What is the Hemoglobin A1C test. How is it used to diagnose and monitor diabetes. What are the normal, prediabetes, and diabetes A1C levels. How often should you get an A1C test. What factors can affect A1C results.

What is the Hemoglobin A1C (HbA1c) Test?

The Hemoglobin A1C (HbA1c) test is a crucial blood test used for diagnosing and monitoring type 2 diabetes and prediabetes. It provides valuable information about a person’s average blood glucose levels over the past 3 months, offering a more comprehensive view of long-term blood sugar control compared to daily glucose monitoring.

Unlike the fingerstick blood sugar checks that people with diabetes perform daily, the A1C test measures the percentage of glycated hemoglobin in the blood. Glycated hemoglobin forms when glucose attaches to hemoglobin, the oxygen-carrying protein in red blood cells. The higher the blood glucose levels, the more glycated hemoglobin is present.

Key Features of the A1C Test:

• Measures average blood glucose over 3 months
• Results expressed as a percentage
• No fasting required
• Used for both diagnosis and monitoring of diabetes
• Recommended at least twice a year for people with diabetes

Interpreting A1C Test Results: Normal, Prediabetes, and Diabetes Ranges

Understanding A1C test results is crucial for both patients and healthcare providers. The test results are given as percentages, with higher percentages indicating higher average blood glucose levels over the past three months.

A1C Percentage Ranges and Their Meanings:

• Below 5.7%: Normal
• 5.7% to 6.4%: Prediabetes
• 6.5% or above: Type 2 diabetes

Is prediabetes a cause for concern? Yes, individuals with prediabetes have an increased risk of developing type 2 diabetes. They should undergo retesting annually and make lifestyle changes to prevent or delay the onset of diabetes.

For people with diagnosed diabetes, the A1C goal is often set below 7%. However, individual targets may vary based on factors such as age, overall health, and the presence of other medical conditions. It’s essential to consult with a healthcare provider to determine the appropriate A1C goal for each patient.

The Importance of Regular A1C Testing for Diabetes Management

Regular A1C testing plays a vital role in diabetes management. For individuals with diabetes, the American Diabetes Association recommends A1C testing at least twice a year. However, more frequent testing may be necessary for those who are not meeting their treatment goals or have recently changed their diabetes management plan.

Why is consistent A1C monitoring crucial? Regular testing allows healthcare providers to:

1. Assess the effectiveness of current diabetes treatment
2. Make informed decisions about adjusting medication dosages
3. Identify the need for lifestyle modifications
4. Detect potential complications early
5. Motivate patients to maintain good blood sugar control

If A1C results are consistently above the target range, it may indicate the need for changes in the diabetes care plan. This could involve adjusting medication, modifying diet, increasing physical activity, or addressing other factors that impact blood glucose control.

Factors That Can Affect A1C Test Results

While the A1C test is generally reliable, several factors can influence its accuracy and interpretation. Healthcare providers must consider these variables when analyzing A1C results:

Medical Conditions That May Impact A1C:

• Anemia
• Hemoglobin variants
• Kidney disease
• Liver disease
• Recent blood loss or transfusions

Do certain medications affect A1C results? Yes, some medications can interfere with A1C measurements. These include:

• High-dose aspirin
• Some HIV medications
• Certain antibiotics
• Vitamin C and E supplements in high doses

Racial and ethnic differences can also influence A1C results. Studies have shown that A1C levels may be higher in African Americans, Hispanics, and Asians compared to non-Hispanic whites with similar blood glucose levels. Healthcare providers should take these factors into account when interpreting A1C results and making treatment decisions.

The Relationship Between A1C and Estimated Average Glucose (eAG)

To make A1C results more relatable to daily blood glucose monitoring, healthcare providers often use the concept of estimated average glucose (eAG). eAG translates A1C percentages into the same units (mg/dL or mmol/L) used in daily glucose meters.

A1C to eAG Conversion:

• 5.7% A1C = 117 mg/dL (6.5 mmol/L) eAG
• 6.5% A1C = 140 mg/dL (7.8 mmol/L) eAG
• 7.0% A1C = 154 mg/dL (8.6 mmol/L) eAG
• 8.0% A1C = 183 mg/dL (10.2 mmol/L) eAG

Understanding the relationship between A1C and eAG can help patients better grasp how their daily glucose readings relate to their overall blood sugar control. This knowledge can motivate individuals to make necessary lifestyle changes and adhere to their diabetes management plan.

A1C Testing in Pregnancy and Gestational Diabetes

A1C testing plays a unique role in pregnancy, particularly in the context of gestational diabetes. While A1C is not typically used to diagnose gestational diabetes, it can be valuable in assessing pre-existing diabetes or diabetes risk before pregnancy.

How does A1C testing differ during pregnancy? During pregnancy, healthcare providers often rely on other glucose tests, such as the oral glucose tolerance test (OGTT), to diagnose gestational diabetes. However, A1C may be used to monitor blood sugar control in women with pre-existing diabetes throughout pregnancy.

A1C Targets During Pregnancy:

• First trimester: Below 6.5%
• Second and third trimesters: Below 6.0%

It’s important to note that A1C levels can be affected by the increased red blood cell turnover during pregnancy. This may lead to slightly lower A1C results than expected based on average blood glucose levels. Healthcare providers should consider this factor when interpreting A1C results in pregnant women.

Limitations and Complementary Tests to A1C

While the A1C test is a valuable tool for diabetes diagnosis and management, it has some limitations. Healthcare providers often use complementary tests to get a more comprehensive picture of a patient’s glucose control.

Limitations of A1C Testing:

• Does not provide information about daily glucose fluctuations
• May be less accurate in certain medical conditions
• Cannot distinguish between fasting and postprandial hyperglycemia
• May not reflect recent changes in glucose control

Which tests complement A1C in diabetes management? To address these limitations, healthcare providers may use the following tests in conjunction with A1C:

1. Fasting Plasma Glucose (FPG): Measures blood glucose after an 8-hour fast
2. Oral Glucose Tolerance Test (OGTT): Assesses how the body processes glucose over a 2-hour period
3. Random Plasma Glucose Test: Measures blood glucose at any time of day
4. Continuous Glucose Monitoring (CGM): Provides real-time glucose readings throughout the day and night

By combining these tests with A1C results, healthcare providers can gain a more comprehensive understanding of a patient’s glucose control and tailor treatment plans accordingly.

The Role of A1C in Diabetes Prevention and Early Intervention

A1C testing is not only crucial for managing diagnosed diabetes but also plays a significant role in diabetes prevention and early intervention strategies. By identifying individuals with prediabetes, healthcare providers can implement interventions to prevent or delay the onset of type 2 diabetes.

Prediabetes Intervention Strategies:

• Lifestyle modifications (diet and exercise)
• Weight loss programs
• Diabetes prevention education
• Regular A1C monitoring
• Consideration of medication in high-risk individuals

How effective are prediabetes interventions? Research has shown that lifestyle interventions can reduce the risk of developing type 2 diabetes by up to 58% in individuals with prediabetes. Early identification through A1C testing allows for timely implementation of these interventions, potentially preventing or delaying the onset of diabetes and its associated complications.

Regular A1C testing in at-risk populations, such as those with a family history of diabetes, obesity, or certain ethnic backgrounds, can help identify prediabetes early. This early detection enables healthcare providers to implement preventive measures and monitor progress over time, ultimately reducing the burden of type 2 diabetes on individuals and healthcare systems.

A1C: MedlinePlus

Also called: Glycohemoglobin, HbA1C, Hemoglobin A1C test

A1C is a blood test for type 2 diabetes and prediabetes. It measures your average blood glucose, or blood sugar, level over the past 3 months. Doctors may use the A1C alone or in combination with other diabetes tests to make a diagnosis. They also use the A1C to see how well you are managing your diabetes. This test is different from the blood sugar checks that people with diabetes do every day.

Your A1C test result is given in percentages. The higher the percentage, the higher your blood sugar levels have been:

• A normal A1C level is below 5.7%
• Prediabetes is between 5.7 to 6.4%. Having prediabetes is a risk factor for getting type 2 diabetes. People with prediabetes may need retests every year.
• Type 2 diabetes is above 6.5%
• If you have diabetes, you should have the A1C test at least twice a year. The A1C goal for many people with diabetes is below 7. It may be different for you. Ask what your goal should be. If your A1C result is too high, you may need to change your diabetes care plan.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

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What is prediabetes?

Prediabetes means that your blood glucose, or blood sugar, levels are higher than normal but not high enough to be called diabetes. Glucose comes from the foods you eat. Too much glucose in your blood can damage your body over time.

If you have prediabetes, you are more likely to develop type 2 diabetes, heart disease, and stroke. But if you make some lifestyle changes now, you may be able to delay or prevent type 2 diabetes.

What causes prediabetes?

Prediabetes usually happens when your body has a problem with insulin. Insulin is a hormone that helps the glucose get into your cells to give them energy. A problem with insulin could be:

• Insulin resistance, a condition in which the body can’t use its insulin properly. It makes it hard for your cells to get glucose from your blood. This can cause your blood sugar levels to rise.
• Your body can’t make enough insulin to keep your blood sugar levels at a healthy level

Researchers think that being overweight and not getting regular physical activity are major factors in causing prediabetes.

Who is at risk for prediabetes?

About 1 out of every 3 adults has prediabetes. It is more common in people who:

• Are overweight or have obesity
• Are age 45 or older
• Have a parent, brother, or sister with diabetes
• Are African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander American
• Are not physically active
• Have health conditions such as high blood pressure and high cholesterol
• Have had gestational diabetes (diabetes in pregnancy)
• Have a history of heart disease or stroke
• Have metabolic syndrome
• Have polycystic ovary syndrome (PCOS)

What are the symptoms of prediabetes?

Most people don’t know they have prediabetes because usually there are no symptoms.

Some people with prediabetes may have darkened skin in the armpit or on the back and sides of the neck. They may also have many small skin growths in those same areas.

How is prediabetes diagnosed?

There are a few different blood tests that can diagnose prediabetes. The most common ones are:

• Fasting plasma glucose (FPG) test, which measures your blood sugar at a single point in time. You need to fast (not eat or drink) for at least 8 hours before the test. The results of the test are given in mg/dL (milligrams per deciliter):
  • A normal level is 99 or below
  • Prediabetes is 100 to 125
  • Type 2 diabetes is 126 and above
• A1C test, which measures your average blood sugar over the past 3 months. The results of an A1C test are given as a percentage. The higher the percentage, the higher your blood sugar levels have been.
  • A normal level is below 5.7%
  • Prediabetes is between 5.7 to 6.4%
  • Type 2 diabetes is above 6.5%

If I have prediabetes, will I get diabetes?

If you have prediabetes, you may be able to delay or prevent type 2 diabetes through lifestyle changes:

• Losing weight, if you are overweight
• Getting regular physical activity
• Following a healthy, reduced-calorie eating plan

In some cases, your health care provider may also recommend taking diabetes medicines.

Can prediabetes be prevented?

If you are at risk for prediabetes, those same lifestyle changes (losing weight, regular physical activity, and a healthy eating plan) may prevent you from getting it.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

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What you need to know about HbA1C

Among the many numbers of test results that doctors prepare, a simple HbA1C test value can help you figure out how well you are monitoring your blood sugar levels.

First of all, let’s find out what is HbA1C?

You can come across different names for this indicator:

• A1c
• Glycated hemoglobin
• Glycosylated hemoglobin
• Hemoglobin A1C

The level of HbA1C (glycated hemoglobin) shows what percentage of hemoglobin in erythrocytes binds to glucose ¹ . Since the lifetime of a red blood cell, which contains hemoglobin, is several months, the HbA1C test allows you to determine how effective blood sugar control was in the previous 2-3 months.

How often should I check my HbA1C level?

The American Diabetes Association (ADA) recommends that diabetic patients with stable blood sugar levels have an HbA1C test every six months, and if blood sugar targets cannot be achieved or treatment needs to be changed, this test is done every 3 months ² .

What level of HbA1C should I aim for?

The American Diabetes Association recommends that HbA1C levels be 7% or lower, and the closer this is to 6% without risk to health, the better. However, for each person, this level should be set depending on the current state of health and taking into account many factors (in particular, whether the person feels the onset of hypoglycemia). Most likely, if your HbA1C level exceeds 7%, then the doctor will advise you on what needs to be done to lower it, because, among other things, lowering this indicator helps to reduce the risk of long-term complications of diabetes, which we strive to prevent ² .

Is it possible to do without blood sugar measurement if an HbA1C test is done?

Since the HbA1C level is an average value, it cannot guarantee that blood sugar levels during the day are in a safe range. Let’s see what the average value means. The average of the numbers 5-5-5-5 and the numbers 1-9-1-9 will be 5, but on the chart, the numbers 1-9-1-9 will look like sharp ups and downs. This also applies to blood sugar levels. If there are many highs and lows after averaging, the HbA1C level may be similar to the HbA1C level of a healthy person ³ .

Therefore, it is best to evaluate HbA1C test results when self-monitoring blood sugar results are available. It is impossible to understand how the disease develops if you do not conduct self-monitoring of blood sugar levels.

If HbA1C is low, does fluctuating blood sugar matter?

Blood sugar levels tend to fluctuate throughout the day, and this is due to what we eat, how much we move and rest. Currently, along with the results of the analysis of HbA1C, high glycemic variability is also being evaluated – this is how these fluctuations in blood sugar levels are called.

Data from the Diabetes Control and Complications Trial (DCCT ⁴ ) showed that patients with the same level of HbA1C were more susceptible to certain types of complications with more pronounced fluctuations in blood sugar levels.

If you want to know if you are at risk and how your actions affect your blood sugar, use the Accu-Chek 360° Form (Blood Glucose Test: Before and After Meals) to understand how food, exercise, medication, stress, or illness can affect your sugar levels throughout the day. This testing system has even been proven to help lower HbA1C levels when worked with a physician ⁵ . Start changing for the better right now.

What do MCV, MCH, MCHC erythrocytes indicate in a blood test?

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What do erythrocyte counts say in a blood test?
What are RBC, MCV, MCH, MCHC values?

Erythrocytes (RBC – Red Blood Cells, literally – red blood cells) are separate components of the clinical (general, morphological) blood test, which is also called “Complete Blood Count” or “Complete Blood Count” (CBC) . Clinical blood test is performed to determine the number of different types of cells found in the patient’s blood, and their physical characteristics.

Blood consists of erythrocytes, leukocytes and platelets, which are suspended in the plasma. Platelets are cells that provide the formation of blood clots and protect the body from blood loss in case of injury. Red blood cells (RBC) contains the protein hemoglobin, which carries oxygen throughout the body, to all tissues and organs. Red blood cells are pale red in color due to hemoglobin. The shape of an erythrocyte resembles a donut, but instead of a hole in the middle, it has a thinning. Normally, all red blood cells in the blood are basically the same color, size, and shape. However, certain conditions can lead to changes that impair their ability to function properly. For example, Anemia .

Anemia is a common blood disorder characterized by too few, deformed, or poorly functioning red blood cells.

RBC values ​​determined in a laboratory indicate the size, shape, and physical characteristics of red blood cells. A veterinarian can use red blood cell counts to diagnose the cause of anemia.

What are RBC counts for MCV, MCH, MCHC in blood test ?

RBC counts and counts are used to diagnose various types of anemia. If, as a result of a clinical blood test, it turns out that the patient has a too low red blood cell count or their characteristics differ from the norm, one can talk about some kind of anemia.

Anemia is a condition in which the number of red blood cells or the amount of hemoglobin in the blood drops below normal levels. This impairs the gas exchange of tissues throughout the body, causing a lack of oxygen in the organs. With various degrees of anemia, the animal feels unwell, tired, dizzy, there is a desire to rest, shortness of breath may occur. Symptoms may be accompanied by other abnormalities if the body does not receive enough oxygen to function normally.

What are the causes of anemia in animals?

Anemia can occur if:

• too few red blood cells are created, which is called aplastic anemia;
• red blood cells are destroyed prematurely, which is called hemolytic anemia;
• Significant blood loss occurs, such as in a hemorrhage

Anemia can occur for a variety of reasons:

• Anemia can be inherited. This means that the genetic condition is passed from parents to children through their genes;
• Anemia may develop suddenly at any time in the patient’s life;
• Anemia can be acute, that is, it develops over a short period of time;
• Anemia can also be chronic, that is, it develops and persists for, for example, several months

Possible immediate causes of anemia:

• iron-free diets, vitamin B-12, folate or folic acid;
• chronic diseases such as cancer (benign neoplasms), diabetes, inflammatory bowel disease, kidney disease, or thyroiditis, which is inflammation of the thyroid gland;
• chronic infections such as feline immunodeficiency virus, tuberculosis or others;
• significant blood loss or hemorrhage;
• diseases affecting the bone marrow, such as leukemia (feline viral leukemia), lymphoma, or multiple myeloma
• chemotherapy;
• lead poisoning;
• pregnancy;
• certain genetic disorders such as thalassemia, which is an inherited form of anemia or sickle cell anemia that occurs when red blood cells cannot carry oxygen well and are crescent shaped

Iron deficiency anemia is the most common type of anemia.

Symptoms of anemia can be very mild at first. For example, many patients do not even notice that they are anemic. The most common early symptoms of anemia are:

• fatigue;
• lack of energy;
• weakness;
• pale skin

As the disease progresses, new symptoms may appear:

• dizziness;
• sensation of coldness or numbness in the limbs;
• erratic breathing;
• irregular or fast heartbeat;
• chest pain;
• headaches

In human medicine, most patients do not know they are anemic until they have a complete clinical (CBC) blood test and are abnormal.

CBC (Complete Blood Count) is a comprehensive set of parameters that measures the number of all red blood cells, white blood cells and platelets in a blood sample. If an animal is found to be anemic, CBC readings can help determine what is causing the anemia.

What happens during a CBC?

To test for RBC indices, a small amount of blood must be taken from the patient. Your animal does not need any special preparations for this test, unlike a biochemical test where a blood sample is taken on an empty stomach after a fasting diet of 6-8 hours.

The following is a description of what happens during CBC:

If blood is taken from a vein, the veterinarian or assistant will first clean the area of ​​skin near the vein of hair, treat it with an antiseptic, apply a tourniquet above the sampling site so that the vein is more filled with blood.

An experienced veterinarian carefully inserts a needle into a vein and slowly draws blood from the bloodstream into a syringe or tube. Sometimes an intravenous catheter is used.

When the required amount of blood has been collected, the veterinarian removes the tourniquet, removes the needle and, in some cases, applies a compress to the blood collection site to prevent hematoma formation.

The blood sample is then sent to a laboratory for analysis, where the laboratory personnel perform the analysis using special equipment. It should be taken into account that a clinical blood test, if performed by old methods using a microscope, gives only an approximate idea of ​​the patient’s condition, since it has a large error. In addition, the calculation of hemoglobin concentration, CBC and such parameters as MCV, MCH, MCHC manually in general is not possible in practice.

In the laboratory of the Kotofey veterinary clinic, a complete CBC count is performed using an automatic computer-controlled analyzer, which ensures high accuracy and stability of the results.

What are the three main RBC indices?

Erythrocyte indices have three main indicators:

• mean body volume (MCV) which shows the average size of red blood cells;
• mean corpuscular hemoglobin (MCH) which shows the average amount of hemoglobin per erythrocyte;
• mean corpuscular concentration of hemoglobin (MCHC) , which is the amount of hemoglobin relative to the size of the concentration of red blood cells, or hemoglobin per erythrocyte

Clinical blood test values ​​not only may differ depending on the types of patients (cats, dogs, etc. ), but also must be taken into account by the laboratory equipment and personnel when performing the analysis. Therefore, clinical analysis of CBC blood in animals must be carried out in specialized veterinary laboratories. It is for this reason that veterinary clinics using the services of human medicine laboratories in many cases receive incorrect results.

Normal ranges may vary slightly from lab to lab.

What do RBC results mean?

The CBC RBC Indices can help your doctor determine the cause of anemia in an animal. The MCV is the most useful value in CBC readings and helps determine the type of anemia.

If your veterinarian sees a low, normal, or high MCV, this will help determine the cause of the anemia.

High MCV

If the MCV is higher than normal, this indicates that the red blood cells are larger than usual. This is called macrocytic anemia .

Macrocytic anemia can be caused by:

• vitamin B12 deficiency;
• folate deficiency;
• chemotherapy;
• preleukemic condition

Low MCV

MCV will be below normal if red blood cells are too small. This condition is called microcytic anemia .

Microcytic anemia can be caused by:

• iron deficiency, which can be caused by poor dietary intake of iron, gastrointestinal or other bleeding;
• thalassemia;
• lead poisoning;
• chronic diseases

Normal MCV

A normal MCV means that the patient’s red blood cells are of normal size. A normal MCV may also be accompanied by anemia, for example, if red blood cells are of normal size but too few, or if other RBCs are abnormal. This is called normocytic anemia .

Normocytic anemia occurs when red blood cells are of normal size and hemoglobin content, but too few.

This can be caused by:

• sudden and significant loss of blood;
• cardiac problems;
• tumor;
• chronic disease, eg kidney disease or endocrine disorder;
• aplastic anemia;
• blood infection

High MCHC

0063 the relative concentration of hemoglobin per erythrocyte is high. MCHC may be elevated in diseases such as:

• hereditary spherocytosis;
• sickle cell anemia;
• homozygous hemoglobin C disease

Low MCHC

If the patient has a low MCHC, this means that the relative concentration of hemoglobin per erythrocyte is low. Red blood cells take on a lighter color when viewed under a microscope. It’s called hypochromia . Patients with anemia and corresponding low MCHC are called hypochromic .

Causes that can cause low MCHC include the same causes that cause low MCV, including:

• iron deficiency;
• chronic diseases;
• thalassemia;
• lead poisoning

Typically, low MCV and MCHC are found together. Anemias in which both MCV and MCHC are low are called microcytic hypochromic anemia .

Conclusion

Your veterinarian may also perform other tests to make a diagnosis.