All About Your A1C

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What has your blood sugar been up to lately? Get an A1C test to find out your average levels—important to know if you’re at risk for prediabetes or type 2 diabetes, or if you’re managing diabetes.

The A1C test—also known as the hemoglobin A1C or HbA1c test—is a simple blood test that measures your average blood sugar levels over the past 3 months. It’s one of the commonly used tests to diagnose prediabetes and diabetes, and is also the main test to help you and your health care team manage your diabetes. Higher A1C levels are linked to diabetes complications, so reaching and maintaining your individual A1C goal is really important if you have diabetes.

What Does the A1C Test Measure?

When sugar enters your bloodstream, it attaches to hemoglobin, a protein in your red blood cells. Everybody has some sugar attached to their hemoglobin, but people with higher blood sugar levels have more. The A1C test measures the percentage of your red blood cells that have sugar-coated hemoglobin.

Who Should Get an A1C Test, and When?

Testing for diabetes or prediabetes:
Get a baseline A1C test if you’re an adult over age 45—or if you’re under 45, are overweight, and have one or more risk factors for prediabetes or type 2 diabetes:

• If your result is normal but you’re over 45, have risk factors, or have ever had gestational diabetes, repeat the A1C test every 3 years.
• If your result shows you have prediabetes, talk to your doctor about taking steps now to improve your health and lower your risk for type 2 diabetes. Repeat the A1C test as often as your doctor recommends, usually every 1 to 2 years.
• If you don’t have symptoms but your result shows you have prediabetes or diabetes, get a second test on a different day to confirm the result.
• If your test shows you have diabetes, ask your doctor to refer you to diabetes self-management education and support services so you can have the best start in managing your diabetes.

Managing diabetes:
If you have diabetes, get an A1C test at least twice a year, more often if your medicine changes or if you have other health conditions. Talk to your doctor about how often is right for you.

How to Prepare for Your A1C Test

The test is done in a doctor’s office or a lab using a sample of blood from a finger stick or from your arm. You don’t need to do anything special to prepare for your A1C test. However, ask your doctor if other tests will be done at the same time and if you need to prepare for them.

Your A1C Result

Diagnosing Prediabetes or Diabetes

A normal A1C level is below 5.7%, a level of 5. 7% to 6.4% indicates prediabetes, and a level of 6.5% or more indicates diabetes. Within the 5.7% to 6.4% prediabetes range, the higher your A1C, the greater your risk is for developing type 2 diabetes.

Managing Diabetes
Your A1C result can also be reported as estimated average glucose (eAG), the same numbers (mg/dL) you’re used to seeing on your blood sugar meter:

What Can Affect Your A1C Result?

Get your A1C tested in addition to—not instead of—regular blood sugar self-testing if you have diabetes.

Several factors can falsely increase or decrease your A1C result, including:

• Kidney failure, liver disease, or severe anemia.
• A less common type of hemoglobin that people of African, Mediterranean, or Southeast Asian descent and people with certain blood disorders (such as sickle cell anemia or thalassemia) may have.
• Certain medicines, including opioids and some HIV medications.
• Blood loss or blood transfusions.
• Early or late pregnancy.

Let your doctor know if any of these factors apply to you, and ask if you need additional tests to find out.

Your A1C Goal

The goal for most people with diabetes is 7% or less. However, your personal goal will depend on many things such as your age and any other medical conditions. Work with your doctor to set your own individual A1C goal.

Younger people have more years with diabetes ahead, so their goal may be lower to reduce the risk of complications, unless they often have hypoglycemia (low blood sugar, or a “low”). People who are older, have severe lows, or have other serious health problems may have a higher goal.

A1C: Just Part of the Toolkit

A1C is an important tool for managing diabetes, but it doesn’t replace regular blood sugar testing at home. Blood sugar goes up and down throughout the day and night, which isn’t captured by your A1C. Two people can have the same A1C, one with steady blood sugar levels and the other with high and low swings.

If you’re reaching your A1C goal but having symptoms of highs or lows, check your blood sugar more often and at different times of day. Keep track and share the results with your doctor so you can make changes to your treatment plan if needed.

Top of Page

• CDC’s Division of Diabetes Translation
• Diabetes Basics
• Blood Sugar Testing
• Diabetes Features & Spotlights
• CDC Diabetes on Facebook
• @CDCDiabetes on Twitter

What Is a Normal HbA1c by Age? | HbA1c Normal Range

Written on January 3, 2023 by Amy Harris, MS, RN, CNM. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

• What is the HbA1c test?
• What are normal HbA1c ranges?
• Why do normal HbA1c ranges vary by age?
• Controversy over updated HbA1c ranges for adults 65 years and older
• At what age should you check your HbA1C?
• Find out whether your HbA1c is normal for your age
• Related content

HbA1c is a “powerhouse” of a diagnostic test, according to the American Diabetes Association [1]. With more than 100 million U.S. adults living with diabetes and prediabetes, a powerhouse is just what the doctor ordered [2]. With just a single finger prick, the HbA1c test can screen for prediabetes, diagnose diabetes, and manage your diabetes treatment plan over time [1]. However, it turns out that factors such as your age, race, and other medical conditions, such as your pregnancy status, can all impact your HbA1c [3]. Learn more about the normal HbA1c by age to stay healthier and live longer (and consider an at-home HbA1c test).

Buy HbA1c Test

What is the HbA1c test?

The HbA1c blood test measures how much blood sugar is attached to your hemoglobin. A1C stands for glycated hemoglobin. Glycated hemoglobin is the medical term describing how your red blood cells (containing a protein called hemoglobin) become loaded up with sugar. As sugar circulates in your bloodstream (such as after eating), it sticks to the hemoglobin in your red blood cells. Sugar is sticky, and in your body, it stays attached to your hemoglobin for up to 3 months (the average lifespan of your red blood cells).

The more sugar in your bloodstream, the more red blood cells are covered with sugar molecules. The HbA1c test measures the percentage of the hemoglobin in your red blood cells covered in sugar. So the higher your average blood sugar level for the past three months, the higher the number of “sugary” red blood cells, and the higher your HbA1c test result.

Healthcare providers use HbA1c alone or in combination with other diabetes tests to diagnose prediabetes or type 2 diabetes.

What are normal HbA1c ranges?

For you sports statheads out there, the A1C test is like a baseball player’s season average — it tells you about a player’s overall success. However, your A1C does not tell you about your blood sugar for just one day, just like a player’s single-game batting record won’t tell you if they are a good player. For adults, healthcare providers use the following HbA1c target ranges [4]:

• A normal A1C level is below 5.7%
• Prediabetes is between 5.7 to 6.4%
• Type 2 diabetes is above 6.5%
• The goal for most adults with diabetes is an A1C that is less than 7%

But, just as a younger, stronger baseball player may have a better season average than an 80-year-old grandfather with poor eyesight, HbA1cs vary greatly with age.

Why do normal HbA1c ranges vary by age?

Diabetes researchers and doctors are still not in agreement over why age makes it harder for people to maintain lower HbA1cs (or better overall diabetic control) [5]. More than likely, there are multiple factors, and as they say, “It’s complicated.”

Regarding the numbers, there’s no one-size-fits-all target for HgA1c. A1C target levels vary by each person’s age, race, and other factors, and your target may be different from someone else’s [3,5].

As you get older, your HbA1c increases [5]. This increase happens regardless of whether or not you have diabetes [6].

Age-Related A1C increase with non-diabetes [6]

Controversy over updated HbA1c ranges for adults 65 years and older

There is an ongoing debate among healthcare providers and diabetes researchers regarding how best to manage older people with diabetes. Adults aged 65 and older have many complex health conditions and represent a diverse patient population to which a single HbA1c target guideline does not always apply [7].

The American Diabetes Association, the American Geriatrics Society, and the International Diabetes Federation all adjusted their target HbA1c ranges for adults older than 65 and then further broke down target ranges by how healthy that senior is. They have increased their HbA1c target ranges up to 8.5 or even 9 for adult seniors greater than 65 years of age.

American diabetes association (ADA) guidelines for adults age 65 or older [8]

American geriatrics society guidelines for adults ≥ 65 years [9]

Health Category	HbA1c
Overall	7. 5-8.0%
Healthy/Few comorbidities	7.0-7.5%
Poor health	8.0-9.0%

International diabetes federation guidelines for adults ≥ 70 years [10]

In contrast, neither the American Association of Clinical Endocrinologists (AACE) nor the European Association for the Study of Diabetes has made age-specific adjustments for HbA1c based on age or health status.

There are several reasons behind the change advocated by the American Diabetes Association, American Geriatrics Society, and the International Diabetes Foundation. First, maintaining an HbA1c of 8% or 9% is much easier than achieving less than 7%. Maintaining less than 7% requires strict glycemic control, often with more potent medications.

The more medicine administered, especially in the elderly or otherwise sick people, the greater the risk of low sugar episodes (hypoglycemia). If severe, hypoglycemia in the elderly can lead to a change in mental status, seizures or loss of consciousness, heart problems, falls leading to fractures, and in some cases, death [8]. Tighter glycemic control (lower HgA1c levels) may come at a higher cost for senior patients.

Additionally, older adults have higher rates of unidentified cognitive impairment and dementia, making it harder to follow strict diabetic treatment plans with glucose monitoring and frequent insulin dose adjustment. Older adults with diabetes also have a greater risk of hypoglycemia than younger adults [8].

All clinical guidelines and research institutions do, however, agree that the management of diabetes, especially in the elderly, needs to be personalized [7-10]. Therefore, frequently monitoring your HbA1c, either with Everlywell’s at-home HbA1c test or with continuous glucose monitoring, is the best way to know how under control your diabetes actually is. In the meantime, more studies need to be done to understand the healthiest HBA1c ranges for the ever-growing number of seniors with diabetes.

At what age should you check your HbA1C?

The CDC recommends getting a baseline A1C test if you’re an adult over age 45 or are under 45, are overweight, and have one or more risk factors for prediabetes or type 2 diabetes [11]. You are at risk for diabetes if you [11]:

• Have prediabetes
• Are overweight
• Are 45 years or older
• Have a parent, brother, or sister with type 2 diabetes
• Are physically active less than three times a week
• Have ever had gestational diabetes (diabetes during pregnancy) or given birth to a baby who weighed over 9 pounds
• Are an African American, Hispanic or Latino, American Indian, or Alaska Native; some Pacific Islanders and Asian American people are also at higher risk
• Have non-alcoholic fatty liver disease

Find out whether your HbA1c is normal for your age

Part of your wellness journey may be learning more about your risk for heart disease or diabetes. Maybe you have family members living with diabetes and are worried about your own risk. Perhaps you want to measure the impact of changes you made in your diet to lower your HbA1c. Everlywell can help you determine your metabolic wellness, using HbA1C. With our simple, quick, and convenient at-home HbA1c blood test, you can have your answers sooner rather than later.

We know that higher A1C levels are linked to more diabetes complications such as coronary heart disease and stroke [1,2]. HbA1c is the test of choice for diagnosing prediabetes and diabetes, monitoring, and managing diabetes. Knowing your HbA1c value will help you be better informed for your next healthcare appointment – more prepared to discuss your personalized diabetes prevention or treatment plan.

Shop HbA1c Test

Prediabetic range for HbA1c

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References

1. HbA1c. American Diabetes Association. URL. Updated 2022. Accessed December 22, 2022.
2. Diabetes and Prediabetes. CDC. URL. Updated September 2, 2022. Accessed December 22, 2022.
3. All About Your A1C. CDC. URL. Updated September 30, 2022. Accessed December 22, 2022.
4. A1C. MedlinePlus. URL. Updated December 22, 2015. Accessed December 22, 2022.
5. Dubowitz N, Xue W, Long Q, et al. Aging is associated with increased HbA1c levels, independently of glucose levels and insulin resistance, and also with decreased HbA1c diagnostic specificity. Diabet Med. 2014;31(8):927-935. doi:10.1111/dme.12459. URL.
6. Pani LN, Korenda L, Meigs JB, and Driver C et al. Effect of aging on A1C levels in individuals without diabetes: evidence from the Framingham Offspring Study and the National Health and Nutrition Examination Survey 2001–2004. Diabetes Care 2008;31(10):1991–1996. https://doi.org/10.2337/dc08-0577. URL.
7. Monami M, Vitale V, Lamanna C, et al. HbA1c levels and all-cause mortality in type 2 diabetic patients: epidemiological evidence of the need for personalised therapeutic targets. Nutr Metab Cardiovasc Dis. 2013;23(4):300-306. doi:10.1016/j.numecd.2012.01.003. URL.
8. Rooney MR, Tang O, Echouffo Tcheugui JB, et al. American Diabetes Association framework for glycemic control in older adults: implications for risk of hospitalization and mortality. Diabetes Care. 2021;44(7):1524-1531. doi:10.2337/dc20-3045. URL.
9. American Geriatrics Society Expert Panel on Care of Older Adults with Diabetes Mellitus. Moreno G, Mangione CM, Kimbro L, et al. Guidelines abstracted from the American Geriatrics Society Guidelines for Improving the Care of Older Adults with Diabetes Mellitus: 2013 update. J Am Geriatr Soc. 2013;61(11):2020-2026. doi:10.1111/jgs.12514. URL.
10. Managing Older People With Type 2 Diabetes. International Diabetes Federation. URL. Updated March 5, 2017. Accessed December 22, 2022.
11. Diabetes Risk Factors. CDC. URL. Updated April 5, 2022. Accessed December 22, 2022.

5 ways to lower your A1C while treating diabetes

A1C is a blood test that shows how well your diabetes treatment plan is working. Here’s how to achieve a healthy A1C number and avoid the complications of diabetes.

A1C is a blood test that shows how well your diabetes care plan is working. Here’s how to achieve a healthy A1C number and avoid the complications of diabetes.

For some people, home blood sugar testing can be an important and useful tool for managing blood sugar levels on a daily basis. However, it gives an understanding of what is happening at the moment, rather than a complete picture of what has happened in the long run.

For this reason, your doctor may sometimes order a blood test that measures your average blood sugar over the past two to three months. This test, called the A1C test or the A1C hemoglobin test, provides another indication of how well your type 2 diabetes treatment plan is working.

How often do you need to take the A1C test?

If blood sugar levels remain stable, the American Diabetes Association recommends an A1C test twice a year. If your therapy has changed or you are not meeting your glycemic (blood sugar) targets, the association recommends getting tested four times a year. This simple blood draw can be done in your doctor’s office.

A1C test results provide insight into how your treatment plan is working and how it can be modified to better manage your condition. Often your blood sample is sent to a lab for results, although some doctors may use an A1C item for a medically assisted test, where a finger stick test can be done in the office, with results available in about 10 minutes. However, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD) notes that point-of-care tests should not be used for diagnosis, which can only be done with NGSP-certified lab tests. Any results indicating a change in your health must be confirmed by routine laboratory tests.

What do your A1C results mean?

The A1C test measures the level of glucose (blood sugar) in your blood by assessing the amount of so-called glycated hemoglobin. Hemoglobin is a protein in red blood cells. When glucose enters the bloodstream, it binds to hemoglobin, or glycates. The more glucose enters the blood, the higher the level of glycated hemoglobin.

According to the ADA, an A1C level below 5.7 percent is considered normal. An A1C between 5.7 and 6.4 percent signals prediabetes, according to the ADA. Type 2 diabetes is diagnosed when the A1C level is at or above 6.5 percent. For many people with type 2 diabetes, the goal is to get their A1C levels down to a healthier percentage.

Your A1C goal is specific to you. Several factors come into play, such as your age, how far you have developed diabetes, and any other health conditions you may have. If you can keep your A1C number below your target, you can help reduce your risk of complications from diabetes, such as nerve damage and vision problems.

What are the top tips for reducing A1C?

Your A1C score is an important part of the diabetes control picture.

1. Regular exercise

2. Eat a balanced diet

3. Follow a healthy eating and lifestyle schedule

4. Follow your doctor’s diabetes management plan

5. Check your blood sugar as directed by your doctor

Sources and References:
Voitkevich, AA Restorative processes and hormones / А.А. Voitkevich. – M.: Medicine, 2019. – 252 p.
Braverman, L.I. Diseases of the thyroid gland / L.I. Braverman. – M.: Medicine, 2019. – 850 c.
Dreval, A.V. Thyroid diseases and pregnancy / A.V. Dreval. – M.: Medicine, 2018. – 722 p.
Ivanova, V. Thyroid diseases and diabetes / V. Ivanova. – M.: Newspaper world, 2018. – 128 p.

Article checked by an expert:
general practitioner Oksana Nikolaevna Bocharovskaya details

Hba1c test cost | Vaidam Zdorovye

HbA1c usually means glycated hemoglobin. It is the form of hemoglobin after being attached to glucose units in the body. It is commonly used in people with diabetes because the HbA1c score is directly related to the risk of diabetes-related complications.

A1C is used to measure the amount of hemoglobin bound to glucose. Hemoglobin is present in red blood cells, which are responsible for transporting oxygen in the body. The average lifespan of hemoglobin cells is three months. Since normal fasting blood sugar may not always indicate the exact situation, therefore, it has now replaced HbA1C testing for the diagnosis and screening of prediabetes and diabetes.

How is it done?

HbA1c testing can be performed in the same way as any other blood test. A blood sample is taken from a finger or from a vein in the forearm. This blood is used to measure fasting plasma glucose levels.

Can HbA1c be wrong?

• In the past, HbA1c test results were not very accurate. Results will vary greatly depending on laboratory conditions. However, the National Glycohemoglobin Program was later developed to improve the accuracy of the tests. After following the guidelines, the results came in accurately and consistently.
• Accuracy is a relative term when it comes to A1C or blood glucose tests. There may be a 0.5 percent change in the actual value. For example, if your HbA1c is 6, the results may indicate a range of 5.5 to 6.5.
• In some cases, a blood glucose test shows that the patient has diabetes but Hb1Ac levels are normal. In such cases, doctors must repeat the test to confirm the diagnosis.
• Sometimes there may be a false report caused by conditions such as kidney failure, liver disease, or severe anemia.
• In addition, people of African, Mediterranean, or Southeast Asian ancestry sometimes have a rare type of hemoglobin that can interfere with A1c tests.
• A drop in red blood cells can also lead to a change in HbA1c.

For further understanding of results, click here.

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What happens if HbA1c is high?

Uncontrolled diabetes may be associated with the following conditions:

• Kidney failure
• Nerve damage
• Heart disorders such as stroke
• Eye damage
• Numbness or tingling in the legs
• Delayed wound healing and infections

In case of type 2 diabetes, that is, only at the initial stage, it can be significantly improved by lifestyle changes. However, if you are diagnosed with type 1 diabetes, you will need regular insulin injections.

What is a normal HbA1c level?

• For a normal healthy person who does not have diabetes, HbA1C levels lie between 4% and 5.6%.
• If levels exceed 5.6 to 6.4 percent, this indicates a high chance of developing diabetes.
• If HbA1c levels are greater than 6.5 percent or more, the patient has diabetes.

HbA1c values ​​can be used to indicate the status of a diabetic patient over a period of 3-4 months. This is because it doesn’t change often.

How can I quickly lower my HbA1c levels?

Because the normal Hba1 range is less than 7 percent. It is important to keep levels within the normal range. A healthy lifestyle is the main key to lowering HbA1c levels. By simply making the following changes, HbA1c levels can be reduced :

• Physical activity – It is important to exercise for at least 30 minutes a day, at least 5 days a week. The motive should be to increase your physical activity, which does not require formal exercise. You can walk, dance or play sports.
• Watch your diet – Diet plays an important role in maintaining sugar levels in the body. Eat more leafy vegetables, fruits, lean proteins for dinner. If you are taking any fats or complex carbohydrates such as potatoes, bread, etc., you must take a certain amount. It is very important to avoid processed and packaged foods as much as possible. It also includes canned drinks or juices containing artificial sweeteners. It is better to consult a nutritionist who will guide you according to the needs of your body.
• Follow a fixed routine – When it comes to proper diet, it is important to have a fixed time for each meal. Avoid skipping meals or overeating between meals. Talk to your doctor about the best time to eat and take your medications.
• Follow your treatment plan – Each patient has their own diabetes care plan. Treatment recommended by your doctor helps you take small steps towards curing your diabetes.
• Monitor your blood sugar regularly – Monitor your blood sugar regularly and plan your diet accordingly.

Is fasting required before an HbA1C test?

No. There is no need to fast before the test because the results do not fluctuate with or without food as it requires an average blood sugar level over 3 months or so.

Understanding the HbA1c 9 molecule0017

Let’s look at some details about HbA1c.

HbA1c or glycated hemoglobin is another form of hemoglobin that is attached to a sugar molecule. The presence of this sugar-Hb link directly indicates that there is an excess of sugar in the blood or that the person has diabetes. The process by which sugar binds to the hemoglobin molecule is known as glycation.

Hemoglobin is a protein molecule that consists of one globin and four hemes. Heme is composed of protoporphyrin IX and ferrous iron. The total body iron content is 0.338% with a molecular weight of 16.520.

Glycated hemoglobin is the most important measure for long-term analysis of blood sugar levels in diabetic patients. Since the average lifespan of red blood cells is approximately 4 months, the test values ​​are limited to a period of only three months. If the amount of glucose in the body is normal, this will result in a normal amount of glycated hemoglobin. An increase in plasma glucose levels leads to an increase in the production of glycated hemoglobin.

Can self-monitoring of blood glucose levels be replaced by an HbA1c test?

HbA1c is a critical test but cannot replace routine home monitoring. Self-monitoring includes regular checks on proper nutrition, exercise, medication, and stress management. HbA1c cannot provide you with exact values ​​as it provides an average value over a longer period of time. Both types of analysis give us different types of results. None of them can be replaced with each other.

HbA1c test cost in India

India is known as a medical center all over the world. Hundreds and thousands of people from all over the world choose to visit India to receive medical care. This is because the doctors here are highly qualified and have rich experience in their fields. Not only that, the infrastructure is well-equipped with world-class technology. These state-of-the-art technologies ensure that a medical condition is diagnosed with the utmost accuracy and that treatment is carried out with precision. Despite all this, the good news is that the prices for all types of surgery or radio imaging tests are much lower than in other countries.

The cost of HbA1c is about 500 – 1000 INR. The exact cost may vary depending on the type of city you’re being tested in, the doctor’s fees, the reputation of the hospital, the cost of living in the city, and many other factors.

How does Vaidam Health help you get the correct diagnosis and treatment in India?

As for international patients, everything is new and different as soon as they land in India. In such cases, it is important to have a guide that can help you plan your medical journey. That’s why a medical travel assistant company like Vaidam Health comes on the scene. Contacting a medical tourism company is a smart decision. They help arrange everything from low-cost treatment to travel and accommodation, including choosing the best doctors in India, assistance with money exchange matters, arranging language interpreters, etc. Vaidam Health is NABH (National Accreditation Council for Hospitals and Healthcare Providers) accredited and ISO certified.

Author name
kavrin
Last updated: December 20, 2022

Dr. Kavrin Arora

Dr. Kavrin studied medicine and has been actively studying medicine for several years practiced before deciding to share her knowledge through medical blogs and articles.