What is the Hemoglobin A1C test. How does it diagnose diabetes. When should you get an HbA1c test. What do the results mean. How often should diabetics get tested. Can HbA1c results be inaccurate. How to prepare for an HbA1c test.

Understanding the Hemoglobin A1C (HbA1c) Test

The Hemoglobin A1C test, also known as HbA1c, glycated hemoglobin, or glycohemoglobin test, is a crucial diagnostic tool in the realm of diabetes management. This blood test provides valuable insights into a person’s average blood glucose levels over the past 2-3 months, making it an essential component in diagnosing and monitoring diabetes.

How does the HbA1c test work? When blood sugar levels are elevated, glucose molecules attach to hemoglobin in red blood cells, forming glycated hemoglobin. The HbA1c test measures the percentage of these glycated hemoglobin molecules, providing a reliable indicator of long-term blood sugar control.

Key Features of the HbA1c Test

• Measures average blood glucose over 2-3 months
• Requires no fasting or special preparation
• Results typically available within 24 hours
• Used for both diagnosis and monitoring of diabetes
• Can be combined with other tests for comprehensive diabetes assessment

The Importance of HbA1c Testing in Diabetes Management

Why is the HbA1c test so crucial in diabetes care? Unlike daily blood glucose monitoring, which provides a snapshot of current sugar levels, the HbA1c test offers a broader perspective on blood sugar control over time. This long-term view is invaluable for several reasons:

1. Early detection of diabetes or prediabetes
2. Assessment of diabetes treatment effectiveness
3. Monitoring of long-term blood sugar control
4. Prediction of diabetes-related complications risk
5. Guidance for adjusting diabetes management strategies

Is the HbA1c test suitable for everyone? While it’s a powerful diagnostic tool, certain conditions like anemia, recent blood loss, or hemoglobin variants can affect its accuracy. Healthcare providers consider these factors when interpreting results.

Interpreting HbA1c Test Results

Understanding HbA1c test results is crucial for effective diabetes management. The test results are expressed as a percentage, representing the amount of glycated hemoglobin in the blood.

HbA1c Result Ranges

• Below 5.7%: Normal
• 5.7% to 6.4%: Prediabetes
• 6.5% or above: Diabetes

How do these percentages correlate with average blood sugar levels? An HbA1c of 7% corresponds to an estimated average glucose (eAG) of 154 mg/dL. For every 1% increase in HbA1c, the eAG rises by approximately 29 mg/dL.

Should you be concerned about slight variations in HbA1c results? Minor fluctuations are normal, but consistent increases or decreases over time can indicate changes in blood sugar control and may warrant adjustments in diabetes management.

Who Should Get an HbA1c Test and How Often?

Regular HbA1c testing is crucial for certain individuals, but how frequently should it be done? The answer varies depending on several factors:

Recommended Testing Frequency

• Individuals without diabetes: Every 3 years after age 45, or earlier if risk factors are present
• People with prediabetes: Annually
• Diagnosed diabetics with stable blood sugar: Every 6 months
• Diabetics with unstable blood sugar or changing treatment: Every 3 months

Are there situations where more frequent testing is necessary? Yes, during pregnancy, when adjusting medication, or if experiencing significant lifestyle changes, more frequent HbA1c tests may be recommended by healthcare providers.

The HbA1c Test Procedure and Preparation

Getting an HbA1c test is a straightforward process that requires minimal preparation. Here’s what you can expect:

Test Procedure

1. A small blood sample is drawn from a vein in your arm
2. The sample is sent to a laboratory for analysis
3. Results are typically available within 24 hours

Do you need to fast before an HbA1c test? Unlike some other diabetes-related tests, the HbA1c test doesn’t require fasting. You can eat and drink normally before the test, making it a convenient option for many people.

Advantages and Limitations of the HbA1c Test

While the HbA1c test is a valuable tool in diabetes management, it’s important to understand both its strengths and limitations.

Advantages

• Provides a long-term view of blood sugar control
• No fasting required
• Less affected by short-term stress or illness
• Helps predict the risk of diabetes complications

Limitations

• May be inaccurate in certain medical conditions (e.g., anemia, kidney disease)
• Doesn’t reflect daily blood sugar fluctuations
• Can be affected by certain medications
• May not be suitable for diagnosing gestational diabetes

How can these limitations be addressed? Healthcare providers often use HbA1c tests in conjunction with other diabetes screening methods to ensure accurate diagnosis and monitoring.

HbA1c Testing and Diabetes Prevention

The HbA1c test plays a crucial role not only in diagnosing diabetes but also in preventing its onset. By identifying individuals with prediabetes, it allows for early intervention and lifestyle changes that can significantly reduce the risk of developing full-blown diabetes.

Prediabetes Intervention Strategies

• Adopting a balanced, nutritious diet
• Increasing physical activity

li>Maintaining a healthy weight

• Quitting smoking
• Managing stress

Can lifestyle changes really prevent diabetes? Research has shown that individuals with prediabetes who implement these changes can reduce their risk of developing type 2 diabetes by up to 58%.

The Future of HbA1c Testing and Diabetes Management

As medical technology advances, the landscape of diabetes testing and management continues to evolve. What innovations can we expect in HbA1c testing?

Emerging Technologies

• Continuous glucose monitoring (CGM) systems that provide real-time HbA1c estimates
• At-home HbA1c testing kits for more frequent monitoring
• Artificial intelligence-powered analysis of HbA1c trends for personalized treatment recommendations
• Integration of HbA1c data with other health metrics for comprehensive diabetes management

How will these advancements impact diabetes care? By providing more frequent and accessible HbA1c monitoring, these technologies have the potential to improve blood sugar control, reduce complications, and enhance the quality of life for individuals with diabetes.

The Hemoglobin A1C (HbA1c) test remains a cornerstone in diabetes diagnosis and management. Its ability to provide a long-term view of blood sugar control makes it an invaluable tool for healthcare providers and patients alike. As we continue to advance our understanding of diabetes and develop new technologies, the role of HbA1c testing will likely expand, offering even more precise and personalized approaches to diabetes care.

For those at risk of diabetes or already diagnosed, regular HbA1c testing, combined with appropriate lifestyle changes and medical interventions, can significantly improve health outcomes. As always, it’s essential to work closely with healthcare providers to interpret HbA1c results and develop an effective diabetes management plan tailored to individual needs.

The journey towards better diabetes control and prevention is ongoing, and the HbA1c test serves as a reliable guide along the way. By understanding its significance and utilizing it effectively, we can take proactive steps towards a healthier future, free from the complications of uncontrolled diabetes.

Hemoglobin A1C Test (hba1c test)

How it Works

Affordable, Rapid, Confidential

The hemoglobin A1C test, also known as the HbA1c test, glycated hemoglobin test, or glycohemoglobin, is a blood test typically used to diagnose diabetes or evaluate diabetes treatment.  This test measures the glucose in your blood over the last 2-3 months.  Hemoglobin is found in red blood cells and helps to carry oxygen throughout the body.  When blood sugar is too high, sugar builds up in the blood and combines with hemoglobin becoming glycated.  The hemoglobin A1C test (hbA1c test) measures the average level of glucose in the blood.  The results of this test can determine if a person has diabetes or how well a person with diabetes is controlling their blood sugar.      

An easy, affordable Hemoglobin A1C test (Hba1c test)

At Request a Test, we have access to labs all over the country.   We use the same testing facilities that are employed by many hospitals and physicians for their testing needs.  All of our labs operate on a walk-in basis so there is no need to schedule appointments.  Ordering your hemoglobin A1C test (hba1c test) with us eliminates the need to go through your doctor or insurance.  Our hemoglobin A1C test (hba1c test) is always reasonably priced with no hidden fees. 

Types of Hemoglobin A1C tests (Hba1c tests)

The hemoglobin A1C with eAG test is conducted with a blood sample and typically sees results the next business day.  This test includes a measurement for estimated average glucose (eag).  The hemoglobin A1C test is also included in our diabetes panel which includes a glucose test and our comprehensive plus heart health panel.  For pricing and more information about these and other tests available in our diabetes testing category, please go to http://requestatest.com/diabetes-testing.

Symptoms of high blood sugar

High blood sugar can be an indicator of diabetes or an increased risk for diabetes.  For those who have already been diagnosed with diabetes, high blood sugar may indicate a need for a change in treatment.  Symptoms of high blood sugar can include increased thirst coupled with an increased need for urination, fatigue, blurred vision, and slow healing infections.  It’s important to note that high blood sugar and diabetes do not always display the same or any symptoms.  The absence of symptoms is not a reason to avoid receiving a hemoglobin A1C test (hba1c test).

Who should get a Hemoglobin A1C test (Hba1c test)?

People with diabetes are typically directed by their doctors to receive regular hemoglobin A1C tests (hba1c tests).  Those who have risk factors for diabetes such as being overweight, or having a family history of diabetes should consider receiving periodic hemoglobin A1C tests (hba1c tests).    

Why get a Hemoglobin A1C test (Hba1c test)?

Early diabetes often shows no symptoms.  Diagnosis through a hemoglobin A1C test (hba1c test) can help to avoid health complication caused by untreated diabetes.  Diabetes that is left untreated can result in heart disease, stroke, kidney disease, blindness, nerve damage, increased risk of cancer, and death.  The hemoglobin A1C test (hba1c test) can be used to determine if a person’s current treatment for diabetes is effective.  A high hba1c result may indicate a need to discuss alternative treatment options with your doctor. 

When to get a Hemoglobin A1C test (Hba1c test)

Those who are using hemoglobin A1C tests (hba1c tests) to monitor their blood sugar as part of their diabetes treatment should consult with a doctor to determine how often testing is needed.  Typically, this test should be taken every 2-3 months for those who are working to control blood sugar and less often once blood sugar is under control.  

Where can I get a Hemoglobin A1C test (Hba1c test)?

Request A Test contracts with 2 of the largest labs in the United States to provide you with 1000s of lab collection centers nationwide.  When you order your hemoglobin test (hba1c test) with us, we will find the lab location that is most convenient for you.  Once your order is complete, you can go to the lab at any time during their business hours.  To find the lab location nearest to you or to view a complete list of available lab locations, please go to http://requestatest.com/testinglocations.   

Hemoglobin A1C test (Hba1c test) preparation

The hemoglobin A1C test (hba1c test) requires no fasting or special preparations. 

Hemoglobin A1C test (Hba1c test) procedure

Upon arrival at the lab, you will undergo a simple blood collection.

Hemoglobin A1C test (Hba1c test) accuracy

At Request a Test we use only nationally accredited labs with highly trained personnel and state of the art equipment to ensure the highest possible accuracy in your hemoglobin A1C test (hba1c test) results.

Hemoglobin A1C test (Hba1c test) results

The hemoglobin A1C test (hba1c test) typically sees results the next business day.  You will be notified by e-mail as soon as your results are available.  You can access your results online or call to speak to a representative.  Results can also be sent by fax or mail by special request.

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HbA1C Blood Test as an Effective Tool For Diabetes Management

Haemoglobin A1c test, better known as HbA1c blood test, checks the amount of glucose bound to the haemoglobin. Haemoglobin is a substance found in our RBC(Red Blood Cells) that carries oxygen throughout our body. When blood sugar increases in your blood, it binds to haemoglobin, and this process is called Glycation. 

The HbA1c blood test is often used to identify both diabetes and prediabetes- a condition characterised by excessive glucose levels, not high enough to be diagnosed as the most common type of diabetes- called Type-2 diabetes. The test is routinely administered in those who have type 1 and type 2 diabetes. 

If you are already diagnosed with diabetes, the test is used to monitor your present condition, whether the levels of glucose are within the range and how well the treatment plan is working. The test can also tell you whether you need to adjust your medications for diabetes. 

The test checks the average amount of glucose or blood sugar bound to haemoglobin, known as HbA1c, for the past three months. This span is considered since that’s the average lifespan of RBC. Even though the level of HbA1c reflects the blood sugar level for the past three months, it won’t reflect the daily blood sugar swings, i.e., the ups and downs. 

If the level of HbA1c in your blood is high, then it may indicate diabetes, a chronic metabolic disease that may lead to health problems such as kidney disease, heart disease and also nerve damage. If your results indicate a high A1c level, then you may have a high risk of diabetic complications and poor blood sugar control.  

Why is an HbA1c Test Done?

If you are experiencing any of the below-mentioned symptoms of diabetes, then your doctor may order an HbA1c blood test: 

• Feeling excessive thirst
• Frequent urination
• Fatigue
• Blurred vision

Your doctor may also order an HbA1c test if you have any of the risk factors for developing diabetes, such as: 

• History of heart disease
• High blood pressure 
• Obese or being overweight
• Physical inactivity

The HbA1c levels often fluctuate due to various factors such as:

• Kidney disease
• Liver disease
• IV glucose intake
• Insulin usage
• Cholesterol levels
• Fasting
• Anaemia

What are the Preparations Required?

There are no special preparations required prior to this test. The test is performed on a blood sample because HbA1c is unsusceptible to the short-term blood glucose fluctuations, for instance, after taking meals. Blood can be collected for the test without regard to when you had food. There is no need for fasting for the blood test. But you should inform your doctor regarding any medications that you are taking, since medications may affect the results. 

How is an HbA1c Test Administered?

Using a small needle, a healthcare professional will draw blood from a vein in your arm. The blood will be collected on a vial or test tube. When the needle goes in and out, you may feel a slight sting. The HbA1c blood test typically lasts for no more than five minutes. 

Are There Any Risks For HbA1c Blood Test?

There is minimal risk of having an HbA1c blood test. But you may experience a bruising or slight pain at the puncture site, and these symptoms won’t last long. 

What Does the Test Results Indicate?

Test results are expressed in percentage (%). High HbA1c percentage means higher average glucose levels. The range of HbA1c has different implications:

• If your HbA1c level is 6.5%, or more then it means that you have diabetes. 
• If your HbA1c level is between 5.7% and 6.4%, then it indicates prediabetes. 
• HbA1c level below 5.7% is considered normal. 

When you have high HbA1c levels, then you have more risk of developing complications related to diabetes. If you’re diabetic, then it is recommended to keep the level of HbA1c below 7%. A lot of studies have confirmed that diabetes complications can be prevented if the level of HbA1c is kept below 7%. Your doctor may have other recommendations for you, based on your overall health, weight, age and other factors. A combination of a healthy diet, proper medication and regular exercise can certainly bring HbA1c levels down. 

If you have diabetes, then you need to take the test every three months to ensure that the levels are within the target range. You may be able to wait for a long time in between the HbA1c blood tests in case if your diabetes is under good control. But it is recommended to take this test at least two times a year. 

The test is not administered in children, to identify diabetes, and also not used for gestational diabetes. It is a diabetes that only affects pregnant women who didn’t have diabetes in the past. The same condition is applicable if you have another type of blood disorder or have anaemia, since the test may become inaccurate. Your doctor may recommend other diagnostic tests if you have any of these conditions or are at risk for developing diabetes. 

Other factors that may affect your test results are supplements like Vitamin C and Vitamin E, as well as conditions such as Liver disease, kidney disease, and high cholesterol levels. 

Frequently Asked Questions

Can I naturally lower my HbA1c?

Maintaining a well-balanced and healthy diet is the key. Besides taking medications, lifestyle changes are effective too. It is important to stay hydrated throughout, exercise regularly, maintain healthy body weight, reduce stress, and also to eat small portions very often.  

Do I have a risk of developing diabetes, if my blood sugar level is 102mg/dL?

You have prediabetes when your blood glucose level is between 100 and 125 mg/dL and your HbA1c is between 5.7% and 6.4%.  

How often do I need this test?

If you have diabetes, then you need to take the test every 3 to 6 months. If the blood sugar levels are well managed, then HbA1c is measured every six months. But if your diabetes medication treatment changes or if you have a high blood sugar level, then your doctor may order for the test every three months, until the glucose level comes within the acceptable range.  

Can other blood glucose tests be used to diagnose prediabetes and diabetes?

Yes. Doctors also use blood glucose tests that require fasting such as Oral glucose tolerance test and Fasting plasma glucose test to diagnose prediabetes and diabetes. If you have experienced diabetes symptoms, then your doctor may order another blood glucose test which doesn’t require fasting called a Random plasma glucose test. 

Why do HbA1c blood test results vary?

Laboratory test results may differ from test to test and from day to day. Medical conditions that affect the lifespan of RBC, such as hemodialysis, recent blood loss, erythropoietin treatment, or sickle cell disease can change the HbA1c levels. Another factor is small changes in temperature, sample handling or equipment, even if the same sample is measured repeatedly in the same laboratory. 

How accurate is the HbA1c test?

When the HbA1c test is repeatedly done, then the test results can be somewhat lower or higher than the first result. For instance, an HbA1c reported as 5.8% on one test can be reported as 6.2% when the test is repeated on the same blood sample. This range was larger in the past, but with the recent, stricter quality control standards, it is expected that the results will be more accurate.

HbA1c Test Purpose, Procedure, Results and more

Glycated hemoglobin is a form of hemoglobin that is chemically linked to a sugar. Most monosaccharides, including glucose, galactose and fructose, spontaneously bond with hemoglobin, when present in the bloodstream of humans.

Also Known as: A1c, HbA1c, Glycohemoglobin, Glycated Hemoglobin, Glycosylated Hemoglobin,Hemoglobin A1C, HgbA1c

Test Purpose:

1. This test is used to monitor diabetes control.
2. This test tells us the patient average glucose index over a long period of time (2 to 3 months).
3. It tracks glucose in the milder form of diabetes.
4. It helps to determine which type of drugs may be needed.
5. Its measurement is of value in a specific group of patients like:
   • Diabetic children
   • Diabetic patients whose renal threshold for glucose is abnormal.
   • Unstable diabetes type I, taking insulin.
   • Type II diabetic women who become pregnant.
   • Patients with changing dietary or other habits.
6. It should be repeated every 3 to 4 months.

Sample Required:

1. The blood sample is taken in the EDTA 3 to 4 ml.
2. Washed RBC or hemolysate is prepared and this is stable for 4 to 7 days at 4 °C.
3. A blood sample can be drawn at any time.

Normal

Source 1

• HbA1 c (% of total Hb) = 4.0 to 5. 2
• Hb A₁  (%  of  total Hb) ₌ 5.0 to  7.5

Source 2

1. Non Diabetic adult = 2.2 to 4.8 %.
2. Non Diabetic child = 1.8 to 4.0 % .
   1. Prediabetic              = 5.7 to 6.4 %
   2. Diabetics                  = >6.5 %
   3. Diabetic HbA1c = > 8.1 % = corresponds with glucose >200 mg/dl.

Diabetic Control And HbA1c

1. Good diabetic control = 2.5 to 5.9 %.
2. Fair diabetic control = 6 to 8 %.
3. Poor diabetic control = > 8 %.
   • (Values may vary according to the lab)

The following table gives a recommendation for the treatment:

HbA1c level	mg/dL	mmol/L	Interpretation
4	65	3.6	non-diabetic
5	100	5.55	non-diabetic
6	135	7. 5	non-diabetic
7	170	9.5	ADA target
8	205	11.5	treatment needed
9	240	13.5	treatment needed
10	275	15.5	treatment needed
11	269	14.9	treatment needed
12	298	16.5	treatment needed
13	326	18.0	treatment needed
14	355	19.7	treatment needed

HbA1c And Estimated Blood Glucose Level:

HbA1c level	Glucose level  mg/dL
4%	65
5%	100
6%	126
7%	154
8%	185
9%	212
10%	240
11%	270
12%	300
19. 4%	350
22.2%	400
24.9%	450
27.7%	500

Formula = mg/dL /18 = mmol/L

                    mmol/L  x 18 = mg/dL

Increased Level Is Seen In:

1. Newly diagnosed diabetic patient.
2. Uncontrolled diabetic patient.
3. Nondiabetic hyperglycemia is seen in:
   1. Cushing’s syndrome.
   2. Acromegaly.
   3. Corticosteroids therapy.
   4. Pheochromocytoma.
   5. Acute stress.
   6. Glucagonoma.
4. Patient with splenectomy.
5. Alcohol toxicity.
6. Iron deficiency anemia.
7. Lead toxicity.

Decreased HbA1c Level Is Seen In:

1. Hemolytic anemia.
2. Chronic blood loss.
3. Chronic renal failure.
4. Pregnancy.

Related Articles:

Keywords: Glycohemoglobin A, Glycosylated Hemoglobin A, Hb A1, Hb A1a+b, Hb A1c, HbA1, Hemoglobin A(1), Hemoglobin A, Glycosylated, Glycosylated hemoglobin A, HBA GLYCOSYLATED, HBA 01, HEMOGLOBIN AA 01, HB AC 01, Haemoglobin A1c, HbA1c, HbA>1c<, Hemoglobin A1c, HbA_1c, Hemoglobin A, Glycosylated [Chemical/Ingredient], hemoglobin a1c, hba1, hemoglobin a 1, glycosylated hemoglobin a, hb a1, hba1c, haemoglobin a1c, HbA_1c (substance), HbA1c (substance), HbA>1c< (substance), HbA1 – Glycated haemoglobin, HbA1 – Glycated hemoglobin, Glycosylated haemoglobin A, Glycosylated hemoglobin A (substance)

Correlation of same-visit HbA1c test with laboratory-based measurements: A MetroNet study | BMC Family Practice

Study design

Patients were recruited for this cross-sectional study from two FPCs that are members of MetroNet, a metropolitan Detroit practice-based research network. At both sites, HbA1c analysis is routinely performed at an outside laboratory on venipuncture samples. Physicians, medical assistants, and research assistants identified consecutive diabetic patients 18 years of age and older whose physicians ordered HbA1c analysis. The study was explained to these eligible patients and informed consent obtained from those who wished to participate.

After patients were enrolled, a finger-prick blood sample was collected for in-office HbA1c testing with the BIO-RAD Micromat II. Since the BIO-RAD Micromat II is compatible with capillary, venous, and EDTA anti-coagulated blood samples, aliquots of these types were also acceptable for analysis. Research and medical staff were instructed to use finger-prick capillary samples whenever possible, but venous samples from the blood draw apparatus, or a drop of blood from the EDTA tube was substituted when necessary. At one FPC only finger-prick samples were used, while at the other FPC, thirteen MicroMat II samples were venous and five were EDTA anti-coagulated; the remaining 56 tests were performed using capillary blood samples.

The data collected included patient name, study site, the person performing same-visit HbA1c analysis, the date, and the rapid HbA1c result. Physicians were blinded to rapid HbA1c results, and relied on the laboratory analysis to make treatment decisions during the study period. One FPC used one of two different laboratories based on the patient’s health insurance carrier. At one laboratory, the Primus Model 386 was used for HbA1c testing, which is a boronate – affinity HPLC method. The other laboratory used the Roche Integra 800, which uses an immuno-turbidimetric methodology. The laboratory of the second FPC used the Tosoh A1c 2.2 Plus, an ion-exchange HPLC, for analysis.

All three methodologies are aligned to Diabetes Control and Complications Trial (DCCT) and National Glycohemoglobin Standardization Program (NGSP) standards. All have linear response from HbA1c level of 3–4% to 20% or higher. The intra- and inter-assay coefficients of variation are displayed in Table 1. These values were either obtained directly from the laboratory performing the assay (Primus 386) or from the manufacturer. All are within NGSP acceptable limits.

Table 1 Coefficients of variation (CV) for three laboratory analyzers

The BIO-RAD Micromat II, which provides results in approximately 5 minutes, incorporates an affinity chromatography method that measures the percent glycated hemoglobin in the sample. According to the manufacturer, the analyzer then uses a factory-set algorithm to deliver an HbA1c result which is calibrated to the recommendations of the DCCT and is traceable to the NGSP. The intra-assay coefficient of variation is reported to range from 2.93 – 4.65%; higher at lower values of HbA1c. The inter-assay coefficient of variation is estimated to be higher; however values are not given in the package insert. The sensitivity of the assay ranges from 4 – 15% HbA1c. BIO-RAD representatives provided an in-service to help familiarize staff in the use and operation of the Micromat II analyzer.

Each HbA1c analysis with the Micromat II requires a single test cartridge, which consists of several tubes with reagents that are mixed and decanted into a collection reservoir for measurement. After a test cartridge has been placed into the Micromat II, a 20 microliter blood sample is added to the first tube. This initiates a series of aliquot additions and incubation steps. In total there are four decanting steps followed by four incubations. These incubations require a total time of 230 seconds and range from 40 seconds to 80 seconds in length. Quality control procedures were carried out as outlined in the Micromat II instruction manual. Controls and standards were run per the manufacturer’s recommendation; results were always acceptable.

Analytic strategy

Data were analyzed separately by type of laboratory methodology. To evaluate the performance of the BIO-RAD Micromat II, Pearson correlations were calculated using the laboratory results as the standard. Scatter plots and regression lines were also examined. The mean absolute difference between the sample groups was determined to test the hypothesis that group means are equal (α = 0.05), using a two-sided paired t-test.

What Is HbA1c? Basics of the Test

You’ve pulled out your logbook and are taking off your jacket to bare your upper arm for the blood pressure cuff, when the nurse walks in and asks you to hold out a finger. “Does it matter that I had breakfast this morning?” you ask, trying to remember if you were supposed to fast before coming in, as she pricks your finger and collects a blood sample. “No, it doesn’t,” she says. “There; all done. The doctor will be in shortly to discuss your result.” And, indeed, several minutes later, your doctor walks in and says with a smile, “Looks like things are coming together for you. You’re at 6.8%.”
For some people, the doctor’s words would be enough for them to realize that the fingerstick in the imaginary scenario above was for a glycosylated hemoglobin (HbA1c) test. What is Hba1c?

The HbA1c test gives an indication of your blood glucose control over the previous 2–3 months and is an important part of your diabetes-care regimen. This article discusses what the test is, why it’s important, and how it’s used to help better blood glucose control.

What is HbA1c? The ABCs

Figuring out how the HbA1c test can help with your blood glucose control starts with understanding a bit about the test and what it measures.

Hemoglobin.

Hemoglobin is a molecule found in great quantities in each of the body’s red blood cells. As red blood cells travel through the circulatory system, the hemoglobin molecules join with oxygen from the lungs for delivery to the peripheral tissues, where they exchange it for some of the carbon dioxide destined for release to the lungs. The hemoglobin molecule is made up of two pairs of protein chains (two alpha chains and two beta chains) and four heme groups (iron-containing structures that act as the site of oxygen attachment and give red blood cells their color). Adults usually have a variety of types of hemoglobin, each with slightly different properties. The type of particular interest to people with diabetes is called HbA1c.

Besides carrying oxygen, hemoglobin molecules were discovered to have a secondary property that could be used to monitor blood glucose levels, namely the ability to join with glucose. Unlike cells that have insulin-controlled gating mechanisms to regulate how much glucose enters cells (such as muscle and liver cells), red blood cells allow glucose from the blood to freely enter and leave. The concentration of glucose inside a red blood cell is therefore the same as its concentration in the blood. The level of glucose in the blood affects how much glucose is available to bind to hemoglobin.

Once bound to hemoglobin, the sugar molecules mostly remain attached for the life of the red blood cell, which averages about 120 days. Your blood cells don’t all die at the same time: New blood cells are constantly being created, and younger cells outnumber older cells. Because the red blood cells in a blood sample used for an HbA1c test are a mixture of cells of different ages, the test gives a “weighted” average of recent blood glucose levels. This average is heavily influenced by more recent blood glucose levels because of the greater number of younger red blood cells; blood glucose levels from the past three months determine most of an HbA1c test’s result. In fact, blood glucose levels in the 30 days before the test determine roughly half of the HbA1c test’s result. Therefore, the HbA1c test is often said to give an indication of blood glucose levels for the previous 2–3 months.

HbA1c test results are given as a percentage that indicates the percentage of your HbA1c molecules that are linked to glucose molecules. A chart like “Blood Glucose Correlations” can help you to figure out what your average blood glucose levels were that caused your HbA1c result.

What’s in a name?

If you look through both the scientific literature and the information produced specifically for people who have diabetes, you will probably see a variety of terms to describe the HbA1c test, such as glycosylated hemoglobin, glycated hemoglobin, and glycohemoglobin, and abbreviations such as GHb and A1C. For the purposes of the average person with diabetes and his health-care team, these terms are all basically referring to the same thing.

When a molecule is said to be glycosylated, it means it has been linked to a glycosyl group (a derivative of a glucose molecule). Glycosylation can either be aided by helper molecules called enzymes or occur chemically without the enzymes. The nonenzymatic form of glycosylation is called glycation. When being precise in their writings for scientific journals, biochemists tend to call the form of hemoglobin examined in the HbA1c test a “glycated hemoglobin,” because the process by which glucose links itself to hemoglobin is nonenzymatic. “Glyco-” is a prefix that usually refers to a sugar, so a glycohemoglobin is a hemoglobin with some sort of sugar attached. GHb is used as a catch-all shorthand for glycosylated and glycated hemoglobin and glycohemoglobin.

To reduce the confusion that all these different-sounding terms could cause, in August 2001, the American Association of Clinical Endocrinologists and the American College of Endocrinology recommended that health-care providers use the shorthand term “A1C” when speaking with people with diabetes, a change that the American Diabetes Association (ADA), the National Glycohemoglobin Standardization Program (NGSP), and the National Diabetes Education Program (NDEP) came to endorse. Researchers were encouraged to continue to use the term “glycated hemoglobin” in scientific papers aimed at their peers.

Setting an HbA1c standard

In the past, a physician’s previous personal experience with a certain illness or the opinion solicited from a specialist at the local medical center used to be considered the basis for good medical care. Over the years, however, physicians came to desire more research-based, statistical data to support long-standing medical practices and to ensure that people were given the best medical care possible. The tail end of the 20th century saw the increasing use of controlled clinical trials to compare the effectiveness and safety of various drugs and therapies. To test theories on whether high blood glucose levels were responsible for some of the complications of diabetes and if complications could be reduced or reversed by lowering blood glucose levels, a number of trials involving volunteers with diabetes were conducted.

Type 1 diabetes.

The longest and largest well-conducted study of controlling high blood glucose in people with Type 1 diabetes was the Diabetes Control and Complications Trial (DCCT). Between 1983 and 1993, the DCCT enrolled and studied over 1400 people with Type 1 diabetes, assigning them to receive either a conventional therapy (one or two daily injections of insulin and either urine testing for glucose several times per day or blood glucose monitoring once per day) or a more intensive regimen intended to achieve near-normal levels of blood glucose. The intensive regimen consisted of monitoring blood glucose levels four times daily and either the use of an insulin pump or three or four daily injections of insulin. The HbA1c test was used to assess the level of blood glucose control achieved by each group and to compare the groups. After an average of 6.5 years of follow-up, people in the intensive-treatment group attained an average HbA1c of 7.3%, while the average HbA1c in the conventional-therapy group was 9.1%.

These differences in HbA1c results translated into significant differences in risks for diabetes complications such as nephropathy (kidney disease), retinopathy (eye disease), and neuropathy (damage to and malfunctioning of nerves, especially those of the legs and feet). When the kidneys are functioning normally, they do not allow proteins from the blood to be filtered out in the urine. Kidneys damaged by diseases such diabetic nephropathy can allow a blood protein called albumin to pass into the urine. Intensive control of blood glucose reduced the development of macroalbuminuria (large amounts of albumin in the urine) by 56%. Every 10% decrease in HbA1c (say, from 11% to 9.9%) led to a 25% decrease in risk for developing signs of nephropathy.

Those participants in the intensive-therapy group who entered the study with no signs of retinopathy and very low to no protein in the urine had a 76% reduction in progression to retinopathy compared with those in the conventional treatment group. Even people with mild to moderate retinopathy and microalbuminuria (very small quantities of albumin in the urine) benefited from intensive therapy, seeing a 54% reduction in retinopathy progression. Even if you haven’t met your HbA1c goal yet, you might be pleased to know that just about any decrease in blood glucose levels can help. The study found that every decrease of 10% of one’s HbA1c was linked to a 39% decrease in risk of retinopathy.

Diabetic neuropathy was reduced by 60% in the intensive-treatment group compared with the conventional treatment group.

Type 2 diabetes.

The DCCT’s findings about the link between HbA1c levels and risks for complications in people with Type 1 diabetes were complemented by similar findings in another large study — this one of people with Type 2 diabetes — called the United Kingdom Prospective Diabetes Study (UKPDS). The UKPDS studied over 4500 people with Type 2 diabetes, assigning them to receive either a diet-based treatment regimen or a more intensive regimen utilizing a sulfonylurea (a class of diabetes pills that stimulate the pancreas to produce more insulin), metformin, or insulin. Those people treated with diet achieved average HbA1c levels of 7.9%, while those on the more intensive regimen attained an average HbA1c of 7.0%. The study found that there was a direct relationship between HbA1c levels and risks for some diabetes complications; people with lower blood glucose levels had lower risks of microvascular (small blood vessel) complications such as retinopathy, neuropathy, and nephropathy.

For every percentage point decrease in HbA1c (say, from 11% to 10%), there was a corresponding 37% decrease in microvascular complications and a 21% decrease in deaths related to diabetes.

“DCCT-comparable.”

When HbA1c tests were first introduced, different laboratories used different methods to compute HbA1c levels. The multitude of methods lead to different results being reported — a result above, say, 8%, which would indicate high blood glucose levels in a DCCT participant, might represent normal blood glucose levels at some laboratories. People who switched physicians or physicians who changed the laboratory to which they sent their samples had to be careful about interpreting HbA1c results.

To reduce confusion and to make HbA1c results readily comparable with the results of the DCCT, the National Glycohemoglobin Standardization Program (NGSP) was begun to certify labs and their testing methods. Most HbA1c tests done by laboratories in the United States today are performed using methods certified by the NGSP as being standardized to DCCT results.

Current HbA1c recommendations

The ADA recommends routine checking of HbA1c levels. Exactly how often yours should be checked depends on your degree of blood glucose control and your physician’s judgment. Because the HbA1c test is an indicator of blood glucose control over the previous 2–3 months, people who are having trouble meeting their goals or people whose medicine, diet, or exercise regimens have changed may be helped by having HbA1c assessments every three months. Many experts recommend having the HbA1c test at least twice a year for people who are meeting their blood glucose control goals.

In some cases, your physician may decide to order more frequent HbA1c tests. Very large changes in your average blood glucose level can be reflected in your HbA1c in about two weeks, so a person who’s been newly diagnosed may have HbA1c tests every few weeks while his initial therapy is adjusted. Pregnant women with diabetes may also have their HbA1c monitored every month or every two months to help them achieve the tight blood glucose control recommended to prevent health problems for the fetus. (See “The Fructosamine Test” for more information on a related test sometimes recommended for pregnant women for gauging long-term blood glucose control.)

Your personal target.

Currently, the ADA recommends that people with diabetes in general achieve HbA1c results below 7%. individuals with diabetes who are not at risk for adverse effects of tight blood glucose control should work with their health-care team to achieve HbA1c results that are as close to normal (a result of 6% is considered normal) as possible. Other groups, including the American College of Endocrinology, the American Association of Clinical Endocrinologists, the European Association for the Study of Diabetes, and the International Diabetes Federation, advocate a target of 6.5%.

Even the carefully monitored people in the DCCT’s intensive-treatment group had to work hard to achieve that group’s average 7.3% HbA1c result. Because everyone’s health situation is unique, you need to work with your health-care team to set a HbA1c goal that will work best for you.

The big picture.

Some people — and even their physicians — focus so much on controlling blood glucose levels that they forget that diabetes is more than just abnormal blood glucose. It’s important to remember that heart disease is the number one killer of people with diabetes. Although a follow-up trial to the DCCT found that lower HbA1c levels reduced the risk of heart attack and stroke, factors other than blood glucose control come into play when it comes to cardiovascular health. High blood pressure and cholesterol abnormalities, two major risk factors for cardiovascular disease, are also problems for people with diabetes.

The UKPDS researchers understood that people with Type 2 diabetes also tend to have or develop high blood pressure, so they used a subset of volunteers from the blood glucose study to study the effects of tighter blood pressure control. Their results along with those from a number of other large studies have shown that tight control of blood pressure reduces the risk of strokes, microvascular complications (such as nephropathy and retinopathy), and diabetes-related deaths in people with diabetes. The ADA currently recommends that people with diabetes aim for a blood pressure below 140/90 mm Hg.

People with Type 2 diabetes also tend to have decreased blood levels of high-density lipoprotein (HDL) cholesterol (the so-called “good” cholesterol) and high blood levels of triglycerides (fat). Current ADA recommendations are to start statin (cholesterol-lowering drug) therapy in people over 40 and in those under 40 with risk factors for heart disease other than diabetes, such as low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol) levels above 100 milligrams per deciliter, high blood pressure, overweight, or smoking.

To remind people that controlling cholesterol and blood pressure are also important components of diabetes care, national health groups began a concerted effort to get the word out with nationwide campaigns and catchy slogans involving the letters “ABC” (for A1C, blood pressure, and cholesterol). You can also call the ADA at (800) DIABETES (342-2382) to order free publications such as the Diabetes Outcomes Wallet Card.

Everyday HbA1c

Although another fingerstick and another blood test may seem redundant to people who monitor their blood glucose levels three or more times per day, self-monitoring of blood glucose and HbA1c tests actually work together and don’t just rehash the same information.

Use in therapy.

Using a home blood glucose meter allows people with diabetes to fine-tune their diabetes regimen and detect low blood glucose levels (hypoglycemia). Blood glucose monitoring several times a day gives people the opportunity to adjust insulin doses before meals and to know if a snack is needed before or after exercising.

The HbA1c test can corroborate the daily blood glucose measurements you take or they can signal the need for a closer look at your therapy. A logbook full of blood glucose results that are in your target range and an HbA1c of 6.5% can leave you and your physician confident that your treatment is going well. However, if you only check your fasting blood glucose once a day and usually find it around 120 mg/dl yet your HbA1c is above 8%, you can be sure your blood glucose is much higher than 120 mg/dl at other times of the day. You will need to work with your health-care team to figure out when and why your highs are occurring. You may be encouraged to check your blood glucose levels more frequently as you and your team review your meal plan, physical activity levels, and medicines. Even people who monitor several times a day with few to no high results may be surprised to find they have a high HbA1c. In such cases, a little detective work might uncover a simple lab or meter error or the need to make changes in your meal plan, the timing of your blood glucose checks, or your blood glucose meter technique.

Who pays?

Every health insurance and managed-care company has its own policies, so you’ll need to check your plan for specifics. However, most companies and Medicare cover the costs of HbA1c tests.

Most variations tend to occur in the number of tests covered per year and who runs the tests. Some plans allow quarterly tests while others cover 10 or more per year. Several devices have been approved by the U.S. Food and Drug Administration for giving HbA1c results right in a doctor’s office (called point-of-service testing) or even at home. Although some physicians use the office-based test and like that they can give people feedback about their results at the time of an office visit, some insurers do not cover these tests and may require physicians to send your blood sample to an approved laboratory. In such cases, a physician may have you make another appointment to go over the results or may call you when results come in. Coverage of home HbA1c tests is variable, and although such tests can be as accurate as any other lab test, they should not be used as a substitute for a regular visit with your physician.

Risks.

For people with diabetes, especially those who use insulin, the main risk in trying to achieve tight control is low blood glucose levels (hypoglycemia). In the DCCT, people in the intensive-control group had three times the risk of hypoglycemia as people in the conventional-treatment group. Severe hypoglycemia can result in altered consciousness, coma, or convulsions; impaired neuropsychological or intellectual function in children; or strokes or heart attacks in older adults.

For some people, the risk of severe hypoglycemia may necessitate higher target blood glucose levels. For others, hypoglycemia is a risk that can be managed by being more aware of when lows can occur, by learning how to treat them effectively, and by reversing any hypoglycemia unawareness (the inability to sense the physical and mental side effects of low blood glucose) by setting temporary, higher blood glucose targets.

HbA1c error.

Several medical conditions can affect the HbA1c test result, including anemia, sickle cell disease (and sickle cell trait), and chronic kidney disease. Simple lab error is a possibility, too. Because HbA1c results are based on hemoglobin levels, anything that affects hemoglobin or the life of red blood cells can affect the HbA1c result. Shortened life spans of red blood cells, such as can happen in people with most forms of anemia or when recovering from blood loss, can falsely lower one’s HbA1c result because the red blood cells have less time to interact and bind with glucose molecules. Iron-deficiency anemia and some forms of genetic abnormalities of hemoglobin may falsely elevate HbA1c results. High levels of vitamins C and E in the blood may interfere with glycation — falsely lowering results.

In some cases, the testing method may contribute to skewed HbA1c results. Alcoholism, the taking of large quantities of aspirin, chronic use of opiate-containing drugs, high levels of blood triglycerides, uremia (high blood levels of nitrogen-containing wastes such as urea — usually caused by kidney failure), high blood levels of vitamin C, and high levels of bilirubin (a product of hemoglobin destruction) in the blood can falsely elevate HbA1c results, depending on a laboratory’s testing method. If your HbA1c test results don’t seem to match your blood glucose monitoring results, talk to your doctor about why this might be the case.

HbA1c and you

The HbA1c test is another tool that you and your health-care team can use to tighten your blood glucose control and reduce your risk for diabetic complications. Work with your team to determine the best, lowest HbA1c goal for you.

Originally Published July 24, 2006

What is a HbA1c blood test and why is it important?

The difference between HbA1c and blood glucose monitoring for diabetes

When it comes to your health, it can seem like there’s a never-ending list of things to keep track of.

But if you have diabetes, there are two things you can’t afford to forget or confuse:

• regular blood glucose monitoring and
• the HbA1c blood test.

And while people sometimes think they’re one and the same, these two tests check and report on blood glucose in two completely different ways.

In this article we explain why you need both to monitor diabetes, and how an HbA1c blood test is like a blood sugar ‘batting average’. It’s also used to monitor your risk of developing diabetes.

If you have #diabetes, there are two things you can’t afford to forget – #BloodGlucose monitoring and the #HbA1c test Click To Tweet

Blood sugar snapshots and average levels over time

If you have diabetes, you may do blood glucose monitoring with test strips at home several times a day. And if you use insulin, it’s important to get accurate results so you can make better decisions about managing your diabetes.

The HbA1c blood test (also known as A1c, glycohaemoglobin and glycated haemoglobin) is a blood test your doctor may order every few months.

If you’re a cricket fan, you know that how many runs a batsman scores in a day isn’t always a good indicator of how well they’re performing. You need to look at their batting average for the entire season.

In the same way, blood glucose monitoring gives you a snapshot at a particular time, while the HbA1c blood test shows what’s happening over a longer period.

Your blood sugar level changes constantly depending on when you eat, when and how much you exercise or whether you’re stressed.

Blood glucose monitoring is important. It can help you work out your insulin dose and monitor any fluctuation in your blood sugar level. But depending on when you take the test, you may miss the highest or lowest points in each day.

This is where the HbA1c test comes in. Your HbA1c level reflects your average blood sugar level over the previous eight to 12 weeks, which is why your doctor may recommend taking the test every three months or so.

Just as a cricketer’s batting average is important for gauging performance, #HbA1c shows #bloodsugar levels over 8-12 weeks. Click To Tweet

It’s all about how sugar attaches to your red blood cells

Some of the glucose in your blood attaches to your red blood cells. When your blood sugar is high, more glucose attaches to them. And when blood sugar is low, less glucose attaches to them.

The glucose remains attached for the lifespan of each red blood cell (around three months).  That’s why your HbA1c level reflects your average blood sugar over the previous three months.

Getting to know your HbA1c level

Knowing your HbA1c level is important, as there’s a proven link between high HbA1c levels and diabetes-associated problems such as heart disease, stroke, kidney failure, loss of sight, and foot ulcers.

There’s a proven link between high #HbA1c levels and #diabetes-associated problems. #bloodsugar Click To Tweet

If you have diabetes, your doctor will recommend a HbA1c level based on your particular life stage and circumstances. The closer your HbA1c level is to your recommended level, the less likely you’ll develop diabetes complications. And if any of these complications do develop, it will more likely be later in life.

The HbA1c blood test is also used in Australia to diagnose diabetes as well as pre-diabetes – a condition where blood glucose is higher than normal but not high enough to be classified as having diabetes. According to Diabetes Australia, two million Australians have pre-diabetes, which puts them at high risk of developing type 2 diabetes.

Diabetes NSW & ACT CEO Sturt Eastwood says there’s strong evidence that type 2 diabetes can be prevented if people take action early.

“Strong evidence shows that type 2 diabetes can be prevented in more than half of cases in the high risk (pre-diabetes) population by eating well and exercising.”

Sturt Eastwood, Diabetes NSW & ACT CEO

If you’re worried you might be developing diabetes you can do a type 2 diabetes risk assessment or take an HbA1c blood test and discuss the results with your doctor.

Monitor your blood sugar levels from home

Blood glucose is usually measured with a glucometer, either at home or at your doctor’s surgery.

Modern home glucometers can give highly accurate results and make it easy to get the information you need.

While your doctor can order a blood test for HbA1c (which is done at a pathology collection centre), you can also do a simple HbA1c blood test at home.

Use a #glucometer to check your #bloodsugar levels throughout the day and an at-home #HbA1ctest to check your levels over time. Click To Tweet

This at-home test involves putting a couple of drops of blood on a special collection card (just like a fingerprick test) and posting it back to our Canberra laboratory. In a few days we’ll give you the results through our secure website. You can then share the results with your doctor as you choose. This blood testing service also allows you to track your results over time via our secure website.

If you’d like more information about diabetes testing, visit Diabetes Australia or Diabetes NSW&ACT.

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Hemoglobin A1C (HbA1c) – Cleveland HeartLab, Inc.

NEW YORK DOH APPROVED: YES

CPT Code: 83036

Order Code: C145

Includes: HbA1c and Estimated Average Glucose
ABN Requirement:  No
Synonyms: Hemoglobin A1c; HbA1c; HgbA1c; Glycohemoglobin; Glycated Hemoglobin; Glycosylated Hemoglobin

Specimen: EDTA whole blood

Volume: 1.0 mL
Minimum Volume: 0.5 mL

Container:

EDTA (Lavender Top tube)

Collection:

1. Collect and label sample according to standard protocols.
2. Gently invert tube 8-10 times immediately after draw. DO NOT SHAKE.
3. Do not centrifuge.

Transport: Store EDTA whole blood at 2°C to 8°C after collection and ship the same day per packaging instructions included with the provided shipping box.

Fasting: Fasting is not required.

Stability:

Ambient (15-25°C): 7 days
Refrigerated (2-8°C): 7 days
Frozen (-20°C): 6 months

Causes for Rejection: Specimens other than EDTA whole blood; improper labeling; samples not stored properly; samples older than stability limits; sodium fluoride/oxalate (gray-top) tube; heparinized plasma

Methodology: Enzymatic Assay

Turn Around Time: 1 to 2 days

Relative Risk:

Hemoglobin A1c:

eAG (Estimated Average Glucose):

Clinical Significance: To assist with control of blood glucose levels, the American Diabetes Association (ADA) has recommended glycated hemoglobin testing (HbA1c) twice a year for patients with stable glycemia, and quarterly for patients with poor glucose control. Interpretive ranges are based on ADA guidelines.

The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.

90,000 What is the HbA1c Diabetes Test?

The HbA1c Diabetes Test is a laboratory blood test that measures a person’s long-term blood sugar levels over several weeks. When combined with daily home glucose monitoring, the HbA1c test is used to measure how well a person’s blood sugar is controlled by medication, diet, and exercise. This test is also sometimes used to aid in the initial diagnosis of diabetes.The HbA1c diabetes test is alternately called the hemoglobin A1c test, the glycated hemoglobin test, or the glycohemoglobin test.

Hemoglobin, sometimes called Hb for short, is a protein in the blood that carries oxygen. In uncontrolled diabetes, high blood sugar levels lead to the formation of glycated hemoglobin. The HbA1c test measures the amount of glycated hemoglobin in a person’s blood to provide a long-term estimate of blood sugar.People with high HbA1c levels are at a higher risk of certain complications of diabetes, such as nerve damage, heart disease, stroke, and eye or kidney problems.

The HbA1c diabetes test is performed in a laboratory after taking a blood sample from an individual. A process called high pressure liquid chromatography is used to separate a blood sample into its various components in order to distinguish the HbA1c molecule from other types of hemoglobin. Finally, the glucose level in the HbA1c molecule is measured.A high HbA1c level indicates a high blood sugar level in a person’s blood in general.

A normal test result for a person without diabetes should be in the 4-6 percent range, and 6.5 percent is generally considered an indicator for diagnosing diabetes. A result of less than 7 percent may be appropriate for a diabetic who is actively treating the disease. Every diabetic should consult a doctor about what HbA1c level represents a successful blood sugar regulation for their individual case.

The HbA1c diabetes test is not affected by daily fluctuations in blood sugar, such as those controlled by home tests. Rather, it is a long-term indicator of how well the disease is coping. It is generally recommended to get tested for HbA1c every 3–6 months, depending on the current stability of diabetes care.

Certain other medical conditions can affect the results of your HbA1c diabetes test. A person with high cholesterol, liver disease, sickle cell disease, kidney failure, or anemia may get inaccurate results.Other factors that affect the test include heavy drinking or taking certain types of vitamin supplements.

OTHER LANGUAGES

Blood sampling with disposable sterile systems

Glycosylated hemoglobin HbA1c

Glycosylated hemoglobin HbA1c – an analysis that is used to identify the chemical compound of hemoglobin (which is contained in red blood cells) with glucose. The analysis shows the average blood glucose value over the past three months.

Blood glucose binds with hemoglobin to form a stable compound – glycosylated hemoglobin. Hemoglobin A, one of several normal types of this protein, accounts for 95% to 98% of all hemoglobin in the body. The more glucose in the blood, the higher the glycosylated hemoglobin HbA1c.

You can find various names for this indicator:

• A1c
• Glycated hemoglobin
• Glycosylated hemoglobin
• Hemoglobin A1C

Indications for appointment

An appointment for the analysis of glycosylated hemoglobin HbA1c can be prescribed by a therapist or endocrinologist.The analysis is prescribed for people with suspected diabetes, namely those who have one of the following indicators:

• intense thirst,
• Frequent, profuse urination,
• fatigue,
• blurred vision,
• Increased susceptibility to infections.

In addition, this analysis evaluates the effectiveness of treatment and its adjustment (if necessary) in order to prevent diabetes.

Patients with diabetes mellitus undergo this analysis 2 times a year, and in case of severe course – 4 times a year.

Reference (laboratory standards)

Capillary or venous blood is taken to test for glycated hemoglobin.

The American Diabetes Association recommends that HbA1C levels be 7% or lower, and the closer to 6% with no health risk, the better.

This laboratory test is widely used to assess the degree of compensation of diabetes mellitus:

• glycated hemoglobin level within 4.8-6.0% indicates good diabetes compensation in the last 1-1.5 months,
• 6.0-8.9% – about disease subcompensation,
• more than 9.0% – about decompensation and the need to adjust antidiabetic therapy.

In addition, this test is performed on pregnant women for pregnancy diabetes.

It is important to know: a decrease in the HbA1C indicator even by 1% means an extension of the life of a person suffering from diabetes mellitus for several more years!

The HbA1C indicator in children, adolescents, pregnant women should be less than 6.5%, and ideally even lower than 5.%.

Increase in indicator

High doses of aspirin and chronic use of opiates can increase the level of glycosylated hemoglobin HbA1c. Also, an overestimated figure occurs with a lack of iron and with a recent blood transfusion.

Decrease in indicator

A decrease in the level of glycated hemoglobin is associated with a decrease in the level of glucose in the blood.

Iron supplements, vitamins B12, C, E, aspirin and antiretroviral drugs can lower the level of glycosylated hemoglobin HbA1c.

90,000 2.7. Laboratory diagnostics / ConsultantPlus

2.7 Laboratory diagnostics

To establish the diagnosis of hypertension, laboratory diagnostics is not required, however, it is necessary in order to exclude secondary forms of hypertension, detect MOM, assess CV risk, and concomitant pathology that affects the effectiveness of treatment and the patient’s quality of life.

– For all patients with hypertension, in order to exclude secondary hypertension, it is recommended to conduct a general (clinical) blood test (hemoglobin / hematocrit, leukocytes, platelets) [21, 22].

EOK / EOAG no (UUR C, UDD 5)

– For the detection of prediabetes, diabetes and the assessment of cardiovascular risk, all patients with hypertension are recommended to study the level of glucose in the venous blood [53, 54, 55, 56, 57, 302].

EOK / EOAG no (UUR C, UDD 5)

Comments. At glucose values> = 6.1 mmol / L, its level should be re-determined in all cases, except for undoubted hyperglycemia with acute metabolic decompensation or obvious symptoms. Determination of glycated hemoglobin (HbA1c) can be used as a test to confirm hyperglycemia.The diagnosis of diabetes is based on two digits in the diabetic range: double HbA1c or single HbA1c and single blood glucose. The values ​​of the listed parameters for assessing glycemia above normal, but below diabetic, indicate the presence of prediabetes. Oral glucose tolerance test (OGTT) is performed in doubtful cases to clarify the diagnosis of diabetes, as well as to identify prediabetes. Glycated hemoglobin (HbA1c) can be used for the diagnosis of diabetes and pre-diabetes if the method for its determination is certified according to the National Glycohemoglobin Standartization Program (NGSP), or the International Federation of Clinical Chemists (IFCC) and standardized according to the reference values ​​adopted in Diabetes Control and Complications Trial (DCCT).In the presence of diabetes, stratification of the patient into the category of high or very high cardiovascular risk is recommended.

– For all patients with hypertension, a study of serum creatinine levels and the calculation of the glomerular filtration rate (GFR) in ml / min / 1.73 m are recommended to identify impaired renal function for the assessment of cardiovascular risk ² according to the Chronic Kidney Disease Epidemiology formula ( CKD-EPI) [58] in special calculators (Table A3, Appendix D3) [21, 22, 58].

EOK / EOAG IB (UUR B, UDD 2)

Comments. It is performed in all patients with hypertension to detect CKD due to the fact that a decrease in GFR <60 ml / min / 1.73 m ² is a significant prognostic factor in hypertension [60] and GFR and increased cardiovascular mortality [61, 62]. The CKD-EPI formula includes the same 4 variables as the MDRD formula. The CKD-EPI formula gives less errors than the MDRD formula, especially when GFR> = 60 ml / min / 1.73 m ² , and is characterized by slightly less data scatter and greater accuracy.A significant part (but not all) of studies in North America and Europe have shown that the CKD-EPI formula gives more accurate results than the MDRD formula, especially with high GFR [63]. The lower error of the CKD-EPI formula in comparison with the MDRD formula reflects a higher eGFR in most of the age range and creatinine values, especially in young people, women and Caucasians [64].

– General (clinical) urinalysis with microscopic examination of urine sediment, quantitative assessment of albuminuria or albumin / creatinine ratio (optimal) is recommended for all patients with hypertension to detect kidney disease and assess CV risk [64, 65].

EOK / EOAG IB (UUR B, UDD 2)

Comments. It is performed in all patients with hypertension due to the fact that kidney damage is a significant prognostic factor in hypertension, the presence of a proven link between the detection of albuminuria and an increase in cardiovascular mortality [60, 61, 64, 66]. Daily urinary albumin excretion> = 30 mg / day is associated with an increased risk of complications of CKD [64]. In a meta-analysis of the CKD Prediction Consortium, associations were found between SEA> = 30 mg / day when tested with test strips, with the risk of overall mortality and mortality from CVD, renal failure and progression of CKD in the general population and in populations with an increased risk of CVD.The ratio of albumin / creatinine in urine (preferably in the morning portion) 30 – 300 mg / g; 3.4–34 mg / mmol is a marker of kidney damage [64].

– For all patients with hypertension, for risk stratification and detection of lipid metabolism disorders, it is recommended to study the level of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) (direct measurement or calculated) and triglycerides (TG) in the blood [21, 67, 68].

EOK / EOAG no (UUR B, UDD 2)

Comments.It is performed in all patients with hypertension for risk stratification [67, 68], as well as due to the high prevalence of dyslipidemia in the population of patients with hypertension and the positive effect of dyslipidemia correction on CV risk in patients with hypertension [21, 22].

– All patients with hypertension are recommended to study the level of potassium and sodium in the blood to detect electrolyte disturbances and differential diagnosis with secondary hypertension [21, 22].

EOK / EOAG no (UUR C, UDD 5)

Comments. It is performed in all patients with hypertension to detect electrolyte disturbances due to the proven relationship between serum potassium and sodium levels and blood pressure [69, 70].

– A study of the level of uric acid in the blood is recommended for all patients with hypertension to detect hyperuricemia [71].

EOK / EOAG no (UUR A, UDD 2)

Comments. It is performed in all patients with hypertension due to the fact that the level of uric acid is a significant prognostic factor in hypertension, as well as the presence of a proven link between hyperuricemia and increased cardiovascular mortality [71–73].

90,000 Glycated hemoglobin up to 50% discount

Deadline

Analysis will be ready in
within 2 days excluding Saturday, Sunday and pick-up day.The term can be extended by 1 day if necessary.
You will receive the results by email. mail immediately when ready.

Deadline: 2 days, excluding Saturday and Sunday (except for the day of taking biomaterial)

Preparation for analysis

In advance

Talk to your doctor about medication the day before and on the day of the blood test, and any other additional preparation conditions.

Do not take a blood test immediately after radiography, fluorography, ultrasound, physiotherapy.

The day before

24 hours before blood sampling:

• Limit fatty and fried foods, do not drink alcohol.

From 8 to 14 hours before donating blood, do not eat, drink only clean non-carbonated water.

On the day of donation

Before taking blood

• No smoking for 60 minutes,
• Be quiet for 15-30 minutes.

Analysis Information

Indicator

Glycated hemoglobin is a complex formed from glucose combined with hemoglobin. The analysis for glycated hemoglobin shows blood glucose over time, that is, over a period of up to three months.

Appointments

Thanks to the study, it is possible to find out the degree of development of diabetes mellitus and the effectiveness of the prescribed treatment.

Specialist

Appointed by a therapist or endocrinologist.

Important

Analysis for HbA1c does not reflect sharp changes in blood glucose levels. Fluctuations in glucose in patients with labile diabetes will also not be detected by this test.

Research method – High performance liquid chromatography

Material for research
– Venous blood with EDTA

Composition and Results

Glycated hemoglobin

Learn more about popular analyzes:

Do’s and don’ts before a blood test?

How to decipher general and biochemical blood tests?

Biochemical blood tests – meaning and importance

The main task of a doctor in the treatment of diabetes mellitus is to normalize blood glucose levels.The patient can control this metabolite in the blood either independently (with portable glucometers) or in the laboratory. According to a one-time determination of blood glucose, it is possible to judge only the concentration of glucose at the time of sampling, therefore, it is not possible to assume about the state of the patient’s carbohydrate metabolism between measurements. To assess carbohydrate metabolism in a patient over a longer period of time, it is necessary to test for the content of glycated hemoglobin (HbA1c) in the blood.

According to data from the National Institute of Diabetes, Digestive and Kidney Diseases (USA) 10-year study called DCCT (The Diabetes Control and Complications Trial) in the USA and Canada in 1983-1993, it was found that glycemia, correlated by the level of HbA1c concentration, is directly related to the risk of developing long-term complications of type 1 diabetes and their progression.In 1999, specialists from Great Britain showed that a decrease in the glucose content in the patient’s serum, assessed by the concentration of HbA1c, reduces the number of microangiopathies in type 2 diabetes mellitus.

Glycated hemoglobin is hemoglobin in which a glucose molecule is non-enzymically linked to the β-terminal valine of β-chains of hemoglobin A1 globin and is designated as HbA1c. The HbA1c content has a direct correlation with the blood glucose level. The normal concentration of HbA1c is from 4.4 to 6.1%, in patients with diabetes mellitus, its level depends on the degree of hyperglycemia and is usually 2 to 3 times higher than normal values.Glycated hemoglobin accumulates inside erythrocytes and remains during the entire period of erythrocyte circulation in the bloodstream, which is about 60 days. Thus, the concentration of HbA1c reflects the degree of glycemia 60 – 90 days before the study. Multiple studies of glucose measurement using traditional methods have confirmed the relationship between HbA1c and the patient’s glycemic level. The results of DCCT studies conducted in the 90s confirmed the hypothesis that the level of HbA1c is directly related to the level of glucose in the blood and is the most appropriate criterion for monitoring the effectiveness of treatment in patients with diabetes mellitus.

In the early 90s, there was no unified international agreed standardization for the measurement of glycosylated hemoglobin, which reduced the clinical effectiveness of this test. To achieve a uniform standard and overcome the challenges associated with its development, the International Federation of Clinical Chemistry (IFCC) established in 1993 the Working Group on the Standardization of HbA1c Assessment. The result of her work is the National Glycosylated Hemoglobin Research Standardization Program (NGSP).Most manufacturers of devices and kits for analyzing blood for glycosylated hemoglobin were required to be tested for compliance with the results obtained by reference methods. If the test result satisfies the reference data, the manufacturer is issued an “NGSP certificate of conformity”. The American Diabetes Association (ADA) recommends that all laboratories use NGSP-certified blood glycosylated hemoglobin tests.

There are many analytical methods available to determine HbA1c.These methods include electrophoresis, liquid chromatography, affinity chromatography, immunological techniques, column techniques. One of the main criteria when choosing an analyzer for performing a blood test for glycated hemoglobin is the presence of a reference NGSP method, which is liquid chromatography. When using standardized research methods, the laboratory has the ability to compare the results obtained with the data obtained using reference methods.This comparison maximizes the reliability of the research results.

Of undoubted importance is the use in the work of the attending physician only of such research results that are obtained in laboratories using NGSP-certified blood tests for glycated hemoglobin.

Diagnostic Center MEDLIFE-BIO

Diabetes mellitus is a disease that is the result of a disruption in the production of the hormone insulin, the action of insulin, or a combination of these factors.

Insulin is necessary for the absorption of sugar (glucose) by the cells of the body. It is formed in the endocrine beta cells of the pancreas, and is secreted by them into the blood.
Insulin deficiency or a violation of its action leads to a persistent increase in blood sugar levels, its appearance in the urine, metabolic disorders.

For what symptoms should you suspect diabetes mellitus?
weakness, increased fatigue,
constant thirst and dry mouth,
frequent urination and a sharp increase in the amount of urine,
progressive weight loss against a background of normal or even increased appetite,
itching of the skin,
smell of acetone from the mouth,
frequent blurred vision ,
prolonged infection and wound healing,
heaviness in the legs, cramps in the calf muscles.

In the absence of treatment, complications of the disease develop: renal failure, blindness, cataracts, stroke, myocardial infarction, gangrene of the extremities. Diabetes mellitus is the first cause of early disability and ranks third among the causes of death. Every 7 seconds, one person in the world dies from its complications.
This is why early diagnosis of the disease is so important.

Unfortunately, the number of patients with diabetes is increasing every year, and today there are more than 370 million of them worldwide.
According to official statistics, there are 1 million 198 thousand patients with diabetes in Ukraine, and more than 430 thousand people do not know that they have this disease.

There are 2 types of primary diabetes mellitus: type 1 and type 2, and 85-90% of all cases are type 2 diabetes mellitus.
It is generally accepted that type 1 diabetes mellitus is a disease of childhood only. However, in more than 15% of patients, the disease debuts after 25 years. Diabetes mellitus type 2 in the overwhelming majority of cases develops in adulthood against the background of obesity, but up to 10% of children and adolescents may suffer from different variants of this disease.
The diagnosis of type 1 diabetes mellitus requires immediate initiation of insulin therapy, and the administration of tableted antidiabetic drugs will only aggravate the severity of the disease and worsen the prognosis. On the other hand, in type 2 diabetes, treatment begins with diet and tableted antihyperglycemic drugs. Therefore, a correctly made diagnosis means a correctly prescribed treatment, and here you cannot do without the help of a laboratory, because the diagnosis of diabetes mellitus is, first of all, a laboratory diagnosis.

Type 2 diabetes mellitus mainly affects young and mature people and is caused by a decrease in insulin sensitivity (insulin resistance) of the liver, muscle and adipose tissue. At the onset of the disease, genetic factors are the cause. Beta cells, however, try to saturate the tissues of the body with insulin, and therefore increase the production of the hormone, and glucose is absorbed by the tissues in time. However, insulin resistance can increase due to overeating, starvation, aging, a sedentary lifestyle, stress, pregnancy.After that, the blood glucose level begins to rise.

Type 1 diabetes mellitus develops more often in children, adolescents and young people, whose immune system begins to “fight” with its own normal beta cells. The disease develops in people with hereditary characteristics of the immune response, and it is provoked by past viral infections, cow’s milk, cereal proteins, nitrates.
While the average person has a 0.4% risk of type 1 diabetes before the age of 15, it ranges from 2 to 50% for relatives of diabetic patients, depending on the degree of relationship.
The disease is initially latent, despite the onset of beta-cell death – this is the stage of “prediabetes”.
Then comes the stage of “latent diabetes”, in which after a meal the blood sugar level does not decrease for a long time, but the symptoms of the disease are still absent, and the fasting blood glucose level is normal. Diabetes mellitus at this stage can be detected by performing a glucose load test (glucose tolerance test).
And only after no more than 15% of living beta cells remain in the pancreas, “manifest diabetes” develops – the fasting glucose level rises and the characteristic symptoms of the disease appear.

Less commonly, type 1 diabetes begins after age 25. This atypical type of diabetes is called LADA diabetes. Symptoms of the disease resemble type 2 diabetes, and therefore, patients are prescribed diet therapy and treatment with tableted antidiabetic drugs, but this is not only ineffective, but also harmful. Such patients are not so few: 10-15% among all patients with diabetes and about 50% among patients diagnosed with type 2 diabetes mellitus, but who do not have obesity.

Laboratory diagnosis of any type of diabetes mellitus is carried out by prescribing the following tests:
– fasting venous blood plasma glucose concentration: ? 7 mmol / l or
– venous blood plasma glucose concentration 2 hours after glucose load – glucose tolerance test: ? 11.1 mmol / L or
– the concentration of glucose in the plasma of venous blood at random determination:? 11.1 mmol / L or
– glycosylated hemoglobin (HbA1c): ? 6.5%.

In case of pathological test results, they must be confirmed by repeated analysis (preferably the same). However, scores above the diagnostic threshold of two different tests also confirm the diagnosis.
Glycosylated hemoglobin and fasting blood glucose tests are usually prescribed for patients to monitor the effectiveness of treatment for disease.

HbA1c determination has several advantages over fasting blood glucose and glucose tolerance test:
– HbA1c level better reflects the patient’s real average blood glucose level over the last 3 months than a single glucose test;
– it allows you to get more accurate results;
– it is more convenient for the patient, since it is not required to donate blood on an empty stomach, donate it again after 2 hours, observe the strict conditions of preparation for the study.

Determination of HbA1c must be performed using a method certified by the US National Glycosylated Hemoglobin Standardization Program (NGSP) and standardized by a reference method according to the Diabetes and Complications Control Study (DCCT).
High-performance liquid chromatography used in the Medlife-Bio DC is considered to be the “gold standard” method for HbA1c determination. This method has the highest analytical accuracy and reproducibility, therefore it is accepted by NGCP as a reference (reference) method and is used in most of the leading laboratories in the world.

The World Health Organization recommends that HbA1c be determined once every 3 months to monitor the effectiveness of treatment in patients with diabetes mellitus.
Depending on the initial level of HbA1c in a particular patient, the goals of treatment and treatment tactics will differ (one drug, a combination of drugs, different doses of drugs).
The goal of glycemic control in most patients is to reduce HbA1c levels to 7% or less (your doctor should determine this), which can actually reduce the incidence of vascular and nerve complications.

Since diabetes mellitus is extremely dangerous for its complications, the World Health Organization recommends preventive examinations for the early detection of this pathology at the stages of development (prediabetes).

Laboratory criteria for pre-diabetes:
– fasting venous plasma glucose level: 5.6–6.9 mmol / L or
– venous blood plasma glucose concentration 2 hours after oral glucose load: 7, 8-11.0 mmol / L or
– glycosylated hemoglobin (HbA1c): 5.7-6.4%.

Patients with prediabetes should be monitored and advised by a physician on effective risk reduction measures (eg weight loss, increased physical activity), and should be screened annually for early diagnosis of diabetes mellitus.

The indication for examining clinically healthy adults is the presence of risk factors for type 2 diabetes:
age? 45 years.
overweight and obesity,
presence of 1st and 2nd degree relatives with type 2 diabetes,
low physical activity.
presence of cardiovascular diseases.
signs of insulin resistance and the presence of diseases accompanied by insulin resistance:
acanthosis nigricans (increased skin pigmentation in the folds of the body (on the neck, in the armpit, in the groin),
high blood pressure,
lipid profile disorders (high cholesterol),
polycystic ovarian syndrome ,
low birth weight,
maternal diabetes mellitus,
women diagnosed with pregnancy diabetes mellitus in previous pregnancies or giving birth to a large child.

For the examination, the same tests are recommended, then for the diagnosis of diabetes: fasting blood glucose, or a glucose tolerance test, or glycosylated hemoglobin.
In the absence of the listed risk factors, the patient should undergo the first examination at the age of 45 years. In the presence of overweight or obesity and one or more additional risk factors, identification of type 2 diabetes and an assessment of the risk of developing diabetes in the future in patients without an obvious clinical picture should be carried out in adults at any age.
With normal test results, it is advisable to re-examine at intervals of 3 years.

Type 1 diabetes or type 2 diabetes?
In order to distinguish between types of diabetes mellitus, which require completely different treatment, the levels of beta-cell hormones and antibodies to insulin in the blood are determined.
The level of beta-cell hormones (insulin and C-peptide) will be reduced until they disappear completely in type 1 diabetes, while in type 2 diabetes they are more often increased at the onset of the disease, then normal, and decrease in 15-20 % of patients 5-15 years after the onset of the disease.

Determination of the concentration of insulin and C-peptide in the blood is necessary for:
diagnosis and differentiation of type 1 and 2 diabetes,
selection of a drug,
selection of optimal therapy,
assessment of β-cell activity.

In the diagnostic and prognostic terms, to clarify the stage of the disease , it is much more useful to determine the C-peptide , since:
in type 1 diabetes patients there are autoantibodies to insulin in the blood, and the analysis data is almost always skewed towards underestimation;
the amount of C-peptide in the blood is 5 times higher than the amount of insulin, which means that its level is determined more easily and more accurately;
the level of C-peptide is a more stable indicator of insulin secretion than the rapidly changing level of the hormone itself;
Insulin testing is not indicated for patients who are already receiving insulin injections.

For the diagnosis of type 1 diabetes, including at the stage of pre-diabetes, the Medlife-Bio laboratory offers the determination of autoantibodies to insulin in the blood. This study is indicated:
for examining children under 15 years of age, in whose families there are patients with type 1 diabetes mellitus;
for examination of middle-aged adults with the aim of differentiating type 2 diabetes mellitus and LADA-diabetes.
for screening women with pregnancy diabetes mellitus for early signs of type 1 diabetes.
for the differentiation of type 1 and type 2 diabetes mellitus in children at the time of diagnosis when deciding whether to start insulin therapy.

Diabetes mellitus during pregnancy – any type of diabetes or impaired glucose tolerance that first appeared or was detected during pregnancy. Diabetes mellitus in pregnancy is usually amenable to dietary therapy and resolves after childbirth, but may be the initial manifestation of type 1 or type 2 diabetes.

Diagnostic criteria for diabetes mellitus in pregnancy:
– fasting venous blood plasma glucose level: ? 7 mmol / l or
– venous blood plasma glucose concentration 2 hours after glucose load – glucose tolerance test: ? 7.8 mmol / L or
– the concentration of glucose in the plasma of venous blood at random determination ? 11.1 mmol / L.

Additional studies
Lipid profile
Due to the increased risk of lipid metabolism disorders, the development of atherosclerosis and its complications in adult patients with diabetes, they are recommended at least an annual study of the lipid profile. The following indicators are optimal:
Low-density lipoproteins (LDL):
in patients without obvious symptoms of cardiovascular pathology:
in patients with obvious symptoms of LDL cardiovascular disease:
High-density lipoproteins (HDL):
in men:> 1.0 mmol / L
in women:> 1.3 mmol / L
Triglycerides (TG):

If these values ​​are normal, the assessment of the lipid profile can be carried out once every 2 years.

For children with type 1 diabetes and if close relatives have hypercholesterolemia, or stroke / myocardial infarction before the age of 55, lipid profile analysis is performed from the age of two, shortly after the established diagnosis of the underlying disease. For other children with type 1 diabetes, the first lipid profile is prescribed after 10 years of age.
If the child is diagnosed after puberty, lipid profile analysis should be performed shortly after the diagnosis is confirmed.For both age groups, annual monitoring of the lipid profile is recommended in case of pathological indicators of lipid concentration.
This analysis can be performed every 5 years if the LDL value is within the acceptable risk range (2.6 mmol / L).

Liver function
Patients with diabetes are recommended to have at least an annual assessment of liver function (AaAT, AaAT, alkaline phosphatase, bilirubin), since they have an increased risk of developing steatohepatitis and fatty hepatosis.

Diagnosis of kidney damage (diabetic nephropathy)
The kidneys are affected in 20-40% of patients with diabetes mellitus, especially type 1.The first symptom of this may be the appearance in the urine of minimal amounts of protein that are not detected in the general analysis of urine. Diagnostics is carried out annually by determining microalbumin in daily urine (normal
Renal function should also be assessed annually. For this, the laboratory offers the determination of the concentration of creatinine in the blood (based on this indicator, the doctor will be able to calculate the glomerular filtration rate), and also performs the Reberg test.
In children who develop diabetes before the age of 5 years, screening begins at the age of 10.

Diagnosis of concomitant autoimmune pathology in type 1 diabetes
Features of the immune response in patients with type 1 diabetes increase the risk of developing other autoimmune pathologies.
1. Patients with type 1 diabetes mellitus are recommended to assess the level of thyroid-stimulating hormone once every 3 years, to determine the levels of antibodies to thyroperoxidase and thyroglobulin, since they may develop autoimmune thyroid diseases.
2. Children with type 1 diabetes should be screened for celiac disease shortly after confirmation of the diagnosis – determination of antibodies to tissue transglutaminase /, deaminated gliadin peptides, native gliadin (see package studies for celiac disease).The examination should be repeated in children with stunted growth, delayed weight gain, weight loss, diarrhea, bloating, and abdominal pain.
3. For the diagnosis of autoimmune vitamin B12-deficiency anemia, patients may be advised to determine antibodies to parietal cells of the stomach, antibodies to intrinsic factor, determine the concentration of vitamin B12 in the blood, and complete blood count.

Calculation of the insulin resistance index HOMA2-IR
Based on the indicators of the concentration of insulin (or C-peptide) and fasting glucose, the Medlife-Bio laboratory offers the calculation of the insulin resistance index (HOMA2-IR).
There are 2 ways to calculate this index: using the formula (HOMA1) and using a computer model (HOMA2). Using a computer program, in comparison with HOMA1, allows:
– to make a more accurate assessment of metabolic processes, since the difference in insulin sensitivity of the liver and peripheral tissues, the secretion of proinsulin into the blood and the loss of glucose through the kidneys are taken into account;
– use for the calculation not only the concentration of insulin, but also the C-peptide,

If the threshold level of insulin resistance diagnostics for the HOMA1 model is> 2.7, then for the HOMA2> 1.8.
Insulin resistance is an independent risk factor for cardiovascular disease. An increase in the HOMA – IR index by only 1 unit is accompanied by an increase in the risk of coronary heart disease and ischemic stroke by 5.4%.
By the value of the HOMA – IR index, one can judge the dynamics of the decrease in insulin resistance during the therapy.
Based on the HOMA IR index, it is possible to predict the development of non-insulin dependent diabetes mellitus.
The HOMA-IR Index is a reliable method for assessing insulin sensitivity both in individuals without diabetes mellitus and in patients with an established diagnosis.

Leptin
Leptin is a hormone secreted by fat cells and is involved in the regulation of the body’s energy metabolism and body weight. It is a signal from adipose tissue to the brain to decrease appetite, increase energy expenditure, and alter the metabolism of fat and glucose. As the amount of adipose tissue increases, the level of leptin in the blood increases, and vice versa, decreases as it decreases.
Genetic leptin deficiency causes morbid obesity, treatable with exogenous leptin.
In other cases, obese people are characterized, on the contrary, by an increase in the concentration of leptin, which is not accompanied by a corresponding change in eating behavior and energy metabolism. Presumably, this is due to “leptin resistance”.
At present, impaired leptin regulation is considered as one of the mechanisms of development of type 2 diabetes mellitus. An excess of leptin leads to suppression of insulin secretion, causes resistance of skeletal muscles and adipose tissue to its effects, suppresses the effect of insulin on liver cells, which leads to an even greater increase in glucose levels in type 2 diabetes.
Leptin is essential for normal reproductive function and affects ovarian steroidogenesis.
In addition, high leptin levels create a high likelihood of thrombosis. It has been found that the relationship between the amount of leptin and cardiovascular disease exists regardless of other risk factors such as smoking, high cholesterol and high blood pressure.
Therefore, a study of the level of leptin in the blood is indicated for patients with early onset of severe obesity, in a complex of studies on the problems of weight gain or weight loss, in the diagnosis of the causes of reproductive dysfunction, to predict the risk of developing type 2 diabetes and its cardiovascular complications, in recurrent thrombosis …

Batch studies
Diabetes mellitus type 2 * : HbA1c, antibodies to insulin, C-peptide – 360.00 UAH.
Diabetes mellitus type 2 * : HbA1c, HOMA, C-peptide, leptin, lipid profile – 456.00 UAH.
Examination of a patient with diabetes mellitus * : HbA1c, insulin, C-pethid, lipidogram, liver function tests, serum creatinine with GFR calculation, microalbumin, TSH – 512.00 UAH.
Assessment of the risk of coronary heart disease in a patient with diabetes * : HbA1c, lipid profile, OAM, screening (albumin / creatinine ratio), serum creatinine with GFR calculation – 189.00
Type 1 diabetes or type 2 diabetes? * : C-peptide, insulin, antibodies to insulin – 268.00 UAH
Monitoring of patients with diabetes without complications * : HbA1c, OAK, OAM, microalbumin, biochemical blood test (total protein, total cholesterol, HDL, LDL, bilirubin, AsAT, ALAT, urea, creatinine, potassium, sodium) -336.00 UAH.

Monitoring of pregnant women with diabetes * : fasting blood glucose, blood glucose 1 hour after meals, HbA1c, OAM screening (ketonuria and microalbuminuria), serum creatinine with GFR calculation – 145.00 UAH.
Planning pregnancy in a woman with diabetes mellitus * : glucose tolerance test, HbA1c, serum creatinine with the calculation of GFR, daily proteinuria – 152.00 UAH.
Planning pregnancy in a woman with type 1 diabetes mellitus * : glucose tolerance test, HbA1c, serum creatinine with GFR calculation, daily proteinuria, TSH, free T4, antibodies to TPO – 305.00 UAH.
Preoperative examination of a patient with diabetes mellitus * : fasting blood glucose, OAM screening (ketonuria, proteinuria), HbA1c, pH, K +, Na +, creatinine, GFR, coagulogram – 292.00 UAH.
Screening for diabetic nephropathy *:
Stage 1: OAM (proteinuria screening), serum creatinine with GFR calculation – 50.00 UAH.
2nd stage: microalbumin, serum creatinine with the calculation of GFR – 100.00 UAH.
Diagnosis of diabetic nephropathy *: microalbumin, protein in daily urine, OAM, urine sediment, urea, serum potassium, serum creatinine with GFR calculation – 198.00 UAH.
Monitoring diabetic nephropathy *:
Stage 1: HbA1c, microalbumin, serum urea, serum creatinine with GFR calculation, serum lipids, hemoglobin, iron, ferritin, transferrin saturation with iron, C-reactive protein – 444
Stage 2: HbA1c, protein in daily urine, serum urea, serum creatinine with GFR calculation, serum albumin, serum lipids, hemoglobin, iron, ferritin, transferrin saturation with iron, C-reactive protein – 427.00 UAH
3rd stage: HbA1c, protein in daily urine, serum urea, serum creatinine with calculation of GFR, serum albumin, plasma calcium (total and ionized), phosphorus, serum lipids, hemoglobin, iron, ferritin, saturation of transferrin with iron, C- reactive protein, parathyroid hormone – 565.00 UAH
* – the term of execution of the package is 1 day.

Glycated hemoglobin (HbA1C): to be tested in “GEMOHELP”

Hemoglobin is a blood protein found in red blood cells and exchanges oxygen between the lungs and body tissues.
Glycated (glycosylated) hemoglobin (HbA1C) is a compound of hemoglobin in erythrocytes with glucose, the concentration of which reflects the average blood glucose level over a period of about three months.An increase in the level of glycated hemoglobin occurs with an excess of glucose in the blood, which occurs in diabetes mellitus.
For the diagnosis of diabetes mellitus and the assessment of diabetes compensation, the use of only a blood glucose test is not enough. At present, glycated hemoglobin is the main indicator for assessing the compensation of diabetes mellitus and verifying the risk of complications.
Patients with diabetes mellitus are recommended to take a biochemical blood test for glycated hemoglobin regularly – once every 3-4 months.
The level of glycated hemoglobin is an indicator of the compensation of carbohydrate metabolism throughout the life of erythrocytes (the average period is 60 days). Test results can be falsely altered for any condition that affects the average life of red blood cells. So bleeding, acute blood loss, hemolytic anemia cause a false decrease in the result; with iron deficiency anemia, a false increase in the result of glycated hemoglobin is observed.
Various analytical methods are currently used to determine HbA1c levels, so values ​​may differ between laboratories depending on the type of analytical method.This was the reason for the creation of a program for the standardization of methods for the study of glycated hemoglobin – NGSP. According to NGSP, the reference technique is high performance liquid chromatography (HPLC), when using which the coefficient of variation (CV) is less than 4% and the result of the HbA1c level is not affected by the high content of atherogenic fractions of lipids, triglycerides and total cholesterol.
In the laboratory of GEMOCHELP, for the determination of glycated hemoglobin, it is the reference technique that is used – high performance liquid chromatography (HPLC), the figures obtained during the analysis correspond to the standards specified in the Federal Target Program “Diabetes Mellitus” and do not need additional recalculation.
Another hemoglobin isoform is distinguished – fetal hemoglobin (HbF), which differs from normal hemoglobin in structure and properties. It is fetal hemoglobin that is the main hemoglobin during intrauterine development. This fraction of hemoglobin in children under one year old is 90% and only 10% is accounted for by the HbA isoform.
After the birth of a child during the first year of life, the HbF concentration gradually decreases to the values ​​observed in adults (no more than 1%). And after a year, the main fraction in children, as in adults, now becomes HbA1 (96%) and HbA2 (3%).
It is the fact of the presence of a high concentration of the fetal hemoglobin fraction in children under one year old that makes the measurement of glycated hemoglobin untenable.
Fetal hemoglobin is the norm in children, but for adults, its content is a sign of serious illness. Determination of hemoglobin in newborns is used in the diagnosis of blood diseases and cancer.
Attention! It is better to monitor glycated hemoglobin indicators in dynamics in one laboratory, since the values ​​in different laboratories may differ depending on the analytical method used.

Indications for the purpose of analysis:

long-term monitoring of the course and control of therapy in patients with diabetes mellitus to determine the degree of compensation of the disease.

When does the level of glycated hemoglobin rise?

• Diabetes mellitus and other conditions with impaired glucose tolerance.
• Iron deficiency.
• Splenectomy.
• False increase in high fetal hemoglobin (HbF) concentration.

When does the glycated hemoglobin level decrease?

• Hypoglycemia.
• Hemolytic anemia.
• Bleeding.
• Blood transfusion.

It can be taken immediately after a meal, it is inappropriate to carry out after bleeding and transfusion.

Clinical study Diabetes mellitus: EGT0001442, Placebo – Clinical study registry

Inclusion criteria:

– Male or female subjects ≥18 years old

– Type 2 diabetes established.

– Body mass index (BMI) ≤ 45 kg / m2

– HbA1c from 7 to 10% (inclusive) at screening

– FPG <250 mg / dL when screening subjects who have not received oral antidiabetic therapy or FPG <240 mg / dL when screening for subjects receiving antidiabetic therapy

– Diabetes is currently treated only by diet and exercise, or diet and exercise together with one approved oral antidiabetic agent

– If you are taking antidiabetic drugs, the dose and regimen should be stable over the course of last 3 months.

– If you are taking antihypertensive drugs, the dose and regimen should be stable for the past 3 years. months

– If you are taking lipid modifying therapy, the dose and regimen should be stable for the past 3 months.

– Blood glucose <250 mg / dL based on blood glucose from finger touch for all randomized subjects

Exclusion criterion:

– Hemoglobinopathy affecting HbA1c measurement

– Current use of injection therapy for diabetes (receptor insulin or GLP-1) based therapy)

– Urogenital tract infection within 6 weeks after examination

– More than 2 episodes of urinary tract infection in the last year

– Kidney stones, bladder dysfunction or other significant risk factor for infection urethra

– eGFR calculated by modifying the diet in the renal failure study equation.(MDRD), <50 ml / min / 1.73 m2

– Abnormal liver function tests ALT, AST or bilirubin ≥ 3x ULN

– Diagnosis of retinopathy or significant nephropathy (eGFR <50 ml / min / 1.