Hba1C means: Hemoglobin A1C (HbA1c) Test: MedlinePlus Medical Test
Hemoglobin A1C (HbA1c) Test – Testing.com
Test Quick Guide
The hemoglobin A1c test estimates how much glucose, or blood sugar, has been in your bloodstream over the last three months. A marker for long-term glucose control, this test can identify diabetes or keep track of how well it is being controlled.
About the Test
Purpose of the test
The hemoglobin A1c test may have several purposes:
- Screening for prediabetes and diabetes: If you are over 40 and are obese, overweight, or otherwise at high risk for diabetes, your doctor may want to check for health conditions before you experience symptoms. The test can be used for diabetes screening, but the results may need to be confirmed by repeating the test or using another type of test.
- Diagnosing prediabetes and diabetes: This uses tests and procedures to find out the cause of health changes. Your doctor may order hemoglobin A1c and other tests if you have symptoms or show signs of diabetes. Symptoms can include excessive thirst, frequent urination, blurred vision, tingling or loss of sensation in the feet and hands, and feeling extremely tired.
- Monitoring diabetes: If you have been diagnosed with diabetes, your doctor may order this test at least twice a year. This gives your doctor an idea of how well your blood glucose has been controlled in the months between appointments and allows your doctor to make adjustments to your treatment plan and lower your chance of health problems.
The hemoglobin A1c test is not used to diagnose gestational diabetes, a form of the disease that can develop during pregnancy.
What does the test measure?
The hemoglobin A1c test measures the percentage of hemoglobin A in your blood that has glucose attached.
Glucose is the type of sugar that your body uses as its principal energy source. Your body makes or receives glucose from the food you eat. The glucose enters your bloodstream and is taken up by your body’s cells with the help of a hormone called insulin.
If your body isn’t able to make enough insulin, or if your body’s cells have trouble accepting insulin, your blood glucose level can rise to a dangerous level. This may lead to diabetes, a serious disease that can damage your body’s organs if it is not kept under control.
Glucose has the ability to attach to hemoglobin in the blood and form hemoglobin A1c. Hemoglobin is the protein in red blood cells that carries oxygen. Measurement of hemoglobin A1c reflects the percentage of hemoglobin A that is attached to glucose compared to the total amount of hemoglobin A in the blood.
The more glucose in the blood, the more glucose can attach to hemoglobin. If your hemoglobin A1c percentage is too high, your average blood glucose in the previous months has been too high as well.
When should I get this test?
The CDC recommends every adult age 45 and older, or those under 45 who are overweight and have risk factors for prediabetes or type 2 diabetes get a baseline A1c test.
If your result comes back normal, repeat the test every three years. If your results show you have prediabetes, repeat the test as often as your doctor recommends, which is usually every one to two years.
If you have diabetes, it is important to get an A1c test at least once a year and more often if you change your medication or have other health conditions. Your doctor can help determine how often you should get tested.
Finding a Hemoglobin A1c Test
How can I get a hemoglobin A1c test?
A hemoglobin A1c test is usually ordered by a doctor. Your doctor may refer you to a lab to have the test performed. Or, if the test is to monitor your diabetes, you may have the test in your doctor’s office. Your doctor may also recommend an at-home version of the test.
Can I take the test at home?
The FDA has approved or cleared a number of over-the-counter hemoglobin A1c test kits that you can use at home. At-home versions of the hemoglobin A1c test may not be as accurate as tests that are performed in a lab. But they offer a convenient alternative to testing in a medical office, which may be useful for some patients.
Your doctor can advise you whether taking the test at home would be right for you and may be able to recommend a specific brand.
How much does the test cost?
The full cost of a hemoglobin A1c test depends on many variables, such as what type of hemoglobin A1c test your doctor orders for you, where the test is performed, whether you have medical insurance, and how much of the cost your insurance provider will cover.
Hemoglobin A1c testing can involve several different charges. These can include fees charged by the laboratory for the technician’s labor and the analysis of your sample, as well as the costs of your visits to your doctor’s office to receive the test or discuss its results.
If your doctor has ordered a hemoglobin A1c test for you, many of these charges will be paid in part or in full by your insurance company. But you may still be responsible for out-of-pocket expenses such as deductibles or copayments. Your doctor or insurance provider can give you more information about the costs that you can expect to pay.
The price of an at-home hemoglobin A1c test device can vary greatly depending on the test kit and manufacturer, the number of tests that come with the kit, and whether the device is covered by your insurance. You may also need to pay for replacement cartridges or other components if you use the device regularly.
Taking a Hemoglobin A1c Test
The hemoglobin A1c test requires a sample of blood. If the test is performed at a lab, the sample is taken through a needle from a vein. And if the test is performed in a doctor’s office or taken at home, a fingerstick is used to obtain the blood sample.
Before the test
You do not need to make any specific preparations before getting your hemoglobin A1c test. But be sure to talk to your doctor about any additional tests that may be conducted during the same visit, since some of those tests may require you to fast or change your diet beforehand or to prepare in other ways.
During the test
For a hemoglobin A1c test that uses a blood sample from a vein, the phlebotomist may start by tying a band at the top of your arm under your shoulder to put pressure on your vein, increasing blood flow. They will clean the skin around your vein using a sterile wipe, then insert a small needle into the vein in the pit of your elbow. Your blood sample will be collected in a tube attached to the needle.
You may notice mild discomfort or stinging when the phlebotomist inserts or removes the needle. Most of the time, your blood draw will take five minutes or less to complete.
If your hemoglobin A1c test uses a fingerstick blood sample, your doctor, nurse, or medical assistant will use a lancet to prick the tip of your finger until a drop of blood appears. You may feel a small amount of pain when your finger is pricked. The blood sample will be mixed with a special substance and then put into a cartridge that is inserted into the testing machine.
For at-home testing, you will collect a blood sample from your finger and process the sample yourself.
After the test
You can generally return to normal activities after the hemoglobin A1c test. If you receive a blood draw, the phlebotomist will put a small bandage over the injection site to make sure any bleeding stops. You may want to leave the bandage on for an hour or more. You may notice some bruising where the needle was inserted.
Fingersticks do not typically cause lasting pain or discomfort. If needed, you can apply a bandage to your fingertip to stop the bleeding.
Hemoglobin A1c Test Results
Receiving test results
If your hemoglobin A1c test was performed in a lab, you will generally receive test results in a few business days. Your results may be available to access online, or they may be sent to you through postal mail or email. Your doctor may call you or reach you by email to talk over your results.
If you have a fingerstick hemoglobin A1c test, your test results will be available in a few minutes. Your doctor may discuss the results right away or may schedule an appointment to go over the results at a later date.
Interpreting test results
Hemoglobin A1c test results are given as percentages. Your test report will also have information on the reference ranges used to interpret your results. Reference ranges are the test result ranges considered normal and the test result ranges that may indicate prediabetes or diabetes.
Doctors use the reference ranges along with your overall health context to interpret the results of your hemoglobin A1c test. Your results will be interpreted differently depending on whether the test is used to diagnose or monitor diabetes that has already been diagnosed.
For diagnostic hemoglobin A1c testing, many expert organizations cite these reference ranges:
- Normal: Under 5.7 percent
- Prediabetes: 5. 7 to 6.4 percent
- Diabetes: At or over 6.5 percent
While the hemoglobin A1c test can be used to diagnose diabetes, doctors do not often rely on the results of just one test to make this diagnosis. Your doctor may order a repeat of your hemoglobin A1c test or compare your results with other tests that have been performed. Your doctor may also order additional diagnostic tests, such as other blood glucose tests.
To understand what the results of a diagnostic hemoglobin A1c test mean for you, it’s important to talk about them thoroughly with your doctor. They can address how your hemoglobin A1c results fit into the reference ranges, what follow-up tests might be required, and what next steps to take in managing your health.
If your test results show that you have prediabetes, this means that you could have an increased risk of diabetes in the coming years. Your doctor may advise you to make changes to your diet, exercise routine, and other aspects of your lifestyle that could reduce your chance of developing diabetes or delay the onset of this disease.
If you are given a diagnosis of diabetes, your doctor or another health care provider may give you advice about monitoring and managing the disease over time. Steps to take often include using blood glucose tests at home, repeating hemoglobin A1c tests periodically, and making lifestyle changes. You may also be prescribed medications to help control your blood sugar.
When the test is used to monitor diabetes, you will work with your doctor to establish a target hemoglobin A1c number. This goal will be specific to you and may change during the course of your diabetes care based on factors such as your age, your past success in controlling blood glucose levels, and any diabetic complications you may have. Your doctor will also consider whether you are prone to low blood glucose.
- Glucose Tolerance Test
- Continuous Glucose Monitoring
- American Diabetes Association
- CDC: Diabetes
- National Institute of Diabetes and Digestive and Kidney Diseases: Managing Diabetes
Take Control of Your Health
Elle Penner, MPH, RD
What does an A1c level of 7 mean? Are there any symptoms associated with this level?
An A1c level of 7 percent is considered high and means that 7% of the hemoglobin in your blood is saturated with sugar. A1c levels of 6.5 or greater are considered diabetes.
If your A1c is high, a combination of diet and lifestyle changes and medications can help you lower your levels. The lower your A1c the lower your risk for developing some of the more serious complications of diabetes including cardiovascular disease, nerve and kidney damage, and vision loss.
An A1c of 7 may or may not have noticeable symptoms. Typical signs of diabetes include increased thirst, frequent urination, excess hunger, unintentional weight loss, fatigue, and/or blurred vision.
Factors that could contribute to an A1c level of 7:
A variety of factors can lead to high A1c levels. Some of these include:
Diet, particularly those low in fiber and high in refined carbohydrates and added sugars
Being physically inactive/ sedentary
Age (A1c tends to increase gradually as you get older)
Race (people of Black, Hispanic/Latino, American Indian, Asian American, or Pacific Islander descent are at greater risk for prediabetes/ diabetes. )
Use of certain medications, including glucocorticoids
Family history of pre-diabetes or diabetes
Adherence to your prediabetes/ diabetes management plan
Chronic disease/ inflammation
Several things can also falsely increase or decrease your A1c result. Some of these include:
Kidney failure, liver disease, or severe anemia
Certain medicines, including opioids and some HIV medications
Blood loss or blood transfusions
Early or late pregnancy
A less common type of hemoglobin found in people of African, Mediterranean, or Southeast Asian descent, as well as people with blood disorders like sickle cell anemia or thalassemia
Let your doctor know if any of these apply to you to determine if you need additional testing.
What to do if your A1c level is 7?
If your A1c is high, a combination of diet and lifestyle changes, and medications can help you lower your levels. The goal for most adults with diabetes is an A1c below 7%, but the lower the better.
Making changes to your diet and adopting healthier habits can help lower your levels. To lower your A1c:
Be active every day: Aim for 150 minutes of moderate physical activity per week (about 30 minutes 5 days per week).
Fill half of your plate with non-starchy veggies at every meal, and incorporate a source of lean protein and plant-based fat to assist with blood sugar control.
Limit refined carbohydrates and added sugar, and choose whole-grain carbohydrates such as whole wheat bread/ pasta, quinoa, farro, and steel-cut oats, instead.
Lose excess weight if you are overweight or obese
Manage stress and get adequate sleep to help balance hormone levels that can impact blood sugar
Follow your diabetes treatment plan if you have been diagnosed with diabetes
Medications used to improve A1c results
If diet and lifestyle modifications are not enough to manage elevated blood sugar, medications can helpl to lower elevated A1c levels into a safer range. If necessary, your doctor and/or dietitian will work with you to determine which ones are right for you. Some common diabetes medications include:
Insulin: Typically given by injection or through a pump to increase glucose (sugar) uptake by cells and thus decrease blood sugar
Sulfonylureas: Increase insulin production by stimulating insulin-producing beta cells in the pancreas
Alpha-glucosidase inhibitors: Help your body break down starches and sugars found in food, lowering your blood sugar levels.
Biguanides: Reduce the amount of sugar your liver produces, as well as how much sugar your intestines absorb and makes your body more sensitive to insulin. The most common biguanide is metformin.
Dopamine agonist: These medications work by affecting the way the brain processes dopamine, an important neurotransmitter (chemical messenger). By increasing the activity of dopamine receptors, dopamine agonists increase insulin sensitivity, allowing cells to use blood glucose more effectively and lower blood sugar.
DPP-4 inhibitors: Help the body continue to make insulin, which lowers blood sugar
GLP-1 receptor agonists: Increase growth of insulin-producing beta-cells in the pancreas, slow stomach emptying, and decrease appetite and how much glucagon (which raises blood sugar) your body uses
Meglitinides: Similar to sulfonylureas (but by a different mechanism) meglitinides stimulate the pancreas to release insulin in response to a meal. This increase in insulin production helps lower blood sugar.
SGLT 2 inhibitors: Prevent the kidneys from holding on to glucose and increasing its excretion in urine
Thiazolidinediones: Decrease glucose in your liver and also help your fat cells better utilize insulin
Clinical significance of the determination of glycated hemoglobin – an article on the topic Diagnostics (laboratory)
Clinical significance of the determination of glycated hemoglobin
Glycated hemoglobin , or glycohemoglobin (abbreviated: hemoglobin A1c , HbA1c ) – biochemical a blood indicator that reflects the average blood sugar content over a long period (up to three months ), as opposed to blood glucose measurement, which gives an idea of the blood glucose level only at the time of the test.
Glycated hemoglobin reflects the percentage of blood hemoglobin that is irreversibly bound to glucose molecules. Glycated hemoglobin is formed as a result of the Maillard reaction between hemoglobin and blood glucose. An increase in blood glucose levels in diabetes mellitus significantly accelerates this reaction, which leads to an increase in the level of glycated hemoglobin in the blood. The lifetime of red blood cells (erythrocytes), which contain hemoglobin, averages 120-125 days. That is why the level of glycated hemoglobin reflects the average level of glycemia for about three months.
Glycated hemoglobin is an integral indicator of glycemia for three months. The higher the level of glycated hemoglobin, the higher was the glycemia over the past three months and, accordingly, the greater the risk of developing complications of diabetes.
A glycated hemoglobin test is commonly used to assess the quality of diabetes care over the previous three months. With a high level of glycated hemoglobin, treatment should be corrected (insulin therapy or hypoglycemic tablets) and diet therapy.
HbA1c values from 4% to 5.9% are considered normal. In diabetes, HbA1c levels rise, indicating a greater risk of developing retinopathy, nephropathy, and other complications. The International Diabetes Federation recommends keeping HbA1c below 6.5%. An HbA1c value greater than 8% indicates that diabetes is not well controlled and therapy should be changed.
Glycosylated or glycated hemoglobin (HbA1c) is an indicator that reflects the level of glucose in the blood over the past 1-2-3 months. The main indications for use are: control of the course of diabetes mellitus (1 time in 3 months), control of the effectiveness of diabetes treatment, an indicator of the risk of developing complications of diabetes mellitus.
Glycosylated or glycated hemoglobin (HbA1c) is a compound of hemoglobin A and glucose that is formed in the body in a non-enzymatic way. Approximately 5-8% of the hemoglobin in erythrocytes binds stably to a glucose molecule. The process of attaching glucose to a hemoglobin molecule is a normal process, but during the life of an erythrocyte, with an increased long-term glucose content in the blood, this percentage increases. Such hemoglobin molecules are called glycosylated. There are several types of glycosylated hemoglobins (HbAIa, HbAIb, HbAIc). It is believed that hemoglobin – HbA1c (due to its quantitative predominance) has the greatest clinical significance. The concentration of glycosylated hemoglobin depends on the concentration of glucose in the blood. Considering that the lifespan of an erythrocyte is on average 120 days, the determination of the HbA1c content will reflect the average content of glucose in the blood serum for 1-2-3 months before the study.
In addition to hemoglobin, albumin, collagen, eye lens proteins, transferrin, erythrocyte membrane proteins and many other proteins and enzymes are subject to glycation, which leads to disruption of their functions and aggravation of the course of diabetes mellitus.
The determination of glycosylated hemoglobin is recognized by the World Health Organization as necessary to control the course of diabetes mellitus once every 3 months.
The determination of HbA1c allows monitoring of glucose levels between visits to the doctor. The higher the HbA1c content in the patient’s blood serum, the worse the glucose concentration was controlled.
Normalization of the level of HbA1c in the blood occurs on the 4-6th week after reaching the normal level of glucose. When monitoring the treatment of diabetes, it is recommended to maintain the level of glycated hemoglobin less than 7% and to review therapy if its content is more than 8% (according to the method for determining HbA1c with normal values in the range of 4-6%).
Glycated hemoglobin is used as an indicator of the risk of complications of diabetes mellitus.
Values may vary between laboratories depending on the analytical method used, so monitoring over time is best done in the same laboratory, or at least by the same method.
The test results can be falsely changed in any condition that affects the average lifespan of red blood cells. Bleeding or hemolysis causes a false decrease in the HbA1c result. Blood transfusions also distort the result. With iron deficiency anemia, a false increase in HbA1c is observed.
Preparing for diagnostics
- Explain to the patient that the study will evaluate the effectiveness of antidiabetic therapy.
- He should be warned that a blood sample must be taken for the study, and told who and when will take blood from a vein.
- After vein puncture, blood is drawn into an EDTA tube.
- Press down on the venipuncture site with a cotton ball until bleeding stops.
- If a hematoma forms at the venipuncture site, warm compresses are prescribed.
- The patient is scheduled for a follow-up study after 6-8 weeks.
- Normally, the content of glycated hemoglobin is 4.0 – 5.2% of total hemoglobin.
Factors affecting the result of the study
- Confounding factors
Incorrect blood sampling – insufficient mixing of the blood with the anticoagulant (EDTA) in the test tube.
- Factors that increase results
- Carbamylated hemoglobin (formed in patients with uremia).
- Factors causing a false increase
Hemoglobin F (fetal) and labile intermediates may cause a false increase in results.
Glycated hemoglobin. Analysis of glycosylated hemoglobin. Get tested for high blood sugar
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Glycated hemoglobin (HbA1c)
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Glucose interacts with proteins (including hemoglobin) with the formation of Schiff bases. Thus, any even short-term increase in the concentration of glucose in the blood leaves a kind of trace in the form of an increased content of glycosylated hemoglobin. HbA1 is made up of three components of HbA1a; HbA1b; HbA1c. HbA1c predominates quantitatively.
The HbA1c level reflects the hyperglycemia that has occurred during the lifetime of erythrocytes (up to 120 days). Erythrocytes circulating in the blood have different ages, therefore, for the average characteristics of the glucose level, they are guided by the half-life of erythrocytes – 60 days. Thus, the level of glycated hemoglobin shows what the concentration of glucose was in the previous 4-8 weeks and this is an indicator of the compensation of carbohydrate metabolism during this period. Measuring the concentration of HbA1 allows you to retrospectively assess the severity of hyperglycemia in diabetes mellitus. The effect of glycosylation does not depend on the daily rhythm of blood glucose fluctuations, on the physiological activity of the body, the nature of food, physical activity, and depends only on the magnitude and duration of hyperglycemia. In diabetic patients with persistent hyperglycemia, the concentration of HbA1c increases significantly. Treatment of diabetes is carried out with drugs that lower blood glucose for only a limited period of time, so it is very important to choose such treatment regimens that would achieve stable normalization of glycemia. The value of the study of glycosylated hemoglobin in diabetes mellitus lies in the fact that HbA1c characterizes a certain average level of glucose in the blood over a long period of time, which is commensurate with the half-life of the hemoglobin molecule. That is, glycosylated hemoglobin characterizes the degree of compensation for diabetes mellitus over the past 1-2 months. The better the diabetes is compensated, the lower the risk of developing such complications of diabetes as eye damage – retinopathy, kidney damage – nephropathy, damage to peripheral nerves and blood vessels leading to gangrene. Thus, the strategic goal of the treatment of diabetes mellitus is to ensure the constant maintenance of glucose within the normal range. Measurement of sugar in capillary blood allows you to assess the current level of glucose, the determination of HbA1c gives an integrated view of the level of glycemia.
Norm: 3.5-7.0 µM fructose/g hemoglobin or 3.9-6.2%
Determination of HbA1c is of great importance in diabetic women when planning pregnancy and during pregnancy. It has been established that the level of HbA1c during 6 months before conception and during the first trimester of pregnancy correlates with its outcome. Strict control of the level of glycemia can reduce the incidence of fetal malformations from 33% to 2%.
Significance of individual HbA1c targets for assessing glycemic control in patients with type 2 diabetes | Misnikova
Currently, special attention is paid to achieving glycemic control in patients with type 2 diabetes mellitus (DM2) as a factor that determines the risk of developing macro- and microvascular complications of DM. Modern guidelines suggest an individual approach in choosing the target level of HbA 1c , taking into account age and the presence of complications.
Estimate the proportion of T2DM patients who achieved HbA targets 1c based on individual goals.
Materials and methods.
2195 patients with DM2 were examined. Patients were divided into age groups: under 45 years old, 45–64 years old, over 65 years old. In each group, two subgroups were identified: without complications and with complications (acute cerebrovascular accident, acute myocardial infarction, angina pectoris). Target HbA 1c : up to 45 years without complications ? Results.
Received hypoglycemic therapy: diet monotherapy? 301 patients (13.7%), non-insulin drugs (NIDs) ? 1335 (60.8%), combined treatment with NIR and insulin ? 319(14.6%), insulin monotherapy? 240 (10.9%) patients. In the age group up to 45 years without complications, the target values of HbA 1c were reached by 27.3% of patients, with complications ? 25% of patients; at the age of 45–64 years without complications? 30%, with complications? 35.2%; over 65 without complications? 43%, with complications ? 55.6% of patients.
With an individualized approach to assessing the achievement of treatment goals by HbA level 1c in T2DM, the proportion of people who have achieved target values is higher than with the traditional approach (HbA 1c
At present, given the trend towards a continuous increase in the number of patients with diabetes mellitus (DM), one of the main tasks of the healthcare system in many countries of the world is to develop programs aimed at improving the treatment and preventive care for this category of patients. In this connection, special attention is paid to achieving the goals of controlling carbohydrate metabolism in patients with type 2 diabetes (DM2) as a factor that determines the risk of developing micro- and macrovascular complications. Since December 2013, a new consensus has been adopted in Russia and algorithms for specialized medical care for patients with DM have been developed , suggesting the choice of an individual treatment goal based on the level of glycated hemoglobin (HbA1c) in accordance with the patient’s age, the presence of severe complications, and the risk of hypoglycemic conditions.
Previously, the assessment of the quality of care in the region was based on the percentage of patients who achieved an average HbA1c score (7% or less). At present, this approach should be recognized as insufficient, since it does not take into account individual characteristics and, accordingly, the goals of treating patients with diabetes.
The main goal of the work was to determine the proportion of patients with type 2 diabetes who reached the target levels of HbA1c, based on an individual approach to treatment.
Materials and methods
The study was conducted in 12 municipalities of the Moscow region as part of a survey of patients with type 2 diabetes under the Diamobil program.
Diamobile is a mobile treatment and diagnostic module equipped with the necessary medical equipment to provide specialized endocrinological care to patients with diabetes. In the Moscow region, the diamobile leaves on a permanent basis 8 times a year, the parking time in one region is 10 working days. During this period, about 300 patients with type 2 diabetes are being examined. The formation of the list of examined patients with DM is carried out randomly by the specialists of the State Budgetary Healthcare Institution of the Moscow Region of the Moscow Regional Research Institute of Public Health on the basis of the data of the Registry of DM of the given municipality. All examined patients with DM undergo a determination of the level of HbA1c, creatinine, urea, lipidogram, an ECG is performed. After receiving the results of laboratory tests, patients are examined by specialists (ophthalmologist, surgeon, cardiologist, endocrinologist).
The article presents the results of a survey of 2195 patients with type 2 diabetes: 1770 (80.6%) women and 425 (19.4%) men. To determine individual treatment goals, patients were divided into age groups: up to 45 years, 45–64, 65 years and older. In each age group, two subgroups were distinguished: the first subgroup included patients with DM2 without complications, the second – patients with complications: acute cerebrovascular accident, acute myocardial infarction, angina pectoris.
The target HbA1c level for each subgroup was set based on the algorithms of specialized medical care for patients with diabetes mellitus  (Table 1).
Determination of glycated hemoglobin was carried out on the device NicoCard Reader II (Axis-Shield), Norway, by the method of borate affinity analysis. The test is NGSP certified as a DCCT reference method.
General characteristics of patients. The average duration of DM2 in the examined patients was 9.4±7.7 years. The duration of the disease was up to 5 years in 699 patients (31.8%), 5-9 years – 599 people (27.3%), 10-14 years – 438 (20%), 15-19 years – 197 (9%) and more than 20 years – 262 patients (11.9%).
Mean body mass index (BMI) was 33.21±6.1 kg/m2. The normal value of BMI was registered in 6.7% of the examined, overweight – in 24.7%, obesity of the 1st degree occurred in 33.7%, obesity of the 2nd degree – in 22.8%, obesity of the 3rd degree – at 12.6%. Thus, obesity or overweight was reported in 93. 3% of patients, with 12.6% having morbid obesity.
By age groups, patients were distributed as follows: group under 45 years old – 59people (2.7%): without complications – 55 people (2.5%) and with complications – 4 people (0.2%). Age group 45-64 years – 1291 patients (58.8%): without complications – 944 people (43.0%), with complications – 347 people (15.8%). At the age of 65 years and older – 845 people (38.5%): 419 (19.1%) – without complications and 426 (19.4%) – with complications.
As concomitant therapy, only antihypertensive drugs were received by 847 patients (38.6%), only lipid-lowering drugs – 83 (3.8%), a combination of antihypertensive and lipid-lowering drugs – 1155 people (52.6%), and 110 patients ( 5%) did not receive the indicated concomitant therapy.
Statistical processing of the material was carried out using the standard Excel package. Data are presented as mean ± standard deviation
The mean HbA1c in the study sample was 8. 2±2.9%. Of the total number of patients with DM2, 28.8% achieved the level of HbA1c<7%, more than 9% had 29.7%. The distribution of patients depending on the level of HbA1c is shown in fig. 1.
In general, 38.2% of patients with type 2 diabetes achieved individual target values for HbA1c levels. The highest percentage of patients who achieved individual treatment goals was registered in the group of 65 years and older: among those without complications it was 43%, with complications – 55.6% (Fig. 2). The worst indicators were found in the age group up to 45 years: both without complications, where the target values of HbA1c were reached by 27.3% of patients, and with complications – 25%. This is largely due to the fact that this age group has the most stringent target values. In the age group 45-64 years without complications, 30% of patients reached the target values, with complications – 35.2%. The percentage of patients who reached the target values was slightly higher in the group with complications, both at the age of 45–64 years (30 and 35. 2%) and 65 years and older (43 and 55.6%). At the same time, at the age of up to 45 years, this percentage practically does not differ between groups.
Mean HbA1c levels were not significantly different between those aged 45–64 years and those aged 65 years and older, and were similar between those with and without complications (Table 2). In patients under 45 years of age, the average HbA1c value was lower in the group of patients who did not have complications compared to people of the same age with complications. It should be noted that due to the small number of younger age groups with complications, the results may be of limited value.
Depending on the type of hypoglycemic therapy received, the patients were distributed as follows: the majority were treated with non-insulin antidiabetic drugs (NIR) – 1335 (60.8%). The total number of patients receiving insulin therapy was 559people (25.5%), including those on combined treatment with oral hypoglycemic drugs (OSSP) and insulin 319 (14. 6%), on insulin monotherapy – 240 (10.9%). A fairly large number of patients remained on monotherapy with a diet and did not receive drug hypoglycemic therapy – 301 people (13.7%) (Fig. 3).
Of the NIR (no insulin) group, 48.3% were treated with a single agent and 51.7% were treated with 2 or more NIRs.
According to the structure of hypoglycemic therapy in the examined sample of patients, comparable results were obtained in comparison with the data of the Register of Patients with Diabetes in the Moscow Region. Thus, the number of patients receiving insulin monotherapy practically coincides (according to the Register – 9%), and those who were on monotherapy with a diet (according to the Register – 11.7%).
At the same time, there was a slightly larger number of patients in the study sample, compared with the data of the Register, receiving insulin in combination with NID (14.6% and 8.7%), and fewer patients who were on NID monotherapy (60.8% and 70.6%).
As a first-line hypoglycemic drug, 39. 4% of patients used metformin, a significant number of patients (59.2%) received monotherapy with sulfonylurea drugs (glibenclamide – 34.9%, gliclazide MB – 15.2%, glimepiride – 5.7%, gliquidone – 3.4%), less than 1.5% of patients were prescribed drugs of other groups (pioglitazone – 0.9%, drugs of the incretin group – 0 ,5%). In the combined treatment with insulin and PSSP, metformin was most often prescribed – in 37.4%, somewhat less often (in 31.5%) – drugs from the sulfonylurea group (glibenclamide – 21.9%, gliclazide MB – 4.8%, glimepiride – 3 .2%, gliquidone – 1.6%). Pioglitazone in combination with insulin was prescribed in 0.3%. 30.8% of patients in combination with insulin received two or more PSSPs.
Thus, in general, metformin was most often prescribed as a basic hypoglycemic drug, it was taken by 1162 people (52.9% of the total number of patients).
In each treatment group, the majority of patients did not achieve individual target values, including those who did not receive hypoglycemic drug therapy (Table 3), which indicates the need for more active tactics in the treatment of patients with diabetes and early prescription of antidiabetic drugs. The average HbA1c level on insulin therapy was above 8% in all age groups, which indicates the need for more active titration of insulin doses, and, if necessary, transfer to an intensified insulin therapy regimen with the addition of short-acting insulin.
Analysis of the results of the study showed that a fairly large proportion of patients with DM2 – 71.2% do not reach HbA1c values <7%, which is comparable to the data for the Russian Federation as a whole, where it was 74.8% . At the same time, 48.1% of patients in the sample had an HbA1c level >8%, while according to some other studies, 57.4% of patients living in the Russian Federation had a similar HbA1c level . In some foreign countries, the situation is somewhat better, but, nevertheless, a similar trend continues. In particular, according to the National Institute of Health and Clinical Research (NHANES), only 50% of patients with type 2 diabetes in the United States had HbA1c≤7.0%, about 20% – in the range from 7% to 8%, and about 30% had at the time of the survey pronounced decompensation of carbohydrate metabolism: HbA1c≥8. 0% . The obtained results indicate insufficient control of carbohydrate metabolism in patients with type 2 diabetes, and if the achievement of the level of HbA1c <7%, and even more so <6.5% is currently not relevant for all patients with type 2 diabetes, then the percentage of patients with HbA1c>8%, and especially >9% can characterize the quality of diabetic care in the region.
UKPDS (UK Prospective Diabetes Study), ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation), VADT (Veterans Affairs Diabetes Trial) have shown that intensive blood glucose control is associated with a reduced risk of microvascular complications that cause disability and mortality in a large number of patients with type 2 diabetes [5–8]. The role of intensive glycemic control in the prevention of macrovascular complications of DM is less clear .]. It is possible that the reduction in the risk of macrovascular complications with intensive glycemic control does not occur due to the worsening of the course of cardiovascular disease due to hypoglycemia in a certain group of individuals. On the contrary, too intense glycemic control may be associated with increased cardiovascular mortality, as happened in the ACCORD study (The Action to Control Cardiovascular Risk in Diabetes) . On the other hand, it is obvious that the potential risk of developing hypoglycemic reactions in some patients should not stop the physician from setting strict treatment goals for T2DM patients with a good life prognosis, without severe comorbidities.
In general, according to our study, the individual target values for HbA1c levels were reached by a larger number of patients with type 2 diabetes compared with the average HbA1c <7% - 38.2% and 28.8%, respectively. The smallest number of patients who reached the target levels of HbA1c was registered at a young age (under 45), which is probably due to the most stringent compensation criteria provided for patients in this age group. At the same time, strict compensation criteria are absolutely justified, since the achievement of optimal control of carbohydrate metabolism among people of this age group will contribute to the prevention of complications of diabetes and the prevention of related disability and increased mortality among people of working age.
According to the results of the study, it was found that in the group of young patients on monotherapy with a diet, only 16.7% of persons reached the target values of the HbA1c level. Accordingly, a more active prescription of hypoglycemic therapy is necessary already at the time of establishing the diagnosis of DM2, especially in young people in the absence of severe comorbidity. At the same time, in the age group of 65 years and older, the number of patients with satisfactory glycemic control on the diet was quite high – 75.8% in persons without complications and 83.9%% with complications. This is due to lower, more easily achievable, glycemic targets and possibly better dietary compliance in older patients. Thus, the use of a diet as a monotherapy is advisable only in older people, while in middle-aged and young patients it is necessary to determine the level of HbA1c every 3 months and add the base drug in a timely manner in order to achieve target glycemic values without waiting for the occurrence and progression of complications. SD. In this regard, it should be noted the need for a more active prescription of metformin, the basic drug for the treatment of type 2 diabetes. Until recently, widespread use of metformin has been somewhat limited due to the risk of gastrointestinal side effects. The need for 2 or 3 doses of the drug reduced the compliance of patients. Currently, an extended form of metformin, Glucophage Long, is registered and widely prescribed in Russia. The risk of side effects from the gastrointestinal tract is much lower with its use compared with the use of the traditional form of metformin, and adherence to treatment is higher due to the possibility of taking it once a day.
Considering that in patients who are already prescribed antidiabetic therapy, in each treatment group there is also a rather low percentage of people who have achieved their individual treatment goals, it is necessary to prescribe NIR at an effective dose, and in the absence of achievement of target HbA1c values, more actively use combined drugs or combinations of NIR.
According to a study conducted in 7 European countries, only 25.5% of patients with type 2 diabetes receiving combination therapy with metformin with glitazones or with sulfonylurea drugs had satisfactory indicators of the state of carbohydrate metabolism . This indicates the need for timely addition of insulin therapy to the treatment.
In our study, among patients receiving combined treatment with insulin and PSSP, there was a low percentage of individuals who reached the target HbA1c values. Mean HbA1c levels on insulin therapy were above 8% in all age groups. Such a low level of achievement of HbA1c target values indicates a late prescription of insulin therapy for patients undergoing NIIR, inadequate titration of insulin doses, the need to train patients in self-monitoring of glycemia and timely decision-making on insulin dose adjustment and insulin therapy regimen.
- With an individual approach to assessing HbA1c target values in T2DM, the proportion of people who achieved them is higher than with the traditional approach (HbA1c<7.