16 Causes & of High and Low Hemoglobin A1c (HbA1c) + Health Risks

Your hemoglobin A1c (HbA1c) indicates your long-term glucose levels and is used along with other markers to diagnose diabetes. Increased HbA1c in nondiabetics, apart from being a risk factor for diabetes, has also been associated with heart disease and elevated all-cause mortality. Read on to learn about the causes and health risks of high HbA1c.

High Hemoglobin A1c (HbA1c) Causes

High HbA1c Causes

Causes shown here are commonly associated with high HbA1c. Work with your doctor or another health care professional to get an accurate diagnosis. Your doctor will interpret this test, taking into account your medical history and other test results.

1) Diabetes

HbA1c ≥ 6.5% is a reliable indicator of diabetes [1].

Values over 5.6% indicate prediabetes.

In non-diabetic Japanese health-check examinees who were 30 – 79 years old, the incidence of diabetes increased with increasing baseline HbA1c [2]. In this and other studies, an HbA1c above 5.7% was a suitable value for predicting future diabetes [2, 3].

According to the American Diabetes Association (ADA), 9.3% of the American population is diabetic [4].

High HbA1c levels may reveal ongoing diabetes, while slightly higher levels predict future diabetes.

2) Being Overweight/Obese

Obesity is associated with impaired glucose tolerance and insulin resistance [5].

A positive energy balance, when there are more calories consumed than spent, is associated with higher HbA1c [6].

Higher body mass index (BMI), waist-to-hip ratio, and waist circumference were all linked to significantly higher HbA1c [7].

High HbA1c is linked with obesity, even in nondiabetics.

3) Smoking

Smoking increases HbA1c levels in both diabetic and nondiabetic people [8, 9].

4) Iron, Vitamin B12, or Folate Deficiency Anemia

Iron, vitamin B12, or folate deficiency anemia can all increase HbA1c levels, irrespective of blood glucose levels [10, 11, 12, 13, 14].

The effect is dependent on the degree of anemia, as a study found that those with mild anemia did not show significant effects on HbA1c [11].

The administration of the deficient nutrient usually decreases the HbA1c back to normal [12, 15]. However, these nutrient deficiencies often have non-dietary causes, such as bleeding or gut disease, that decrease nutrient absorption. That’s why it’s important to work with your doctor to address all underlying health issues.

Anemia due to iron, vitamin B12, or folate, deficiency can increase HbA1c levels, which go back to normal once the deficiency is corrected.

5) Chronic Disease

Some chronic conditions, such as periodontal (gum) disease, H. pylori infection, and chronic kidney disease increase HbA1c levels [16, 17, 18, 19, 20].

HbA1c levels are often correlated with CRP levels, which are a marker of chronic inflammation, increased in many chronic diseases [21, 22].

Gum Disease

Research suggests there is an association between oral hygiene practice and blood glucose levels in diabetes [23]. Individuals with better self-reported toothbrushing practices tend to have lower levels of blood glucose and HbA1c [23, 24].

An Indian study reported that tooth brushing twice daily was associated with good diabetes control (HbA1c < 6.0%) in both male and female adults with type 2 diabetes [23].

HbA1c is significantly elevated with periodontal (gum) deterioration even in nondiabetics [16, 17]. Studies show that treatments that improve gum inflammatory conditions helped decrease HbA1c levels [25, 26].

H. pylori Infection

Chronic H. pylori infection was associated with high levels of HbA1c and type 2 diabetes in the elderly [18].

A study showed that H. pylori eradication treatment had beneficial effects on insulin resistance and favorably changed HbA1c in patients with normal glucose concentrations [19].

Chronic Kidney Disease

In patients with elevated blood urea due to kidney failure, there is an elevated production of carbamylated hemoglobin, which can make HbA1c results inaccurate [27, 28].

People with chronic diseases and those experiencing chronic inflammation tend to have higher HbA1c levels.

6) Sleep Disorders

Both short and long sleep durations were associated with an increased HbA1c. Similarly, poor sleep quality was associated with a higher HbA1c [29].

The presence of sleep apnea and lower levels of oxygen in the blood were associated with higher HbA1c levels in patients with type 2 diabetes [30]. Sleep apnea is a sleep disorder characterized by pauses in breathing or periods of shallow breathing during sleep.

Type 1 diabetes patients with moderate-to-severe obstructive sleep apnea had a trend toward higher HbA1c [31].

Even in nondiabetic men with obstructive sleep apnea, high HbA1c levels were associated with a more severe disorder [32].

Getting too little or too much sleep is linked with higher HbA1c. Diabetics with sleep apnea also tend to have higher levels.

7) Some Genetic Hemoglobin Disorders

Some genetic hemoglobin disorders can falsely increase HbA1c levels, depending on the methods that a laboratory uses for testing [14].

8) Some Drugs

Opiates

Chronic opiate use has been reported to increase HbA1c levels, but the exact mechanism remains unknown [15].

In a study that compared 1.6k people with and 2.8 k people without substance abuse, HbA1c level was elevated in those with substance abuse [33].

Statins

The use of high-potency statins may increase HbA1c levels in people with or without diabetes [34]. A study has shown that In people with diabetes, HbA1c increased by 0.4% after high-potency statin use [34].

Studies also suggest that there is an increased risk of new-onset diabetes with statin use [34]. The effects, though, may vary by drug. HbA1c was significantly increased after 3 months in patients receiving atorvastatin, while levels remained unchanged in those receiving pitavastatin [34].

9) High Bilirubin Levels

An increase in bilirubin levels (hyperbilirubinemia) that often accompanies liver disease can result in falsely elevated HbA1c levels [14].

10) Alcoholism

Heavy alcohol use can falsely increase HbA1c levels. This happens because alcohol products react with hemoglobin in the blood forming hemoglobin-acetaldehyde (HbA1-AcH), which can be mistakenly measured as HbA1c [14, 35, 36].

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401751/

Health Risks of High Hemoglobin A1c (HbA1c)

1) Diabetes Complications

A study showed that the incidence of impaired eye and kidney function in 451 patients with type 1 diabetes increased sharply and happened earlier on with increasing HbA1c. None of the patients developed these complications when HbA1c was below 7.6% [37].

The variability of HbA1c levels is equally important. Unstable levels increase the risk of kidney and eye disease and even lower extremity amputation in patients with diabetes [38, 39, 40, 41].

High HbA1c was also associated with nerve pain. In a study of 417 diabetics, those reporting pain were more than twice as likely to have HbA1c levels > 8% (64 mmol/mol) [42].

Both high HbA1c levels and their variability (instability), could predict the development of kidney disease in T1DM and T2DM patients [38].

People with diabetes and unstable or high HbA1c levels are at a greater risk of complications, such as kidney disease, eye disease, and chronic nerve pain.

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2) Cognitive Impairment

Higher HbA1c was associated with poor cognitive performance in a study of over 1100 healthy middle-aged people [43].

Higher levels were also associated with poorer baseline episodic memory and greater episodic memory decline in 2 studies with over 5k adults [44, 45]. This association was more pronounced in women [45].

Memory and learning problems in 233 children and adolescents were associated with HbA1c > 8.8% (73 mmol/mol) [46].

High levels of HbA1c have been linked with poor cognition, forgetfulness, and learning problems.

3) Dementia

Higher levels of HbA1c have been associated with an increased risk of dementia and Alzheimer’s in the elderly.

In a study of over 1.3k elderly, HbA1c levels ≥6.5% were associated with a 2.8-fold increased risk of all-cause dementia and Alzheimer’s. HbA1c levels ≥7% were associated with a 5-fold increased risk of all-cause dementia and a 4.7-fold increased risk of Alzheimer’s [47].

Higher HbA1c levels have been linked with an increased risk of dementia and Alzheimer’s disease.

4) Hardening of the Arteries (Atherosclerosis)

There is an interwoven relationship between unsatisfactory blood sugar levels, low-grade inflammation and low HDL cholesterol on the hardening of the arteries in type 2 diabetes [48].

In 77 adolescents with type 1 diabetes, arterial stiffness was directly related to high HbAc1 [49].

Arterial stiffness positively correlated with both HbA1c and duration of diabetes in 1000 subjects with diabetes and elevated blood pressure [50].

High HbA1c was also associated with a higher atherosclerotic burden in nondiabetic patients. In 6.5 nondiabetics, high-normal HbA1c levels were independently associated with arterial stiffness [51, 52].

Both diabetics and nondiabetics with higher HbA1c values are more likely to have hardened arteries.

5) Heart Disease

Increased risk of heart disease was found with higher HbA1c levels in both those with established diabetes and in non-diabetic adults [53, 54, 55].

HbA1c showed a direct correlation with blood cholesterol, triglycerides, and LDL in diabetic patients. All three are risk factors for heart disease [56].

Chronically elevated glucose, measured by HbA1c, was also disruptive for the heart function [57].

However, lower HbA1c was also reported to increase the risk of cardiovascular disease in some studies. In one study of over 8.6k people, both HbA1c < 6% as well as HbA1c > 10% were independently associated with the risk of heart failure [58].

Even slight increases in HbA1c levels can increase the risk of heart disease in people with diabetes.

6) Fatty Liver

Fatty liver is associated with higher HbA1c [59].

In nondiabetic individuals, the risk for non-alcoholic fatty liver disease (NAFLD) increased with increasing HbA1c levels, independent of obesity and other metabolic components [60, 61].

In another study, the prevalence of NAFLD was significantly higher in subjects with HbA1c ≥ 6.5% [61].

7) Fatigue (in Diabetes)

About three-quarters of patients with type 1 diabetes suffer from persistent fatigue. Higher HbA1c was weakly associated with fatigue [62].

In patients with type 2 diabetes, with an HbA1c greater than 7%, fatigue was indirectly related to HbA1C. This relationship was mediated through diabetic symptoms, depression and diabetes distress [63].

People with type 1 and 2 diabetes who have high HbA1c levels are more likely to suffer from fatigue.

8) Anxiety and Depression (in Diabetes)

In over 800 diabetics, depressed mood, sleeping difficulties, appetite problems, and suicidal ideation correlate with higher baseline HbA1c levels and higher HbA1c values at 1-year follow-up. These associations were more pronounced in type 1 diabetes than in type 2 diabetes patients [64].

High levels of HbA1c (HbA1c≥9.0%) were associated with a greater risk of anxiety and depression in a study of 491 African diabetic men [65].

Diabetics with higher HbA1c levels are at an increased risk of anxiety and depression.

9) Bone Loss (in Diabetics)

Bone loss is a complication of diabetes characterized by osteoporosis, increased risk for bone fractures and alterations in bone metabolism [66].

Osteocalcin (OC) is a bone-specific protein produced by bone cells, involved in the regulation of glucose and energy metabolism [66]. This is a bone-building protein and correlates well with a person’s bone mineral density (BMD). In type 1 diabetes of long duration, lower osteocalcin in the blood was associated with higher HbA1c [66].

Similarly, in type 2 diabetic patients, lower bone mineral density was associated with higher HbA1c [67].

Also, higher bone resorption was independently associated with higher HbA1c in women [68].

Higher HbA1c levels are linked with bone loss, which is especially dangerous for people with diabetes.

10) Hearing Loss

High HbA1c was associated with increased hearing loss in a study of 7. 5 nondiabetics [69].

11) Irregular Menstrual Cycles

In one study, girls with type 1 diabetes and HbA1c levels of 7.6 – 8.9% had increased cycle duration, menstrual cycle variability, and infrequent periods (oligomenorrhea). For each point of increase in HbA1c, the menstrual cycle duration increased by 5.1 days [70].

Girls with type 1 diabetes and high HbA1c levels are more likely to experience irregular or long menstrual cycles.

12) Cancer

Studies report that higher HbA1c levels are associated with higher incidence and/or mortality risk of cancers. In a systematic review of 19 studies, elevated HbA1c levels were associated with a higher risk of developing colorectal, pancreatic, respiratory and female genital tract cancers [71].

In a study of over 300 people with colorectal cancer those with poorly controlled type 2 diabetes, with HbA1c > 7.5, had more advanced colorectal cancer, a younger age of onset and poorer 5-year survival. Additionally, in patients with type 2 diabetes who have colorectal cancer, unsatisfactory blood sugar levels are associated with a clinically more aggressive course of the disease [72].

According to some studies, both diabetics and nondiabetics with high HbA1c are at an increased risk of cancer. High levels might also predict worse cancer outcomes.

Low Hemoglobin A1c (HbA1c) Causes

Low HbA1c Causes

Causes shown here are commonly associated with low HbA1c. Work with your doctor or another health care professional to get an accurate diagnosis. Your doctor will interpret this test, taking into account your medical history and other test results.

1) Conditions that Decrease or Destroy Red Blood Cells

Conditions that decrease the number of red blood cells, such as blood loss, donation, or transfusion can falsely decrease HbA1c levels despite possibly elevated blood glucose [15, 73].

Destruction of red blood cells (hemolysis) that can occur in infections, autoimmune diseases, tumors, and as a side effect of some drugs also decreases HbA1c [15].

An enlarged spleen is another condition that destroys red blood cells and decreases HbA1c [14].

2) Alcoholism

Excessive alcohol consumption can decrease HbA1c levels despite elevated blood glucose because it may interfere with the binding of glucose to hemoglobin. It also may have an effect by lowering blood glucose levels [74, 75, 76].

3) Liver Disease

HbA1c can be lower in chronic liver disease [77].

The mechanisms involved are still not known, but scientists suggest it may be a combination of abnormal red blood cell turnover and function (e.g., anemia and iron overload) and viral infection [77].

4) Pregnancy

HbA1c can be lower in the second trimester of pregnancy [14].

5) Some Drugs and Supplements

Any drug which causes the rupture or destruction of red blood cells can potentially lower HbA1c by increasing the proportion of younger cells in the blood. Dapsone, ribavirin, antiretroviral, and sulfonamide drugs have all been reported to reduce the HbA1c in this manner [15].

Hydroxyurea is used for the treatment of some leukemias and sickle cell disease. This drug can significantly reduce the number of blood cells and causes a decrease in HbA1c levels [15].

Chronic use of aspirin has been reported to falsely decrease HbA1c [15]. However, aspirin can also modestly, in a way that is not clinically relevant, increase HbA1c levels in some cases [78].

Vitamin E can decrease the binding of glucose to hemoglobin, falsely decreasing HbA1c [14].

6) Some Genetic Hemoglobin Disorders

Some genetic disorders such as sickle cell anemia and thalassemia can cause falsely low HbA1c, depending on the method the laboratory uses for the test [15].

Low HbA1c can be caused by conditions that decrease red blood cell levels, alcohol, liver disease, some drugs and supplements, and genetic hemoglobin disorders.

Hemoglobin A1c and Lifespan

Several studies observed that higher HbA1c levels (≥6.5%, 48 mmol/mol) were associated with increased mortality, whereas others failed to find any significant associations with mortality across the whole HbA1c range. Furthermore, some studies also found increased mortality in people with lower HbA1c values [79].

High HbA1c May Increase Mortality

Higher HbA1c levels were associated with increased mortality from all causes among nondiabetics, in a meta-analysis of 11 studies with over 113k people [79].

A study of over 2.1k people who had a stroke reported that the risk for all-cause mortality was significantly increased when HbA1c level was > 5.5% compared to HbA1c < 5.5%, and it further dramatically increased 2 – 3 times in the highest HbA1c group ≥ 7.2% [80].

The American Diabetes Association (ADA) estimated that the risk of diabetes-related mortality increased by 25% for each 1% increase in HbA1c. It has also been estimated that each percentage point increase in HbA1c corresponds to a 35% increase in the risk of heart disease and an 18% increase in the risk of heart attack [56].

Why does elevated HbA1c relate to mortality? Ample evidence shows that elevated glucose can increase oxidative stress. Oxidative stress then damages blood vessels, contributing to heart disease. Oxidative stress can also damage DNA, potentially resulting in gene mutation and cancer development [79].

High HbA1c points to high glucose, which increases oxidative damage and may reduce lifespan in both diabetics and nondiabetics.

Low HbA1c May Also Increase Mortality

Increased mortality was also reported for HbA1c levels below the optimal range in diabetics. Some reported an increased risk for heart disease or death among nondiabetic subjects with HbA1c levels below 4.0% (20 mmol/mol), 4.8% (29 mmol/mol), 4.9% (30 mmol/mol) or 5.0% (31 mmol/mol) [81, 82].

Some explanations for the low HbA1c and mortality relationship, include: being underweight or malnourished, inflammation, anemia, high alcohol consumption, liver disease and chronic kidney failure [81].

It appears that malnutrition, inflammation, and functional decline are characteristics shared by the populations that showed increased mortality and low HbA1c. Thus, frailty or decline may be the main confounding factor explaining the relationship between increased mortality risk and low HbA1c [83].

In one study, where HbA1c < 5% was associated with adverse outcomes in nondiabetic people, a link to inflammation and autoimmunity was suggested [82].

Lower than normal HbA1c levels have been linked with increased mortality, possibly because they point to frailty, autoimmune inflammation, or inadequate nutrition.

Takeaway

Though HbA1c is a direct measure of long-term sugar levels, diabetes is not the only cause of high values. Sleep disorders, gum disease, H. pylori infections, chronic inflammation, and anemia can also increase HbA1c. Additionally, high levels are linked with metabolic syndrome and obesity, which often progress to type 2 diabetes. High HbA1c levels can have many negative effects on your health, whether you have diabetes or not. People with high levels are at an increased risk of dementia, heart disease, kidney disease, mental health problems, fatigue, and bone loss. Scientists think HbA1c levels might also impact a person’s lifespan. Both above and below normal levels have been linked with increased mortality, but it’s still too early to say why or to what extent. Keeping your levels in the normal range is the best step you can take to lower your overall risk of health problems.

What Now?

Read our other posts to learn about:

Can you have a high A1C and not be diabetic?

If your blood sugar has ever surged up or you experience a regular surge in your sugar level, your doctor will probably recommend you to get an A1C test to see if you might have type 2 diabetes or prediabetes.

What is A1C and A1C test?

A1C or hemoglobin A1C Is a protein that resides in red blood cells and carries oxygen to the rest of your body. Moreover, since glucose is in your blood, these hemoglobins affix themselves to the glucose and become Haemoglobin AIC or HbA1C. When your sugar level surges, it means you have higher levels of hemoglobin AIC in your blood.

So, what do the doctors do in this regard? Well, most of the GPs recommend such patients to take the A1C test. An A1C test is a sugar level test that, over the last 3 months, measures the level of blood sugar levels in your blood. If the AIC test comes higher, it means you have a higher level of glucose or sugar in your blood. Typically, the sugar level should be less than 5.7%.

So, what if your test says you have a higher level of A1C but you do not have diabetes?

Yes, some conditions may raise the level of A1C in your blood, but that does not mean you have diabetes. According to a study by Elizabeth Selvin, a single elevated A1C level greater than 6% was found in the general population with no history of diabetes. Such adults may have compromised fasting glucose or other cardiovascular diseases. Other factors that contribute to higher levels of A1C in no-diabetic patients are:

Anemia:

A lack of iron, vitamin B12 can also falsely level up your A1C test results. This means your body is not making new blood cells, and older ones with glucose are floating around.

Kidney diseases and disorders:

Many kidney diseases usually lower the levels of vitamins and minerals, causing anemia, which may cause a rise in your A1C level. Uremia, a condition where the blood develops high Urea levels, can also falsely increase A1C level.

High Triglycerides

High levels of triglycerides (a fat in the blood that does not convert into calories and forms into triglycerides) may result in a spike in your A1C test result.

Spleen disorders:

Spleen’s primary function is to remove old blood cells from your bloodstream. When you go through splenectomy or other spleen disorder, i.e., sickle cell disease or asplenia, this function is lost, which means the old blood cells float around for a while resulting in a higher level of A1C.

Thyroid disorders:

Lower levels of thyroid hormones (hypothyroidism) can also erroneously increase A1C levels.

Certain medications:

Certain medications and their long-term use (aspirin, opioids such as morphine, fentanyl, hydrocodone, and hydromorphone, among others) can also misleadingly increase A1C level.

Donated Blood:

Donated blood in your system can also give incorrect (higher or lower levels) of A1C results. According to a study by (Angelique et al.), blood donations can give incorrect readings and impact the level of hemoglobin in diabetic and non-diabetic patients, thus affecting the checking of diabetes.

Interestingly, your ethnicity can also affect your A1C result.

Everyone has a different type of hemoglobin, depending on their ethnicity. A1C test works best with type A hemoglobin. Hemoglobin variants such, C, D or E, can affect the precision of A1C as well (higher level or low levels).

It is crucial to note that the A1C test is not always accurate. Repeated checks can give higher or lower measurements for the same blood samples. Doctors rely on other tests as well called fructosamine blood tests. This test gives an extended-term assessment of your sugar level.

To view the list of factors that may cause a high A1C result, please click here.

Do you need more information on the Haemoglobin A1C blood test, please click here

What Do Your Fasting Blood Glucose and Hemoglobin A1c Levels Mean?

Blood glucose (aka “blood sugar”) serves as the primary energy source for our brain and body. Healthy blood glucose levels are therefore essential for maintaining overall health and longevity. Unfortunately, several factors including the Standard American Diet and a sedentary lifestyle can increase glucose beyond normal levels, and over time, result in prediabetes and type 2 diabetes. If undetected, consistently high glucose can lead to long-term health complications, including nerve damage, cardiovascular disease, and kidney failure. This article explains the two most common blood tests (fasting blood glucose and hemoglobin A1c) used to detect abnormal glucose levels and ways to properly regulate them.

Glucose normally fluctuates throughout the day, particularly after meals. On a typical diet, we consume 45-60% of our calories from carbohydrates, which the body converts into glucose for fuel. When glucose enters our bloodstream, the pancreas receives a signal to release a hormone called insulin. As you can see below, insulin acts as a “key,” allowing glucose to funnel out of the bloodstream and into our cells. As this process continues, blood glucose levels drop back down to a normal range.

We can measure glucose levels with a fasting blood glucose (FBG) test. An FBG measures blood glucose concentration at a single point in time and provides a glimpse into your body’s efficiency at regulating your blood sugar. An FBG test requires fasting for at least 8 to 12 hours beforehand for an accurate depiction. Routine blood tests ordered by your physician, such as basic and comprehensive metabolic panels, include an FBG test.  

Fasting Blood Glucose Ranges [1]

• Normal range: 65-99 mg/dL
• Prediabetes: 100-125 mg/dL
• Diabetes: 126mg/dL or higher on two separate tests

Healthy glucose levels are associated with better weight control, increased energy, and improved mood and cognition. High FBG after eight to 12 hours without eating indicates an issue with glucose regulation, and should be discussed with a physician.

When FBG levels are high, physicians typically order a hemoglobin A1c, or HbA1c, test to gain more insight into someone’s overall health. Unlike FBG tests, which are only meant to look at short-term health, your HbA1c value reflects your average blood glucose concentration over the previous three to four months. Here’s why. 

As glucose builds up in the blood, it binds to hemoglobin, a protein found in red blood cells. Since glucose remains attached to hemoglobin throughout its life (90-120 days), HbA1c provides insight into your long term glucose exposure. The higher the glucose in your bloodstream, the more glucose will attach to hemoglobin, thus, the higher your HbA1c. HbA1c is reported as a percentage: the greater the percentage, the greater your blood glucose level. 

Hemoglobin A1c Ranges [1]

• Normal range: below 5. 7%
• Prediabetes: 5.7-6.4%
• Diabetes: over 6.4% 

As a rule of thumb, every 1% change in HbA1c results in an approximate 30 mg/dL change in glucose.[2] 

As previously mentioned, insulin is essential for properly regulated glucose levels. But several factors, including some outlined below, interfere with insulin’s effect, either by weakening its signal or making cells less responsive to it. 

Excess body weight—Excess body fat is a major contributor to insulin resistance.[3] The accumulation of fat, especially visceral fat (the kind that surrounds our internal organs), directly interferes with insulin signaling. This results in raised blood glucose and HbA1c levels, and therefore poses a risk for type 2 diabetes. Maintaining a healthy weight is imperative to well-controlled glucose levels. Even a 5-10% reduction in body weight can significantly improve glucose levels in overweight individuals.[4] 

Meat intake—Several studies consistently show a link between the consumption of meat and the incidence of type 2 diabetes. A 2015 meta-analysis—a study that reviews multiple studies at once—examined the meat intake of over 50,000 people. They found that the consumption of both processed and unprocessed meat was associated with higher fasting glucose levels.[5] One explanation for this outcome may be due to red meat’s high content of saturated fat. When examining saturated fat specifically, its high intake also increases one’s risk of developing type 2 diabetes.[6] It could also be due to the high content of iron in red meat, which interferes with insulin signaling.[19]  

Low fiber & high sugar intake—The majority of Americans do not reach the recommended intake of dietary fiber. Fiber is a nutrient found in all plant-foods, but humans do not contain the necessary enzymes to break it down for digestion. As a result, fiber goes undigested in our body, and foods high in fiber tend to keep us full for longer. Multiple studies show that a fiber-rich diet leads to an overall decrease in calorie intake and weight loss, and reduces your risk of developing diabetes. You should aim for at least 25-38 grams of fiber per day – that’s around 2 cups of black beans or 3 cups of raspberries. Low fiber intake is often coupled with high sugar intake. Sugar is not only found in juice, soda, and candy but it’s also added to salad dressings, nut butters, yogurt, and even bread. Several studies indicate that excess sugar intake can result in increased fat, especially in the stomach region and liver.[21] Excess fat, especially in these areas, can increase one’s HbA1c and risk for diabetes. 

Because an FBG test measures your glucose levels at a single point in time, it is more susceptible to your daily or weekly actions. If your HbA1c is normal but your blood glucose is above optimized, it could be due to one of the reasons below.  

Sleep deprivation—There’s evidence that poor sleep patterns impair glucose metabolism. People on restricted sleep demonstrate worsened insulin response to food, resulting in higher blood glucose spikes. In one study, sleep-deprived people had higher glucose and insulin levels after consuming breakfast compared to those who slept a healthy eight hours.[7] Other studies confirm this finding—insulin resistance is more common in people deprived of sleep.[8-9] 

Stress—The body releases a steroid hormone called cortisol to activate our “flight-or-fight” responses to counteract acutely stressful situations. Cortisol stimulates the release of blood glucose by breaking down its storage form, glycogen. If you’ve experienced a stressful week, good chances are your blood sugars may be slightly higher than normal. 

Food—Because glucose fluctuates after meals, we recommend fasting for a full 12 hours prior to getting a blood test for an accurate reading. This means water only, not even black coffee. People react differently to coffee so we suggest to err on the side of caution and stick to just water.

Maintaining a healthy weight, limiting meat intake, and getting a good night’s sleep all contribute to better glucose control. However, several other lifestyle changes can help, too. 

Adopt a more vegetarian diet, including beans & nuts—Vegetarian diets are inversely associated with the risk of developing type 2 diabetes.[10] In a meta analysis comparing nine different experiments, researchers found that vegetarian diets consistently improved fasting blood glucose and HbA1c.[11] Why? They generally emphasize a diet rich in whole grains, fruits, vegetables, beans, and nuts, and lower levels of saturated and trans fat. Plus, beans often replace meat in these diets by acting as a protein source. Thanks to their high fiber content and low glycemic index (i.e. they don’t cause a blood sugar spike), beans stabilize blood glucose and insulin levels.[12] So individuals with type 2 diabetes may notice significantly lower A1c levels if they increase their bean intake to at least one cup per day.[13] Similar to beans, nuts are low glycemic and help regulate blood sugar levels. In a recent experiment, people who replaced some of their food with a serving of nuts saw improved glycemic control and HbA1c levels. [15] On a grander scale, eating nuts has an inverse association with type 2 diabetes—that is, people who include nuts in their daily lives tend to have a lower risk of developing diabetes.[16-17] 

Exercise—Exercise is a crucial component in managing glucose and insulin levels. It directly improves blood glucose control, increases insulin sensitivity, and helps maintain a healthy weight.[14] Exercise is a very effective tool in preventing the development of type 2 diabetes. 

Practice mindfulness—Incorporating mindfulness into your daily routine can improve both glucose and cortisol levels. [20] Start by practicing mindfulness for 5 minutes at a time and gradually increase this time to 30 minutes or more per day. 

Prep more meals at home—Takeout and restaurant food are typically higher in calories and saturated fat, both of which we know can increase blood glucose levels. Cooking meals at home allows you to control what goes into your food and generally leads to healthier glucose and insulin levels. [18] 

Consider supplements—Lastly, certain supplements may help lower your blood glucose as well. You can find them here. 

Your physician will routinely measure your glucose at annual check-ups, but it usually stops there. InsideTracker tests your blood, pulls data from thousands of studies, and combines this information with your unique characteristics to deliver personalized recommendations for you to incorporate into your daily life. 

• Maintain a healthy weight
• Limit red meat and sugar intake
• Get 8 hours of sleep each night
• Try a vegetarian diet (at least some days)
• Maintain an exercise regimen
• Incorporate nuts and beans into your diet
• Make more meals at home
• Practice mindfulness
• Consider adding the right supplements for you

Learn how your biomarkers affect your body in this FREE e-Book download!

Hemoglobin A1c | Labcorp

View Sources

Sources Used in Current Review

2018 review completed by Alina G. Sofronescu, PhD, NRCC-CC, FACB.

2018 American Diabetes Association Standards of Care (January 2018). Available online at https://diabetesed.net/wp-content/uploads/2017/12/2018-ADA-Standards-of-Care.pdf. Accessed June 2018.

(April 2018) National Institute of Diabetes and Digestive and Kidney Disease. The A1C Test & Diabetes. Available online at https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis/a1c-test. Accessed June 2018.

Sacks D, et. al. Refining Measurement of Hemoglobin A1c. Clinical Chemistry Sep 2017, 63 (9) 1433-1435.

Sources Used in Previous Reviews

2015 reviewer: Irene Shu, PhD, DABCC, Assistant Laboratory Director, USDTL.

American Diabetes Association (2015). Standards of Medical Care in Diabetes. Diabetes Care, Volume 38, Supplement 1. Available online at http://professional.diabetes.org/admin/UserFiles/0%20-%20Sean/Documents/January%20Supplement%20Combined_Final. pdf. Accessed on 8/11/2015.

Diabetes.co.uk. Diabetes Symptoms: The Big 3 Signs. Available online at http://www.diabetes.co.uk/The-big-three-diabetes-signs-and-symptoms.html. Accessed on 8/11/2015.

(August 10, 2015) U.S. Food and Drug Administration IVD OTC-Over the Counter Database. Available online at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfIVD/Search.cfm. Accessed on 8/11/2015.

National Glycohemoglobin Standardization Program, NGSP. Convert between NGSP, IFCC, and eAG. Available online at http://www.ngsp.org/convert1.asp. Accessed on 8/11/2015.

(Updated May 2015) National Glycohemoglobin Standardization Program. Factors that Interfere with HbA1c Test Results. Available online at http://www.ngsp.org/factors.asp. Accessed on 8/11/2015.

Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby’s Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc. , Saint Louis, MO.

(2002 May 01, Updated). Other Diabetes Management Tests, Glycosylated Hemoglobin. Diabetes Information, U.S Food and Drug Administration [On-line information]. Available online at http://www.fda.gov/diabetes/glucose.html#18.

(1995-2004). Diabetes Mellitus. The Merck Manual of Medical Information-Second Home Edition [On-line information]. Available online at http://www.merck.com/mmhe/sec13/ch265/ch265a.html?qt=Diabetes&alt=sh.

Mbanya, J. et. al. Working Group Members (2004 January 20). Report of the ADA/EASD/IDF Working Group of the HbA1c Assay. EASD All News [On-line Report]. Available online at http://www.easd.org/. (Click “All News” and “2004/05”).

A.D.A.M., Updated (2003 October 10, Updated). HbA1c. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003640.htm.

(2004 June). 2004 NGSP Clinical Advisory Committee Meeting. American Diabetes Association 64th Annual Scientific Sessions, June 2004. NGSP, What’s New [On-line information]. Available online at http://www.missouri.edu/~diabetes/ngsp/indexwn.html.

Pagana, Kathleen D. & Pagana, Timothy J. (© 2007). Mosby’s Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 503-505.

Little, R., Nathan, D. and Sacks, D. (2008 December 9). Hemoglobin A1c: New Uses for Today and Possibilities for Tomorrow. AACC [Audioconference].

Holt, E. (2008 June 17, Updated). HbA1c. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003640.htm. Accessed on 12/13/08.

American Diabetes Association. A1C test. [On-line information]. Available online at http://www.diabetes.org/type-1-diabetes/a1c-test.jsp. Accessed on 12/13/08.

(2008). But What Does My A1C Level Really Mean? American Diabetes Association [On-line information]. Available online at http://www.diabetes.org//diabetes-research/summaries/nathan-what-a1c-level-means.jsp. Accessed on 12/13/08.

Nathan, D. et. al. (2008 June 7). Translating the A1C Assay Into Estimated Average Glucose Values. Diabetes Care 31:1473-1478, 2008 DOI: 10.2337/dc08-0545 [On-line journal]. Available online at http://care.diabetesjournals.org/cgi/content/abstract/31/8/1473. Accessed on 12/14/08.

Crandall, J. (2007 May, Revision). Diabetes Mellitus. Merck Manual for Healthcare Professionals [On-line information]. Available online at http://www.merck.com/mmpe/sec12/ch258/ch258b.html?qt=diabetes&alt=sh#sec12-ch258-ch258b-1159. Accessed on 12/14/08.

Consensus Committee (2007 September). Consensus Statement on the Worldwide Standardization of the Hemoglobin A1c Measurement. Diabetes Care v30 (9). [On-line journal]. PDF available for download at http://www.ifcc.org/4dc9925consensus.pdf.

Kahn, R. and Fonseca, V. (2008 August). Translating the A1c Assay. DiabetesCare v 31(8) [On-line information]. PDF available for download at http://professional.diabetes.org/Content/Editorial.pdf. Accessed on 12/14/08.

(2007 November). Sickle Cell Trait and Other Hemoglobinopathies and Diabetes: Important Information for Physicians. National Diabetes Information Clearinghouse [On-line information]. Available online at http://diabetes.niddk.nih.gov/dm/pubs/hemovari-A1C/index.htm. Accessed on 12/14/08.

S11 (2008). Q&A Estimated Average Glucose: an alternative to A1C. American Diabetes Association [On-line information]. Available online at http://professional.diabetes.org/GlucoseCalculator.aspx. Accessed on 12/21/08.

American Diabetes Association. Executive summary: standards of medical care in diabetes—2010. Jan 2010. Diabetes Care 33: S4-S10.

(January 2010) The Endocrine Society Statement on the use of A1c for Diabetes Diagnosis and Risk Estimation. PDF available for download at http://www.endo-society.org/advocacy/upload/TES-Statement-on-A1C-Use.pdf. Accessed January 2010.

(Updated 2012 June 19). The A1C Test and Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [On-line information]. Available online at http://diabetes.niddk.nih.gov/dm/pubs/A1CTest/. Accessed October 2012.

Topiwala, S. (Updated 2012 April 29). HbA1c. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003640.htm. Accessed October 2012.

Horowitz, G. (Updated 2012 January 6). Hemoglobin A1c Testing. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/2049478-overview#showall. Accessed October 2012.

(© 1995-2012). A1C. American Diabetes Association [On-line information]. Available online at http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c/. Accessed October 2012.

(© 1995-2012). Hemoglobin A1c, Blood. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/82080. Accessed October 2012.

(Updated 2011 November 4). For People of African, Mediterranean, or Southeast Asian Heritage: Important Information about Diabetes Blood Tests. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [On-line information]. Available online at http://diabetes.niddk.nih.gov/dm/pubs/traitA1C/index.aspx. Accessed October 2012.

Pagana, K. D. & Pagana, T. J. (© 2011). Mosby’s Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 508-510.

Inzucchi, S. et. al. (2012 April 19 Online). Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach, Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012;35:1364–1379. [On-line information]. PDF available for download at http://care.diabetesjournals.org/content/early/2012/04/19/dc12-0413.full.pdf. Accessed October 2012.

2010 Consensus Statement on the Worldwide Standardization of the Hemoglobin A1c Measurement. Ragnar Hanas and Garry John, on behalf of the International HbA1c Consensus Committee. Published May 27, 2010. Latest version available online at http://www.clinchem.org/cgi/doi/10.1373/clinchem.2010.150540. Accessed October 2012.

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(2013©) American Diabetes Association. Diabetes Basics, Diagnosing Diabetes and Prediabetes. Available online at http://www.diabetes.org/diabetes-basics/diagnosis/?loc=DropDownDB-diagnosis. Accessed May 2012.

Hemoglobin A1C Article

Introduction

The hemoglobin A1c (glycated hemoglobin, glycosylated hemoglobin, HbA1c, or A1c) test is used to evaluate a person’s level of glucose control. The test shows an average of the blood sugar level over the past 90 days and represents a percentage. The test can also be used to diagnose diabetes.[1]

Hemoglobin is a protein only found in red blood cells. In fact, hemoglobin is what gives blood its bright red coloring. Since red blood cells live about an average of three months, the A1c test will reflect those red blood cells that are present in the bloodstream at the time of the test; this is why the A1c serves as an average of blood sugar control.

The main job of hemoglobin is to carry oxygen from the lungs to all the cells of the body. Hemoglobin becomes glycated or coated with glucose from the bloodstream. The amount of glucose that is present in the blood will attach to the hemoglobin protein, and increased glucose levels will reflect on the surface of the hemoglobin protein, thereby rendering a higher A1c level.[2]

Etiology and Epidemiology

The Diabetes Control and Complications Trial (DCCT)[3] was a landmark trial that provided a wealth of data on A1c and its correlation to blood glucose levels, as well as establishing specific treat to target A1c goals. From the completion of the trial, the National Glycohemoglobin Standardization Program (NGSP) was formed to define a standardized assay that was usable across laboratories.  

The DCCT trial reported that a higher mean A1c level was the dominant predictor of diabetic retinopathy progression. Tighter control shown by levels of HbA1c in the 7% range or lower, were correlated with 35-76% decrease in microvascular complications, like retinopathy, nephropathy and neuropathy, in patients with type 1 diabetes. In addition to the determination of A1c levels predicting progression of microvascular complications, the extension of DCCT into EDIC study showed benefit in the cardiovascular risk and mortality in the longterm for those patients with lower levels of HbA1c.[4][5][6]

Pathophysiology

People with diabetes need to have their A1c checked regularly to determine if their average blood glucose levels are within the target range. The American Diabetes Association (ADA) recommends that the HbA1c is checked twice a year in patients that are stable and well controlled, versus every 3 months in patients with changes in their medications, or not well controlled. [7]

Specimen Requirements and Procedure

The HbA1c test can either be done as a point of care (POC), STAT test, or by sending a sample to a laboratory. The POC test uses a STAT analyzer that evaluates the A1c from a capillary fingerstick. The laboratory test uses a teaspoon of blood drawn from a venous sample into a K2 EDTA (lavender top) tube. The sample gets processed as whole blood.

Diagnostic Tests

The venous sample A1c test may be used as a diagnostic tool in clinical practice when determining diabetes risk or onset. Due to the variability of capillary point of care testing, any A1c done by capillary sample should be confirmed with a venous sample before rendering the diagnosis.

For an HbA1c test to classify as normal, or in the non-diabetic range, the value must be below 5.7 %. Anyone with an HbA1c value of 5.7 % to 6.4 % is considered to be prediabetic, while diabetes can be diagnosed with a HbA1c of 6.5% or higher.

Tests should be sent to a laboratory certified by the NGSP to ensure results are standardized.[8][9]

Testing Procedures

The HbA1c test done by a point of care machine in a doctor’s office may be less accurate than one that is drawn from a venous sample and processed in a laboratory. Typically, the results can vary by different laboratories by as much as 0.5%.

The HbA1c test should be performed using an NGSP-approved method.

Interfering Factors

There are several conditions where the HbA1c test can produce inaccurate results. People diagnosed with sickle cell anemia, thalassemia, anemia, kidney failure, liver disease, or patients receiving blood transfusions can experience altered results due to the longevity of the red blood cell. HbA1c measurement in these patients must be interpreted with caution and should be confirmed with plasma glucose samples to diagnose diabetes.[10]

A falsely low HbA1c value can result from several conditions including high altitude, pregnancy, hemorrhage, blood transfusion, erythropoietin administration, iron supplementation, hemolytic anemia, chronic kidney failure, liver cirrhosis, alcoholism, folic acid deficiency, sickle cell anemia, and spherocytosis. Vitamin C supplementation can either increase or decrease the HbA1c level depending on the method used for its measurement.[15]

On the other end of the spectrum, a falsely high HbA1c can be due to a lack of available iron in the blood. This condition can result from iron deficiency anemia, infection-induced anemia, or tumor-induced anemia. Hemoglobinopathies such as thalassemia can also cause a falsely high HbA1c. Other causes of falsely high HbA1c levels include hypertriglyceridemia, organ transplantation, and hyperglycation in certain ethnic groups. Medications such as immunosuppressants and protease inhibitors can sometimes lead to a falsely high HbA1c.[10][7][11][12]

Results, Reporting, Critical Findings

Relationship Between A1c and Glucose Level

The HbA1c percentage equates to an average glucose level in the body that the patient experienced over the past 90 days.[13][14][15]

A1c (%)       Average Blood Glucose (mg/dL)

6                  126

8                  183

10                240

12                298

14                355

Clinical Significance

Hemoglobin A1c serves as an indicator of overall glycemic control and a reflection of the average blood sugar over the past three months.[2]

Quality control and Lab Safety

Laboratories can use several methods to determine HbA1c. High performance liquid chromatography (HPLC) method is one of the most popular methods because it can eliminate labile components that other methods such as immunoassay or affinity chromatography use.[16]

The point of care (POC) machine is widely used as well to determine HbA1c levels. The variety of POC machines on the market can make it difficult to determine the one best suited for one’s practice. Also, there is a shortage of information comparing the different machines. When using POC testing, one should keep in mind that POC values are often below results reported by a laboratory test, with the mean difference being -0.5%.

Enhancing Healthcare Team Outcomes

All clinicians who look after diabetic patients need to know what HbA1c means. In general, HbA1c provides a measure of the average glucose concentration over three months.

Hemoglobin A1c is often used as an outcome measure to determine if an intervention in a population is successful by showing a decrease in HbA1c by a certain percentage. There is a movement within the medical community to move away from using HbA1c as an exclusive standard of care test to measure patient response to treatment. The Estimated Average Glucose (eAG) is the newest proposed method. This method uses data obtained by continuous glucose monitors (CGMs) that record blood glucose 24 hours a day. This method gives providers a more accurate view of the blood sugar average and fluctuations, but the method is not available to all patients on a wide-spread basis.

As per ADA guidelines, the levels of HA1c should be measured twice a year in stable patients and at least four times in patients who have glucose fluctuations or those who have had a change in their diabetic treatment. Hemoglobin A1c is one of the preferred diabetes diagnostic tests today. The blood draw can occur at any time, and there are no special handling requirements. However, to ensure that the A1c value is correct, clinicians need to be aware of the causes of false-positive and false-negative results.

Since many patients with diabetes have their condition managed in outpatient clinics, the diabetic nurse should be fully aware of HbA1c values and when to refer the patient to an endocrinologist for further workup and treatment. Pharmacists are also required to fully understand and interpret this test, as they will be involved in glycemic management medication agent selection, dosing, and monitoring.  Both the nurse and/or pharmacist need to inform the treating physician regarding any changes in hemoglobin A1c and verify patient medication compliance. Hemoglobin A1c is a very valuable tool in the fight against diabetes and other glycemic control disorders, but to be effective, it functions best in an interprofessional healthcare team environment. [Level V]

Falsely Lowered A1C and Falsely Elevated A1C

Falsely Elevated A1C
“Any condition that prolongs the life of the erythrocyte or is associated with decreased red cell turnover exposes the cell to glucose for a longer period of time, resulting in higher A1c levels. Iron deficiency anemia is a commonly reported condition associated with falsely elevated A1c. Studies in patients with and without diabetes have demonstrated that treatment of iron deficiency anemia lowers A1c, although the exact mechanism remains unclear. Other conditions associated with decreased red cell turnover are also associated with falsely elevated A1c including vitamin B-12 and folate deficiency anemias, and asplenia. ” J Gen Intern Med. 2014 Feb; 29(2): 388–394.

Falsely Lowered A1c
“Similarly, any condition that shortens the life of the erythrocyte or is associated with increased red cell turnover shortens the exposure of the cell to glucose, resulting in lower A1c levels. Conditions such as acute and chronic blood loss, hemolytic anemia, and splenomegaly can all cause falsely lowered A1c results.

Patients with end-stage renal disease generally have falsely low A1c values. This is primarily due to the associated chronic anemia with decreased red cell survival” J Gen Intern Med. 2014 Feb; 29(2): 388–394.

Conditions Associated with Falsely Elevated or Lowered A1c

This table is from J Gen Intern Med. 2014 Feb; 29(2): 388–394.

References / Further Reading
Radin MS. Pitfalls in Hemoglobin A1c Measurement: When Results may be Misleading. Journal of General Internal Medicine. 2014;29(2):388-394. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912281/

Am Fam Physician. 2016 Jan 15;93(2):103-109.Diabetes Mellitus: Screening and Diagnosis. https://www.aafp.org/afp/2016/0115/p103.html

Related

Understanding HbA1c — The Long-Term Blood Sugar — Diet Doctor

Have you recently had an HbA1c blood test? It is quite likely that at least once a year you will have one. It’s a common and important test that can measure your long-term average blood sugar levels.

This guide will help you interpret your HbA1c results, and explain why HbA1c is an important way to measure metabolic health. We’ll also explain reasons for occasional unexpected variations in HbA1c results and the strengths and weaknesses of the test.

What is HbA1c and why does it matter?

Hemoglobin A1c (HbA1c, or sometimes just called an A1c) is a way to assess your average blood glucose levels. It differs from a fasting glucose measurement in that fasting glucose is a snapshot of your blood glucose level at that one moment in time, when you first wake up in the morning before eating. The HbA1c, however, is a longer-term measurement that reflects your average blood sugar over the previous two to three months.

It can measure this longer time frame because hemoglobin, which transports oxygen in your blood, is a protein that glucose sticks to over time. The more sugar in your blood, the more it sticks to the hemoglobin. When any protein becomes sticky with sugar in this way it’s called glycation or glycosylation. So rather than measuring the amount of glucose in a drop of blood, HbA1c measures the percentage of glucose stuck to the hemoglobin in your blood, or in medical terms, the percentage of glycation of the hemoglobin.

How do you interpret HbA1c numbers?

HbA1c is an important measure because it can be used to diagnose type 2 diabetes or pre-diabetes. It can also be used to monitor how well you are managing your blood sugar levels if you have type 2 diabetes or pre-diabetes, especially if you’ve made changes to your diet and lifestyle.

The American Diabetes Association (ADA) uses the following cutoff points for HbA1c:

• Normal: less than 5.7%
• Pre-diabetes: 5.7% to 6.4%
• Type 2 diabetes: 6.5% or higher

A diagnosis of type 2 diabetes or pre-diabetes should not be made using only one measurement of your HbA1c. The test should be repeated to confirm that the results are consistent or it should be used in conjunction with a fasting blood glucose or an oral glucose tolerance test to confirm the diabetes diagnosis.

HbA1c and average blood glucose

HbA1c result can be translated into an estimated average daily glucose level. Here are the averages and ranges the ADA uses:
 

Maintaining blood sugar within a normal range is critically important for long-term health. Does that mean, however, that you’re totally fine if your level is consistently 5.6% or below? Not necessarily. When your HbA1c is bordering the cuttoffs for pre-diabetes, and your results are trending up, it can be an indicator that you are on your way to future blood sugar problems and perhaps an eventual type 2 diabetes diagnosis.

If your HbA1c is obviously quite high — regularly in the type 2 diabetes range— that is a clear indication that your blood glucose is elevated most of the time and you should explore ways to help bring it down to a healthier level, such as with a low-carb or ketogenic diet or intermittent fasting.

Why do low-carb diets often lower HbA1c?

Since HbA1c is an indicator of your long-term blood glucose level, it makes sense that strategies to lower your daily blood glucose levels would also lower your HbA1c. Low-carb and ketogenic diets are powerful ways to do this. If you are not eating sugar, or carbohydrates that rapidly digest to sugar, you won’t have excess sugar circulating in your blood.

Blood glucose may improve so quickly on a ketogenic diet that some people with type 2 diabetes need to reduce or discontinue their insulin on the very first day of adopting the diet. (Always work with a physician or other qualified medical professional for this. Do not adjust medications on your own.)

Low-carb and keto eating, however, aren’t the only ways to lower HbA1c. This can also be accomplished with a low-glycemic diet, intermittent fasting, and even by incorporating more exercise into your life without much of a change in diet.

Most of the research comparing low-carb and keto diets to other ways of eating, however, shows that carb restriction is more effective, and moreover, it’s effective even without exercise. In a study comparing different interventions in overweight individuals with type 2 diabetes, pre-diabetes, or metabolic syndrome, subjects who followed a ketogenic diet for 10 weeks (<30 g carbs per day) but did not exercise had much greater reductions in HbA1c than subjects who followed a standard American diet and exercised three to five days per week.

The American Diabetes Association recently issued a consensus report in which they acknowledged the effectiveness of low-carb and very low-carb diets for improving blood sugar control. The consensus panel noted that multiple meta-analyses have shown that these carbohydrate restricted ways of eating typically lower HbA1c results more than low-fat diets, although the differences tend to get smaller over time. This might not be because low-carb stops being more effective, but rather, because some people may have difficulty sticking to the diet after a while, so they may inadvertently start eating more carbs.

With regard to improving blood glucose control, and thereby improving HbA1c results, the ADA panel wrote: “reducing overall carbohydrate intake with low- or very low-carbohydrate eating plans is a viable approach.”

90,000 What is Hemoglobin A1C Test?

The hemoglobin A1c (A1c) test is a measure of blood sugar that is more reliable than the standard finger prick test done at home using a blood sugar meter. Hemoglobin is the main protein in red blood cells and carries oxygen throughout the body. If your blood sugar is high, they will bind to hemoglobin. This forms glycated hemoglobin , which is detectable by a laboratory hemoglobin A1c test.This reading provides a blood sugar measurement to help diagnose diabetes or help patients determine how well they are in controlling their blood sugar.

Even when people with diabetes constantly monitor their blood glucose levels at home with a blood sugar meter, blood sugar levels vary considerably. These levels often fluctuate throughout the day. It is difficult to get an accurate estimate of total blood sugar using this technique.The hemoglobin A1c test provides a reliable measurement of blood sugar levels over the past three months, which is the approximate lifespan of red blood cells.

Once sugar binds to hemoglobin, it remains bound. Since it measures the amount of glycated hemoglobin in red blood cells, the Hemoglobin A1c test gives an estimate of the blood sugar level over the previous months. Reading between 4 and 6% is considered normal. Levels between 6.5 and 7% indicate a diagnosis of diabetes.

One might expect that low levels from a hemoglobin A1c test would be considered healthy for diabetics, but this may not be the case. Diabetics struggle with high blood sugar, but low blood sugar – hypoglycemia – can also often be a problem. This is especially true for type 1 diabetics who must be injected with insulin, or type II diabetics on certain medications. Extreme levels of hypoglycemia can cause unconsciousness and death. It is possible that the test results with low hemoglobin A1c indicate a combination of high blood glucose and hypoglycemia.

It is considered desirable for diabetics to have hemoglobin A1c levels below 6.5%. This correlates with a lower incidence of diabetes complications such as blindness, kidney problems, cardiovascular problems, gangrene, and loss of sensation in the legs. The patient should consult with their physician to determine the ideal target range that minimizes high blood sugar without causing hypoglycemia.

There are certain people for whom the hemoglobin A1c test is not recommended.People with certain types of anemia, such as hemolytic and sickle cell anemia, decompose their blood cells. In other words, red blood cells do not live for three whole months. In addition, people with vitamin 12 or folate deficiency have blood cells that live much longer than usual. People with these conditions are advised not to use this method of measuring their long-term blood sugar levels.

An alternative fructosamine test is sometimes used instead of the hemoglobin A1c test for patients who need it, such as those with hemolytic anemia.Unfortunately, it only measures blood sugar for the past two to three weeks. This test measures the response of blood glucose to blood proteins such as albumin. One such test is known as the test for glycated albumin .

OTHER LANGUAGES

Application of high-performance liquid chromatography method for determination of glycated hemoglobin level in patients with diabetes mellitus

Safronova O.N., Sergeeva S.M., Romanovskaya I.O.

Diabetes mellitus (DM) is a systemic metabolic disease that has become a pandemic spread. Over the past 30 years, in terms of the growth rate of the incidence of diabetes, it has outstripped many infectious diseases, and the number of patients with diabetes in the world has more than doubled and reached 366 million people in 2011. In the Russian Federation, as in all countries of the world, there is a high growth rate of the incidence of diabetes; according to the State Register, there are 3.357 million.patients with diabetes. The most dangerous consequences of the global epidemic of diabetes are its systemic vascular complications: retinopathy, nephropathy, damage to the great vessels of the heart, brain, and peripheral vessels of the lower extremities. It is these complications that are the main cause of disability and mortality in patients with diabetes. Treatment of diabetes mellitus is aimed at preventing, delaying, slowing down, or stopping the development of late complications.

Diagnosis of diabetes, monitoring the effectiveness of the therapy is not possible without the use of laboratory research methods, among which the most important is the study of glycated hemoglobin.

Glycated (glycosylated) hemoglobin (HbAlc) is a compound of hemoglobin with glucose, which is formed as a result of a non-enzymatic chemical reaction of hemoglobin A contained in erythrocytes with blood glucose. The speed and volume of this reaction depend on the average blood glucose level throughout the life of the erythrocyte. Thus, the level of glycated hemoglobin reflects the glycemia that took place during the life of the erythrocyte (up to 120 days), i.e. by the content of glycated hemoglobin, one can judge what was the concentration of glucose for the previous study 4-8 weeks.In this regard, patients with diabetes mellitus are recommended to conduct a study of the level of glycated hemoglobin once a quarter to control diabetes therapy, and 4-6 weeks after changing treatment tactics [1]. There are several forms of glycated hemoglobin: HbAla, HbAlb, HbAlc. The latter form is quantitatively predominant and gives a closer correlation with the severity of hyperglycemia, therefore, in the prospective DCCT studies (Diabetes Control and Complications Trial, 1983-1993.) it was determined that of all variants of glycated hemoglobin, only the determination of the HbAlc fraction is clinically significant [2].

Methods for the determination of glycated hemoglobin include electrophoresis, immune tests and chromatography [3]. Considering the narrow range of glycated hemoglobin values, which is used to assess the degree of diabetes compensation, and, consequently, the effectiveness of the therapy, the method for determining glycated hemoglobin must meet the following requirements: the method must be certified (NGSP or IFCC certificate), the analysis must provide the possibility of direct determination of the fraction of glycated hemoglobin HbAlc, the intra- and interlaboratory coefficient of variation should not exceed 4%, the study should be short-lived.

The method of high-performance liquid chromatography (HPLC), which is used by the leading laboratories of the world, meets the most modern requirements. The HPLC method has been successfully implemented by Bio-Rad Laboratories in the D-10 analyzer. The company is a world leader in the production of equipment and reagent kits for the determination of glycated hemoglobin. The use of the analyzer D10 “Bio-Rad” provides the necessary reproducibility of the results of HbA1c determination: the coefficient of variation is 1.5-2.0%.The analyzer is NGSP certified and offers standards based on DCCT (Diabetes Control and Complication Trial) guidelines. The D-10 analyzer has a built-in quality control system. The use of control allows for a high level of automation. For the analysis, both venous and capillary blood can be used. The time for one analysis is 3 minutes.

Our laboratory has accumulated significant experience in the study of the level of glycated hemoglobin using the analyzer D-10 from Bio-Rad.The analyzer allows you to determine the percentage of HbA1c in human whole blood using ion-exchange high-performance liquid chromatography. In this case, the sample is automatically diluted, the sample is injected into the analytical cartridge, where a programmed buffer gradient of an increasing ion concentration is created, due to which the separation of hemoglobins is carried out on the basis of their ionic interactions with the cartridge material. The separated hemoglobins then pass through the flow cell of the photometer, where changes in absorbance are measured at 415 nm.The result of the study is issued in the form of a chromatogram, which clearly shows various variants of hemoglobin, each of which has its own peak (Fig. 1). The area and the percentage of hemoglobin A1c are calculated. The results do not require further recalculations, while the HbA1c results obtained on analyzers oriented to IFCC standards must be recalculated using a special formula. The work uses calibrators and control materials from Bio-Rad.Intralaboratory quality control is carried out in each analytical batch at two levels of certified control samples. Participation in the external quality control system of the Russian Federation FSVOK makes it possible to obtain an assessment according to the following parameters: repeatability (intra-batch variation), reproducibility.

Fig. 1. (interday) and correctness.

Carrying out a study of the HbA1c level in the samples submitted by FSVOK (2 in each cycle out of two annuals) showed that the data obtained by us in all cases were within the range of acceptable for the HPLC method.The practical use of the methodology in the clinical diagnostic laboratory of the Central Dispatch Office of Russian Railways began in 2009. Determination of the level of glycated hemoglobin was carried out in patients sent for analysis by endocrinologists of the polyclinic. The volume of research has steadily increased. (Table 1).

Table 1

Moreover, in more than half of the patients (59% of cases), the HbA1c level was higher than 6%.

Interpretation of the results of determining the level of HbA1c in patients was carried out taking into account modern ideas about the clinical significance of the method. In 2011, WHO approved the use of glycosylated hemoglobin for the diagnosis of diabetes. The HbA1c level> 6.5% was chosen as a diagnostic criterion, the HbA1c level up to 6.0% is considered normal. At the same time, based on international and domestic experience in the treatment of diabetes, including the recommendations of IDF 2005; AACE 2009; ISPAD 2009; RAE2011, changes have been made to the tactics of managing patients with type 1 and 2 diabetes mellitus.According to these changes, the choice of individual therapeutic goals is based on the values ​​of the HbA1c level, which is estimated depending on the patient’s age, life expectancy, the risk of severe hypoglycemia, and the presence of late micro- and macrovascular complications. (Table 1).

Table 1

Thus, the test results help the doctor develop patient management tactics, i.e.because the determination of HbA1c allows you to judge the level of glucose in the blood for the last 6-8 weeks.

Maintaining the level of glycated hemoglobin in the blood at close to normal values ​​helps to reduce the incidence of vascular complications of diabetes or slow down their progression, i.e. to preserve the working capacity of patients for a longer time.

References:

1. Diabetes, “Hemoglobin A1c as an Indikator of the Degree of Glucose Intolerance in Diabetes”, 25 (3): 230-2, 1976.
2. Algorithms for specialized medical care for patients with diabetes mellitus (second edition). M., 2006.
3. Ilyin A.V. The level of glycated hemoglobin is a key control parameter in the treatment of diabetes mellitus and the prevention of its complications. Laboratory. 1,2008.

ELISA analysis to determine the level of glycohemoglobin

More than 346 million people worldwide suffer from diabetes. The International Diabetes Foundation predicts that their number will increase by almost 26% by 2030.In this connection, it is becoming increasingly important to create more advanced laboratory equipment and research methods for accurate diagnosis and treatment prescription.

Glycosylated hemoglobin and serum fructosamine testing is currently used to control diabetes mellitus. These indicators make it possible to generally assess the patient’s condition, namely, they show the level of compensation for high blood sugar over a long period of time. The level of fructosamine indicates the level of sugar over the past two weeks, glycated hemoglobin indicates the state of a patient with diabetes mellitus over the past two months.

Where is glycosylated hemoglobin located? The composition of hemoglobin, which is the main constituent element of erythrocytes and is the main oxygen carrier, includes hemoglobin A and its fraction AJ (93%). Hemoglobin A is an active element of hemoglobin, and its fraction AJ is glycohemoglobin, hemoglobin associated with glucose. Its content directly depends on the level of glucose in the blood – the higher the glycemia, the higher the level of glycohemoglobin.

A laboratory test for glycohemoglobin (HbA1c) is recommended for monitoring patients with diabetes.This helps to assess the effectiveness of the prescribed drugs and their dosage.

The Architect HbA1c Microparticle Immunoassay (CMIA) fully automated chemiluminescence assay (CMIA) assists in the laboratory management of demanding diabetic patients and delivers results within 36 minutes. Results correlate well with the gold standard in diagnostics (high performance liquid chromatography), which provides reliable, repeatable and accurate analysis results.

Testing is carried out at the same time as blood sugar measurement. The test provides the ability to quantify the percentage of hemoglobin A1c (HbA1c) in whole blood on an enzyme immunoassay analyzer. The new test will allow laboratories to improve the quality of care for patients with diabetes with less time spent.

The test is intended for an enzyme immunoassay analyzer and is already approved for use in most countries in Europe and Asia. The Architect HbA1c analysis was presented by one of the US companies that specializes in the design and manufacture of laboratory equipment (enzyme immunoassay analyzer, hematology analyzer, and much more) and biochemical reagents.

Based on the materials of the online magazine Labmedica

Published: 01/21/2014

Hemoglobin A1c (HbA1c) Test: Normal, Low / High, Chart, Ranges

Checked on 22.10.2019

Hemoglobin A1c Definition & Facts

Hemoglobin A1c Levels and Ranges

Hemoglobin is a red blood cell molecule that carries oxygen to the tissues of the body. A small percentage of hemoglobin contains sugar, and this type of hemoglobin is known as hemoglobin A1c.The amount of hemoglobin A1c depends on the blood sugar (glucose) level: the higher the blood sugar level, the higher it is. the amount of hemoglobin A1c.

Facts

• The higher the blood glucose level, the higher the level of hemoglobin A1c is determined on red blood cells.
• Hemoglobin A1c levels correlate with average blood glucose levels over approximately three months.
• Normal hemoglobin A1c levels in people without diabetes are between 4% and 5.9%.People with diabetes with poor glucose control have hemoglobin A1c levels above 7%.
• Hemoglobin A1c levels are commonly used to measure blood sugar control over time in people with diabetes.
• A 1% reduction in hemoglobin A1c may reduce the risk of microvascular complications (eg, diabetic eye, nerve or kidney disease) by 10%.
• Hemoglobin A1c levels should be checked, according to the American Diabetes Association, every six months in people with stable blood sugar control and every three months if a person is trying to establish stable blood sugar control.
• Hemoglobin A1c has many other names such as glycohemoglobin, glycosylated hemoglobin, glycosylated hemoglobin, and HbA1c.

What is Hemoglobin A1c?

To explain what hemoglobin A1c is, think in simple terms. Sugar sticks to things, and when it sticks to something for a long time, it is more difficult to remove the sugar (glucose). In the body, sugar also sticks, especially to proteins. The red blood cells circulating in the body live for about three months before they die.When sugar (glucose) attaches to these red blood cells by binding to hemoglobin A1c, it gives the doctor an idea of ​​how much glucose was in the blood during the previous three months. Hemoglobin A1c is a minor component of hemoglobin that glucose binds to. Hemoglobin A1c levels depend on the blood glucose concentration. The higher the blood sugar concentration, the higher the detectable hemoglobin A1c level. At any given time, hemoglobin A1c levels represent the average blood sugar concentration of a person with diabetes over the past 3 months or so.Other ways of referring to hemoglobin A1c include HbA1c, A1c, and Hb1c.

What causes high or low hemoglobin A1c?

Hemoglobin A1c levels can be changed:

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• Oral or IV glucose
• Fasting
• Insulin use
• Combinations of these and other factors

The goal for people with diabetes, with the help of their doctor, is to establish stable blood glucose levels leading to hemoglobin A1c levels that are at least below 7% to reduce or stop complications of diabetes (eg, diabetic diseases of the nerves, eyes, and kidneys).

What are normal hemoglobin A1c levels and are high or low levels dangerous?

• In most laboratories, the normal range for hemoglobin A1c is 4% to 5.9%.
• In well-controlled diabetic patients hemoglobin A1c level is less than 7.0%.
• In , poorly controlled diabetes , its level is 8.0% or more.

The advantage of measuring hemoglobin A1c is that it gives a smarter idea of ​​what happens over time (about 3 months) in relation to the average blood glucose level.Hemoglobin A1c values ​​do not fluctuate as much as daily blood sugar measurements.

Hemoglobin A1c Conversion Table (HbA1c chart)

Although there is no recommendation for using hemoglobin A1c levels as a screening tool, this gives the healthcare professional a good idea that someone might have diabetes if the value is elevated; however, it is used as a standard tool for determining blood sugar control in diabetic patients.

The correlation between hemoglobin A1c and average blood sugar is presented in the following conversion table:

The American Diabetes Association currently recommends an A1c target of less than 7.0%, while other groups such as the American Association of Clinical Endocrinologists recommend a target of less than 6.5%. In 2016, the ADA recommended an A1c level of 6.5% as a threshold level for diagnosing diabetes.

Studies have shown that the relative risk of microvascular complications is reduced by 10% for every 1% decrease in hemoglobin A1c. Thus, if a person with diabetes had an initial hemoglobin A1c level of 10.7 and dropped to 8.2, although they had not yet reached the goal (about 6.5%), they were able to reduce the risk of microvascular complications by about 20%.The closer to normal hemoglobin A1c, the lower the absolute risk of microvascular complications.

How often should hemoglobin A1c be checked?

The American Diabetes Association (ADA) suggests that if people with diabetes want to quickly lower their hemoglobin A1c, they should have their hemoglobin A1c checked every three months until they reach their treatment goals.

People with diabetes who achieve treatment goals and have stable blood control are advised to have their hemoglobin A1c checked every six months according to the ADA.

Tracking hemoglobin A1c levels allows the patient and their healthcare provider to determine how well a person is controlling blood sugar (glucose) levels over time. However, they do not replace daily glucose monitoring.

References American Diabetes Association. Diagnosing diabetes and studying prediabetes. Updated: November 21, 2016

McCulloch, DK, MD, et al. Patient Education: Preventing Diabetes Complications (Beyond the Basics).Until now. Updated: February 5, 2018

National Diabetes Education Initiative. Diabetes Management Guidelines 2016 Updated: January 2016

US NATIONAL HEALTH INSTITUTIONS. A1C test and diabetes. US NATIONAL HEALTH INSTITUTIONS. Updated: April 2018

Glycated hemoglobin in the diagnosis and control of type 2 diabetes.

What is glycated hemoglobin?

Glycated hemoglobin is an indicator showing the average blood sugar level over the last three months.Other names for this indicator: glycosylated hemoglobin, hemoglobin A1C, HbA1C, or simply A1C.

Why measure glycated ( glycosylated

) hemoglobin? What is the rate of glycated hemoglobin?

• For the detection of diabetes mellitus
• To assess the quality of diabetes care and management
  
• Glycated hemoglobin level below 5.7% is normal
• If the level of glycated hemoglobin is in the range of 5.7 – 6.4%, then you have a risk of developing type 2 diabetes mellitus.You should talk with your doctor about how to reduce this risk.
  
• If the level of glycated hemoglobin is more than 6.5%, a diagnosis of diabetes mellitus is likely, but it requires confirmation
• The recommended level of glycated hemoglobin in people with diabetes is less than 7%, if your level is higher, discuss the situation with your doctor. It should be borne in mind that the level of glycated hemoglobin above 7% can be assessed by your doctor as optimal.

How does the level of glycated hemoglobin and blood sugar compare?

The approximate ratio of blood sugar (glucose) and glycated hemoglobin is presented in table

How often should the level of glycated hemoglobin be monitored?

• If your A1C is less than 5.7%, it means that you do not have diabetes, and you should have your A1C checked every three years.
  
• If your A1C level is in the range of 5.7 – 6.4%, taking into account the risk of illness, you need to monitor this indicator once a year
  
• If you have diabetes that is well controlled, i.e. A1C indicators are less than 7%, then you need to check this indicator once every six months
  
• If you have just started diabetes treatment, or have changed your treatment regimen, if there is insufficient control over the disease, then this indicator should be checked once every three months.
  

For convenience, you can save for yourself a table of the ratio of blood sugar and glycated hemoglobin in the form of a picture

Is it necessary to control glycosylated hemoglobin in healthy people?

For early detection of type 2 diabetes, everyone should periodically check the level of glycated hemoglobin, starting from the age of 45, with a frequency of once every three years.

If you are under 45 years old, overweight or obese, and have one or more of the following risk factors:

• Hypodynamics (insufficient physical activity)
  
• Close relatives diagnosed with diabetes mellitus
  
• You are a woman and have gestational diabetes
  
• You gave birth to a baby weighing more than 4 kg
  
• You have a confirmed diagnosis of arterial hypotension
  
• HDL cholesterol level less than 0.9 mmol / L, or triglyceride level more than 2.82 mmol / L
  
• You are a woman with polycystic ovary syndrome (PCOS)
  
• Previously detected A1C level of more than 5.7% or impaired glucose tolerance
  
• Diseases associated with insulin resistance, e.g. acanthosis nigricans

If your doctor determines that you have a high risk of diabetes mellitus, then you should monitor the level of glycated hemoglobin once a year.

Why is the recommended glycated hemoglobin level important?

Many studies have shown that reaching the recommended level of glycated hemoglobin can reduce the risk of developing:

Do I need to monitor my blood sugar if I regularly check my glycated hemoglobin level?

As mentioned above, glycated hemoglobin shows average blood sugar levels over the past three months.Your doctor may recommend that you monitor your sugar level in order to know this indicator at a specific time unit.

IMPORTANT: the level of glycated hemoglobin, for all the importance of this indicator, is not the only method in the diagnosis and control of type 2 diabetes.

How to prepare for a blood test for glycated hemoglobin? What can affect the result of the analysis?

A blood test for glycated hemoglobin does not require any preparation.Food and / or water intake does not affect the test result in any way. It should be noted that the test result may differ from laboratory to laboratory. This means that if, as a result of a single study, you have received a result that is in doubt from the doctor, then he may ask to repeat the analysis for glycated hemoglobin.

Diseases and conditions affecting the indicators of glycated hemoglobin

• Acute (recent) or chronic bleeding may underestimate the actual level of glycated hemoglobin.
• In iron deficiency anemia, the result of the study of glycated hemoglobin may be overestimated
• Recent blood transfusions, hemolytic anemia may cause low levels of glycated hemoglobin

If you have any of the listed diseases or conditions or other known diseases of red blood, inform your doctor about it.

Dried Blood Spot Collection of Health Biomarkers to Maximize Participation in Population Studies

Biomarkers are extremely useful tools in several disciplines, including medicine, cell biology, genetics, psychology, sociology, demography, and social epidemiology.In each discipline, the early phase of action and robustness of biomarker research has been used to uncover both latent disease risk and provide longitudinal predictions of health outcomes. In these cases, biomarkers that are accurate, durable (i.e. they can survive the lag between collection and implementation of laboratory analysis of samples to extract biomarkers), and generic (i.e. are useful in various models) are required for filling.

While DBS collection is a relatively straightforward procedure, several methods can help maximize the amount of stains collected.Before collection begins, ensuring the participant’s hand is warm, and therefore that the blood vessels are dilated, will help blood flow once the finger is punctured. Using a hand warmer or having a hand run your hands under warm water can help in this process. A milking finger prior to collection will draw blood at the tip of the finger and warm the hand to help blood flow. Milking is a process that improves with practice. Collectors should use whatever technique they find most convenient and effective, but the most common approach involves milking the participant’s hand from the opposite side of the collector.This method will allow the collector’s finger to work deep in the participant’s palm while the opposite hand can stabilize the participant’s wrist. As an example, if blood was collected from the finger on the participant’s left hand, the collector would stabilize the participant’s wrist with the left hand and milk from the right hand. Common mistakes made during milking include not using tight control by pulling over the hand, but rather working into the muscles to pull blood towards the fingertip of the skin. It is also important to avoid pinching the finger with the milking by hand or by firmly squeezing the participant’s wrist on the nonmilking side, both of which obstruct blood flow.

When piercing the finger, make the puncture as deep as possible, pressing the lancet firmly into the finger before discharge. A shallow puncture results in less blood flow and rapid clotting. After piercing your finger, working quickly is key. Thin blood leads to easier collection and larger stains. After the puncture, the blood becomes more and more viscous before clotting. The less time it takes to collect a blood stain on the map, the larger their volume.

Ideally, the participant’s blood will be thin enough that droplets will fall from their own weight, but this will not be the case for all participants as some people’s blood is thicker or clots faster than others.If the blood is too thick to fall from the finger, the filter card must be brought up to blood collection. Whitean bringing the card into the blood is important to keep the card in contact with the drop while it hangs from the finger as long as possible, rather than just wiping the blood onto the card. This will help draw blood from the finger to maximize the spot size. This method requires steady hands to maintain contact between the blood and the card. With both hands, one to stabilize the contestant’s hand and one to hold the card, and keeping both hands in contact with each other helps stabilize the cards and blood together.

Advanced research areas, such as cardiometabolic risk assessment, have long relied on biomarkers such as C-reactive protein (CRP), insulin and glycosylated hemoglobin (HbA1c) for early risk detection and preventive measures, as well as biomarkers of hard endpoints cardiovascular disease (CVD) risk and cardiovascular disease associated mortality ^12. Clinical epidemiology often evaluates biomarkers prospectively to predict cardiometabolic risk outcomes such as heart disease and type II diabetes.Perhaps the most widely used of all biomarkers is the Framingham risk score, a composite that includes blood pressure, HDL cholesterol, and total cholesterol levels, which has been shown to be useful in predicting CVD ^13. However, the Framingham estimate experienced some technical disagreement and has limitations in studies aimed at linking social and environmental factors to health, which suggests the need for clarification and specific biomarkers associated with cardiovascular research.

There are a number of commercially available ELISA kits using or similar methods available for analyzing DBS samples. Required for the analysis of DBS samples are the use of precise and optimized elution steps to bring dried samples into solution ^2. This is an emerging area of ​​research, as analyzes for multiple analytes are currently being developed ^1. Among these analyzes are already proven and widely used cholesterol ^2, CRP ^10,14,15, IgE16, EBV ^9,15, leptin ^17, and cyotkines ^18. There are a number of laboratories specializing in DBS analysis, including the University of Washington Department of Laboratory Medicine (UW Lab Med) Biomarker Laboratories (Director: Mark Wener).

Given that a panel of biomarkers, rather than lone biomarkers, is most useful in the field of cardiovascular and diabetes research, biomarkers should be considered alongside various situational factors in order to maximize their usefulness. Biomarker studies can be expensive, however, both financially and in time to collect data.Thus, while it is very important to select biomarkers that are accurate, durable, and versatile, the work and family of biomarker research must rely on practicality, choosing biomarkers that are inexpensive is essential, and can be collected quickly with ease. In addition, practical considerations often lead to the inability to simultaneously maximize price, quality and speed in a single procedure. Here lie the next steps in biomarker health research through field and population research.The biomarker research field is currently in a period of rapid growth, however, much of the work is yet to come.

Metabolic Surgery ⋆ Prof. Dr. Alper Celik

Metabolic Surgery

Metabolic surgery, popularly known as diabetes surgery, is also a technique used to cure diseases such as hypertension, obesity, type 2 diabetes and high cholesterol. When these metabolic syndrome diseases are not treated, they cause a significant decrease in a person’s quality of life and cause serious life-threatening conditions.The method is called metabolic surgery, which relies on surgical treatment of metabolic diseases. In recent years, the success rate in the treatment of metabolic surgery has increased significantly with the methods developed. It is used as a quick form of treatment, especially for diseases with early diagnosis.

What is metabolic surgery?

In short, metabolic surgery is a bariatric treatment for some forms of metabolic syndromes, especially type 2 diabetes.When it comes to metabolic surgery, there is no mention of one single method. There are many surgical techniques that are performed. The chosen surgical method is determined depending on the patient’s illness and suitability for the method. The main goal of metabolic surgery is to ensure that the nutrients received by the body reach the bile and pancreatic fluid late. Thus, the substances that stimulate the production of insulin in the pancreas are released, and the release of insulin is increased and the level of insulin is automatically increased.

How is metabolic surgery performed?

All methods performed during metabolic surgery are performed laparoscopically, known as closed surgery. The incision does not open in the patient; instead, four or five holes are made for surgery through them. The duration of the surgery varies depending on the method used. The operation can take up to 1 or 3 hours, depending on the type of operation. According to the operation, the patient can be hospitalized for 4 or 5 days.The methods used during these surgeries are: gastric reduction, mini gastric bypass, gastric bypass, transit division, ileal interposition options. Some of the surgeries are restrictive on food, and some are operations that restrict intestinal absorption.

How to decide about metabolic surgery?

A detailed examination of the patient is performed prior to the metabolic surgery. The patient’s body mass index must be above 40 or above 30 and blood sugar levels not controlled despite treatment.At the same time, how many years the patient has been suffering from diabetes, insulin use, hemoglobin A1c levels are considered. The most important criterion for patients to see the necessary benefit from these surgeries is the continuation of insulin secretion in the pancreas. In other words, the secretion of insulin from the pancreas must continue. The condition of the pancreas is determined by tests performed before surgery. The patient’s obesity level is also assessed. People who are just starting out with diabetes and who do not need insulin therapy and take fewer medications are more likely to have a successful operation.

Why is metabolic surgery performed?

It has been proven to date that when it comes to type 2 diabetes, metabolic surgery is the most appropriate method. Although the priority in type 2 diabetes treatment is to control the patient’s lifestyle, sometimes blood sugar levels cannot be kept at the desired level.