    • 1.13.0.1 What is glycated hemoglobin and why is it important for diabetics?
    • 1.13.0.2 What are the optimal glycated hemoglobin levels for diabetics?
    • 1.13.0.3 How can I lower glycated hemoglobin?
    • 1.13.0.4 What can affect the accuracy of glycated hemoglobin results?
  • 1.14 Related video:

Norms of glycated and glycosylated hemoglobin in the human body. The significance of these indicators for the diagnosis and control of diabetes mellitus. The difference between glycated and glycosylated hemoglobin and their role in assessing blood sugar over the past two to three months. Review of methods for analysis and interpretation of results.

Glycated hemoglobin (HbA1c) and Glycated hemoglobin (GHb) are indicators that are used to assess glycemic levels in patients with diabetes. Hemoglobin is a protein found in red blood cells and is responsible for transporting oxygen throughout the body. With elevated blood glucose, part of the hemoglobin binds to glucose, forming a glycated component. Therefore, the level of glycated and glycosylated hemoglobin allows us to estimate the average concentration of glucose in the blood for 2-3 months.

Glycosylated and glycosylated hemoglobin levels depend on age, sex and the presence of diseases such as diabetes. In the absence of diabetes, HbA1c and GHb levels are approximately 4-6%. However, in the presence of diabetes, the goal of treatment is to achieve a certain level of glycated hemoglobin, which will allow control of blood glucose levels and reduce the risk of complications.

Reducing glycated hemoglobin to the desired level may require changes in diet, physical activity, and medication to lower blood glucose levels. It is also important to conduct regular tests to monitor the level of glycated and glycosylated hemoglobin and evaluate the effectiveness of treatment.

Remember that glycated and glycosylated hemoglobin are important indicators that help control blood glucose levels in patients with diabetes. Compliance with the norm of glycated hemoglobin helps to prevent the development of complications and maintain good health.

Hemoglobin and its meanings

Hemoglobin is a complex protein complex found in red blood cells. It is responsible for transporting oxygen from the lungs to tissues and vice versa, as well as transporting carbon dioxide from tissues to the lungs. Normal hemoglobin levels vary by gender and age.

Low hemoglobin levels can indicate various diseases or disorders in the body. It can occur due to a deficiency of iron, vitamin B12, or folic acid. Also, low hemoglobin can be associated with blood loss or chronic diseases.

A high hemoglobin level can be a sign of dehydration or polycythemia, a disorder in which the number of red blood cells is higher than normal. Also, a high level of hemoglobin may be the result of a long stay at high altitudes, in which the body tries to compensate for the lack of oxygen.

Changes in hemoglobin levels can be associated with various factors, so its importance is important to consider in the diagnosis and control of various diseases.

What is glycated hemoglobin?

Glycated hemoglobin is the result of a glycation process that occurs in the body. Glycation is a chemical reaction between glucose and hemoglobin, the main function of which is to transport oxygen in the body.

During glycation, glucose binds to amino acids to form glycated products. These glycated foods can lead to various complications associated with diabetes and other disorders of glucose metabolism.

Evaluation of glycated hemoglobin is an important indicator for long-term control of blood glucose levels. An increase in glycated hemoglobin indicates inadequate glucose control and may indicate a metabolic problem.

The value of glycated hemoglobin is determined as a percentage. Usually the level of glycated hemoglobin in healthy people is from 4% to 6%. If the level exceeds 7%, this may indicate the presence of diabetes or other metabolic disorders.

Glycated hemoglobin

Glycated hemoglobin (HbA1c) is an important indicator of blood sugar control in patients with diabetes. This indicator reflects the average level of glucose in the blood over the past 2-3 months. Glycated hemoglobin is formed by the binding of glucose to hemoglobin in red blood cells.

Normal HbA1c is less than 5.7%. A level of 5.7% to 6.4% indicates a pre-diabetic condition that may progress to the development of diabetes. An HbA1c level above 6.5% usually indicates the presence of diabetes. The optimal level of glycated hemoglobin for most diabetic patients is less than 7%.

The measurement of glycated hemoglobin is an important part of diabetic management and helps evaluate the effectiveness of treatment. The higher the HbA1c level, the greater the risk of complications of diabetes, such as heart and kidney disease. Therefore, regular monitoring of the level of glycated hemoglobin and maintaining it at an optimal level is important to prevent complications and improve the quality of life of patients with diabetes.

Role of glycated hemoglobin in the diagnosis of diabetes

Glycated hemoglobin, or HbA1c, is an important biomarker for diagnosing and monitoring diabetes. It is a form of hemoglobin that results from the binding of glucose to hemoglobin in red blood cells. The level of glycated hemoglobin reflects the average level of glucose in the blood over the past 2-3 months.

Glycated hemoglobin measurement is a reliable and convenient way to determine the degree of glycemic control in diabetic patients. The results of the HbA1c analysis can be used to judge how well the patient controls blood sugar levels and assess the effectiveness of the treatment.

Normal glycated hemoglobin is less than 5. 7%. A value between 5.7% and 6.4% indicates a pre-diabetic state, which means an increased risk of developing diabetes in the future. A level above 6.5% is a diagnostic criterion for diabetes.

Regular HbA1c testing can effectively control blood sugar levels and prevent complications associated with diabetes. Regular monitoring allows you to timely adjust treatment and control the progression of the disease.

Relationship between glycated hemoglobin and blood glucose

Glycated hemoglobin, also known as HbA1C, is a measure of the average blood glucose level over the past 2-3 months. The HbA1C level is measured as a percentage and reflects the number of glycated red blood cells in the blood. The higher the glucose level, the more red blood cells become glycated.

The relationship between glycated hemoglobin and blood glucose levels is integral. Elevated blood glucose leads to an increase in the amount of glycated hemoglobin. This is because glucose can bind to hemoglobin without the participation of insulin.

The HbA1C level is an important indicator of blood glucose control in patients with diabetes. The higher the HbA1C, the worse the blood glucose control. The optimal HbA1C level for most diabetics is 6.5-7%. When this level is reached, the risks of developing complications such as damage to the heart, kidneys and eyes are significantly reduced.

Studying the relationship between glycated hemoglobin and blood glucose levels allows clinicians and patients to better control diabetes and take action to prevent it. Continuous measurement of HbA1C levels and adjustment of treatment in accordance with this indicator allows you to achieve stable and effective blood glucose control, improve quality of life and prevent the development of serious complications.

Glycated hemoglobin ranges for different age groups

Glycated hemoglobin, or HbA1c, is an important indicator of blood sugar control in patients with diabetes. It displays the average concentration of glucose in the blood over the previous 2-3 months and helps to determine the effectiveness of diabetic therapy. Guideline values ​​for HbA1c differ depending on the age of the patient.

In adults without diabetes, normal HbA1c values ​​are between 4% and 5.6%. In children and adolescents without diabetes, the HbA1c level is usually around 4-5%. However, in diabetic patients, HbA1c guideline values ​​vary and depend on the specific type of diabetes and the target glycemic level of the individual treatment plan.

For most adult patients with type 2 or uncomplicated type 1 diabetes, it is recommended to maintain an HbA1c level below 7%. However, for some patient groups, such as pregnant women with diabetes or the elderly, more stringent HbA1c reduction targets can be set, for example, to 6.5% and 6%, respectively.

In the case of children and adolescents with type 1 diabetes, the goal of HbA1c control is usually less than 7.5% to prevent complications of micro- and macroangiopathy. However, for younger children, a higher range of normal HbA1c values ​​may be set to prevent the risk of hypoglycemia.

How to increase or decrease the level of glycated hemoglobin?

To increase glycated hemoglobin levels, follow certain diabetes management guidelines and control blood glucose levels. It is important to take your medications prescribed by your doctor and follow your food intake.

Watch your diet and follow a diet rich in natural products. Limit consumption of fast carbohydrates, unhealthy fats and sugar. Include more vegetables, fruits, cereals, protein foods in the diet.

Physical activity will help lower your glycated hemoglobin levels. Regular workouts, sports, going for walks improve metabolic processes in the body and normalize blood glucose levels.

It is important to follow the dosage regimen prescribed by your doctor. Medications must be taken on time and in the correct dosage. Regularly monitor the level of glycated hemoglobin using tests.

In addition, a positive emotional background and avoidance of stress will help normalize the level of glycated hemoglobin. Strive for psychological comfort, engage in relaxation, participate in activities that are pleasant for you, communicate with loved ones.

What is glycated hemoglobin?

Glycosylated hemoglobin , aka hemoglobin A1c , is a form of hemoglobin associated with blood glucose. Glycosylated hemoglobin is an indicator of the average blood glucose level over the past 2-3 months. This is due to the fact that glycosylated hemoglobin is formed in the process of long-term interaction of hemoglobin with glucose.

The level of glycosylated hemoglobin is one of the main criteria for the diagnosis and control of diabetes. Elevated levels of glycosylated hemoglobin indicate inadequate control of blood glucose levels and may indicate a risk of complications associated with diabetes.

Chronic hyperglycemic background affects the binding of hemoglobin to glucose in red blood cells. As the average blood glucose level increases, so does the amount of glycosylated hemoglobin, which can be detected by a blood test.

Glycosylated hemoglobin is measured to give an idea of ​​the average concentration of glucose in the blood, and this indicator is more reliable and stable than the usual sugar load of the body and other blood glucose tests.

Glycosylated hemoglobin

Glycosylated hemoglobin (HbA1c) is an important indicator of blood glucose levels during the last 2-3 months. This indicator is used to diagnose and control diabetes.

Normal HbA1c levels are between 4% and 5.6%. In diabetic patients, an HbA1c level of less than 7% is considered normal. This indicates good control of blood glucose levels. However, in some patients, an individual HbA1c target value can be set.

Glycosylated hemoglobin reflects the average blood glucose level over a period of 2 to 3 months, since the lifespan of red blood cells is about 120 days. This distinguishes it from glycochemoglobin, which is a combination of glucose and hemoglobin and can only be measured directly at the time of measurement.

Glycosylated hemoglobin is measured in the laboratory using a blood test. It is recommended to measure HbA1c twice a year to control diabetes. It is important to note that HbA1c is an additional tool for monitoring blood glucose levels and does not replace the daily measurement with a glucometer.

Similarities and differences between glycated and glycated hemoglobin

Glycated hemoglobin and glycated hemoglobin are two concepts that refer to the state of hemoglobin in the blood and help determine the level of sugar in the body over the past few months. They are important biomarkers for diabetes and serve to monitor and evaluate the effectiveness of treatment in patients with this disease.

Glycated hemoglobin is a form of hemoglobin that results from the reaction of glucose binding to unattractive amino acid residues within the hemoglobin molecule. This happens gradually and regardless of the current blood sugar level. Glycated hemoglobin represents the average blood glucose level over the previous 2-3 months and is usually measured as a percentage of total hemoglobin.

Glycosylated hemoglobin, on the other hand, refers to hemoglobin to which glucose and other sugars are attached as a result of constant exposure to high blood sugar levels over an extended period of time. Glycosylated hemoglobin is used to measure the average blood sugar concentration over the past 6-8 weeks and is usually measured in millimoles of glucose associated with a gram of hemoglobin.

Both indicators are reliable indicators of blood glucose levels and help evaluate the effectiveness of sugar control in diabetes. Their regular measurement allows patients and their doctors to determine how well their condition is being controlled and take the necessary measures to maintain a stable blood sugar level.

The importance of monitoring glycated and glycosylated hemoglobin levels

Monitoring of glycated and glycosylated hemoglobin levels is an important tool for diagnosing and managing diabetes mellitus. Hemoglobin is a protein found in red blood cells and is responsible for transporting oxygen in the body.

Glycated hemoglobin (HbA1c) is a combination of hemoglobin and glucose and measures the average blood glucose level over the past 2-3 months. HbA1c measurement shows how well diabetes is being controlled and provides information on the extent of organ and tissue damage due to high blood glucose levels.

Glycosylated hemoglobin (HbA1) is a general indicator of hemoglobin glycation and includes not only the bond with glucose, but also with other substances. Elevated HbA1 levels may indicate hyperglycemia and metabolic disorders.

Monitoring the level of glycated and glycosylated hemoglobin allows you to determine the effectiveness of the ongoing treatment of diabetes, as well as adjust the treatment plan and measures taken to maintain normal blood sugar. Regular measurement of glycated and glycosylated hemoglobin is essential to control and prevent the development of diabetes complications such as cardiovascular disease, retinopathy, nephropathy and neuropathy.

The level of glycated and glycosylated hemoglobin should be within certain limits, which depend on age, gender, health status and type of diabetes. These indicators help to assess the degree of compensation of the disease and the patient’s ability to self-control diabetes.

In general, monitoring of glycated and glycosylated hemoglobin levels is an important component of care for patients with diabetes mellitus and allows you to more accurately control blood sugar levels, prevent complications and achieve optimal disease control.

Q&A:

What is glycated hemoglobin and why is it important for diabetics?

Glycated hemoglobin is a form of hemoglobin that is bound to glucose in the blood. It is considered primarily for the control of blood sugar levels in diabetics, as it reflects the average concentration of glucose over the past 2-3 months. This allows you to evaluate the effectiveness of treatment and control the risks associated with unstable blood sugar levels.

What are the optimal glycated hemoglobin levels for diabetics?

The optimal level of glycated hemoglobin for diabetics is less than 6.5%. This indicator indicates sufficient control of blood sugar levels and reduces the risk of complications associated with diabetes. However, it is necessary to take into account the individual characteristics of the patient and consult with the doctor about the desired targets.

How can I lower glycated hemoglobin?

If the level of glycated hemoglobin exceeds the optimal values, it is urgent to take measures to normalize the level of sugar in the blood. First of all, it is required to follow a low-carbohydrate diet, control food intake, regularly measure blood sugar levels and take recommended medications or insulin.

What can affect the accuracy of a glycated hemoglobin measurement?

Several factors can affect the accuracy of the glycated hemoglobin measurement. Uncontrolled blood sugar levels, anemia, use of certain medications or iron supplements, and the presence of genetic variants of hemoglobin can all affect the result. Therefore, it is important to follow all the doctor’s recommendations and conduct tests in specialized laboratories that use standardized methods.

Related video:

Glycosylated hemoglobin – what is it, the norm in women and men

Published: 04/16/2012 Updated: 06/26/2023

It is very important in the management of patients with diabetes to achieve optimal blood glucose levels. The patient can control the level of glucose in the blood independently (with portable glucometers) or in the laboratory.

The result of a single determination of glucose in the blood shows the concentration of glucose at the time of taking, therefore, it is not possible to make any assumptions about the state of the patient’s carbohydrate metabolism between measurements. It is possible to assess the patient’s carbohydrate metabolism over a long period of time only by measuring the concentration of glycated hemoglobin in the blood, according to the recommendations of the Committee for the Control of Diabetes and its Clinical Complications (DCCT).

According to DCCT studies, it has been shown that the risk of developing and progressing of long-term complications of type 1 diabetes is closely related to the degree of effectiveness of glycemic control, expressed in the content of glycated hemoglobin in the blood [10]. Specialists from the UK have shown that a decrease in the patient’s blood glucose, assessed by the concentration of HbA1c, reduces the incidence of microangiopathies in type 2 diabetes mellitus [4].

Indicator characteristic

Glycosylated hemoglobin (the term “glycated hemoglobin” is also used) is formed as a result of non-enzymatic addition of glucose to the N-terminal regions of the β-chains of hemoglobin A1 globin _{and is designated as HbA1c. The concentration of HbA1c is directly proportional to the average concentration of glucose in the blood. In healthy people, the concentration of HbA1c in the blood is from 4.80 to 5.90%, in patients with diabetes its level is 2-3 times higher (depending on the degree of hyperglycemia).}

The resulting HbA1 accumulates inside the erythrocytes and persists throughout the life of the erythrocyte. The half-life of erythrocyte circulation in the bloodstream is 60 days, thus, the HbA1c concentration reflects the patient’s glycemia level 60-90 days before the study [2, 3].

A huge number of studies using traditional methods for measuring glucose content have confirmed the relationship between HbA1c and the level of glycemia of the patient [12-14]. Results of studies conducted by DCCT in 90s, served as the basis for confirming the hypothesis that the level of HbA1c reflects the level of glucose in the blood and is an effective criterion for monitoring patients with diabetes mellitus.

Standardization of methods for the study of glycosylated hemoglobin

In the early 90s, there was no interlaboratory standardization of methods for measuring glycosylated hemoglobin, which reduced the clinical effectiveness of this test [15-17]. In this regard, the American Association of Clinical Chemistry in 1993 formed a subcommittee on the standardization of methods for measuring glycated hemoglobin. As a result of his work, the National Glycosylated Hemoglobin Standardization Program (NGSP) was developed. Manufacturers of test systems for measuring glycated hemoglobin have been required to undergo rigorous testing to ensure that the results correspond to data obtained by reference DCCT methods. In case of a positive result of the check, the manufacturer is issued a “DCCT certificate of conformity”. The American Diabetes Association recommends that all laboratories use only NGSP-certified tests [7].

There are currently many methods for studying glycosylated hemoglobin:

• liquid chromatography;
• affinity chromatography;
• electrophoresis;
• column techniques;
• immunological techniques.

When a laboratory chooses an analyzer for glycated hemoglobin testing, preference should be given to analyzers based on the DCCT reference method, which is liquid chromatography. The use of standardized test methods enables the laboratory to obtain results that can be compared with data obtained using reference methods and published by DCCT. Such a comparison maximizes the reliability of the research results.

It is extremely important that the attending physician use in his work the results of studies obtained only in those laboratories that conduct the study of glycosylated hemoglobin using NGSP certified methods.

Study of HbA1c concentration in the laboratories of the Citylab Association

The concentration of glycosylated hemoglobin (HbA1c) in the laboratories of the Citylab Association is determined by the reference method (DCCT) of high performance liquid chromatography (HPLC), (the method is certified by NGSP), on D 10 analyzers from Bio-Rad, which is the world leader in the production of glycosylated hemoglobin analyzers. hemoglobin. This study is 23-10-002 – Glycosylated hemoglobin.

Mean blood glucose assessment

The DCCT study group demonstrated the clinical relevance of HbA1c as an estimate of mean blood glucose concentration (over 60-90 days). In these studies, patients had their daily glucose profile recorded every 3 months (seven measurements daily). The resulting profile was compared with the level of HbA1c. Over 36,000 studies have been conducted over 9 years. Empirically, a linear relationship between the average glucose content and the HbA1c level was obtained:

Average glucose concentration (mg / 100 ml) = 30.9 x (HbA1c) -60.6, where:

HbA1c is the concentration of glycosylated hemoglobin.

Simply put, a 1% change in HbA1c corresponds to a 30 mg/100 ml (1.7 mmol/L) change in mean glucose.

Note: This relationship was obtained in the study of glucose concentration in capillary blood. The concentration of glucose in the blood serum is approximately 15% higher.

The diagram (Fig. 1) [11] can be used to interpret the results of HbA1c studies.

Rice. 1. Diagram of the control of carbohydrate metabolism in patients with diabetes mellitus

Note: The concentration of glucose is indicated in mmol / l, in brackets in mg / 100 ml, 1 – High risk of developing long-term complications such as retinopathy, nephropathy and neuropathy. 2 – Increased risk of hypoglycemic reactions in patients with type 1 or type 2 diabetes when taking insulin or oral hypoglycemic drugs.

To convert glucose concentration in mg/100 ml to SI units (mmol/l), the following formula is used:

Glucose (mg/100 ml) x 0.0555 = Glucose (mmol/l)

Recommended testing frequency

The American Diabetes Association recommends that for patients whose therapy has been successful (stable carbohydrate metabolism), an HbA1c test should be performed at least 2 times a year, while in case of a change in diet or treatment, the frequency of testing should be increased to 4 times a year [ 7]. In the Russian Federation, according to the Targeted Federal Program “Diabetes Mellitus”, HbA1c testing should be carried out 4 times a year for any type of diabetes [1].

According to the American Diabetes Association, women with diabetes in the pre-pregnancy period need a special monitoring regimen. It is recommended to reduce the level of HbA1c in order to create optimal conditions in the body of the future mother for conception and fetal development. At the beginning, HbA1c should be tested monthly. When carbohydrate metabolism is stabilized with appropriate therapy, HbA1c testing should be performed at intervals of 6-8 weeks prior to conception [5, 6].

Modern studies have shown that many patients do not comply with the recommended interval between studies [8], however, experts have come to a common opinion that regular studies of HbA1c levels significantly reduce the risk of complications in patients with diabetes mellitus.

Interpretation of test results

The goal of hypoglycemic therapy in diabetes mellitus is to normalize blood glucose levels. DCCT studies have shown that intensive treatment prevents the patient from developing long-term complications such as retinopathy, nephropathy and neuropathy, or significantly delays their clinical manifestation. If patients strictly adhere to a regimen aimed at normalizing carbohydrate metabolism, the incidence of retinopathy decreases by 75%, nephropathy – by 35-36%, and the risk of polyneuropathy decreases by 60% [10].

Below are the therapeutic goals in the treatment of diabetes mellitus according to the Target Federal Program “Diabetes Mellitus”.

Table 1.

Therapeutic goals in the treatment of type 1 diabetes mellitus [1, 18]

Table 2.

Therapeutic goals in the treatment of type 2 diabetes mellitus [1, 19]

Note: In parentheses are glucose values ​​in mg/100 ml.

The federal target program “Diabetes mellitus” [1] adopted the values ​​recommended by the European Committee for Diabetes Recommendations [18, 19].

When evaluating the results of treatment in patients with concomitant diseases, young people, the elderly, pregnant women and patients with an unusual pattern of diabetes mellitus, other criteria for stabilizing carbohydrate metabolism should be used.

In case of an inadequate level of carbohydrate metabolism in a patient, additional measures are necessary, which depend on the clinical picture of the patient’s disease, such measures may include:

• enhanced patient education on self-monitoring of glucose levels;
• organization of patient support groups;
• regular examination by an endocrinologist;
• changes in drug therapy;
• more frequent testing of glucose and HbA1c.

Conclusions

1. The HbA1c study allows to assess the level of glycemia in a patient with diabetes mellitus 60-90 days prior to the study.
2. This study provides an opportunity to monitor the course of the disease and control the adequacy of the treatment.
3. An HbA1c study should be performed to assess the risk of complications in a patient with diabetes mellitus.

References

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2. Peters – Harmel E., Mathur R. Diabetes mellitus. Diagnosis and treatment. // Practice, 2008.
3. Popova Yu.S. Diabetes. // Krylov, 2008.
4. AD. Implications of the United Kingdom Prospective Diabetes Study (Position Statement). // Diabetes Care 1999, (SI), 27-31.
5. AD. Standards of Medical Care for Patients With Diabetes Mellitus (Position Statement). // Diabetes Care 1999, (SI), 32-41.
6. AD. Preconception Care of Women With Diabetes (Position Statement). // Diabetes Care 1999, (SI), 62-63.
7. AD. Tests of Glycemia in Diabetes (Position Statement). // Diabetes Care 1999, (SI), 77-79.
8. Auxter S. Another Study Shows Laboratory Tests are Underutilized. // Clin Lab News 1998, 24(9): 24-5.
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10. DCCT Research Group. The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long – Term Complications in Insulin – Dependent Diabetes Mellitus. // Engl J Med 1993; 329:977-86.
11. Goldstein D.E., Little R.R. Bringing Order to Chaos: Standardizing the Hemoglobin A1c Assay. // Contemp Int Med 1997; 9(5): 27-32/
12. Gonen B.A., Rubinstein A.H., Rochman H. et al. Hemoglobin A1: An Indicator of the Metabolic Control of Diabetic Patients. // The Lancet 1977, Oct 8; 2(804): 734-7.
13. Koenig R.J., Peterson C.M., Kilo C. et al. Hemoglobin A1c as an Indicator of the Degree of Glucose Intolerance in Diabetes. // Diabetes 1976, 25(3): 230-2.
14. Koenig R.J., Peterson C.M., Jones R.L. et al. Correlation of Glucose Regulation and Hemoglobin A1c in Diabetes Mellitus. // Engl J Med 1976, 295(8): 417-20.
15. Little R.R., England J.D., Wiedmeyer H.M. et al. Interlaboratory Standardization of Glycated Hemoglobin Determinations. // Clin Chem 1986; 32:358-60.