What is the Hemoglobin A1C test. How does it measure blood glucose levels over time. Why is it crucial for diagnosing and monitoring diabetes. What are normal A1C levels for adults. How often should A1C tests be performed.

The Basics of Hemoglobin A1C: A Revolutionary Tool in Diabetes Care

Hemoglobin A1C, also known as HbA1c or simply A1C, has transformed the landscape of diabetes management since its introduction in the 1980s. This test provides a comprehensive view of blood glucose control over an extended period, offering advantages over traditional daily blood sugar measurements.

A1C tests measure the percentage of hemoglobin proteins in red blood cells that have bonded with glucose. This glycation process occurs naturally, but elevated levels indicate higher average blood glucose over time. The test’s ability to reflect glucose levels over 2-3 months makes it an invaluable tool for both diagnosing and monitoring diabetes.

Why is A1C more reliable than daily glucose readings?

Daily glucose readings, while accurate at the moment of testing, fail to capture the full picture of a person’s glucose control. Blood sugar levels fluctuate throughout the day due to various factors such as meals, physical activity, stress, and hormonal changes. A1C, on the other hand, provides an average of blood glucose levels over approximately three months, offering a more stable and comprehensive assessment of glucose control.

Decoding A1C Levels: What Do the Numbers Mean?

Understanding A1C levels is crucial for both healthcare providers and patients in managing diabetes effectively. The test results are expressed as a percentage, reflecting the amount of glycated hemoglobin in the blood.

• Below 5.7%: Considered normal
• 5.7% to 6.4%: Indicates prediabetes
• 6.5% or above: Diagnostic of diabetes

These ranges, established by the National Institute of Diabetes and Digestive and Kidney Diseases, serve as important benchmarks for assessing diabetes risk and progression. It’s worth noting that in individuals without diabetes, approximately 5% of hemoglobin is typically glycated.

How do A1C percentages correlate with average blood glucose levels?

The American Diabetes Association provides a helpful calculator that translates A1C percentages into estimated average glucose (eAG) levels. This conversion allows patients and healthcare providers to relate A1C results to the more familiar daily glucose readings, enhancing understanding and facilitating better diabetes management strategies.

The Science Behind A1C: How Does It Work?

The effectiveness of the A1C test lies in the natural lifespan of red blood cells, which is approximately 120 days. As glucose circulates in the bloodstream, it attaches to hemoglobin molecules within these cells. The amount of glucose attached to hemoglobin provides a record of average blood glucose levels over the lifespan of the red blood cells.

This unique characteristic allows the A1C test to capture a long-term view of glucose control, reflecting not just recent blood sugar levels but also those from weeks prior. This comprehensive picture is invaluable for assessing overall diabetes management and making informed treatment decisions.

Why can’t A1C detect day-to-day fluctuations in blood sugar?

While A1C provides an excellent overview of long-term glucose control, it cannot capture daily or hourly fluctuations in blood sugar levels. This limitation means that A1C should be used in conjunction with, rather than as a replacement for, regular blood glucose monitoring. The combination of A1C and daily glucose readings offers a more complete understanding of a person’s diabetes management.

A1C Testing Frequency: How Often Should You Get Checked?

The frequency of A1C testing varies depending on individual circumstances and diabetes management goals. Generally, people with diabetes should have their A1C levels checked at least twice a year. However, more frequent testing may be necessary in certain situations.

1. Every 3 months for individuals with type 1 diabetes
2. During treatment adjustments
3. When setting new blood sugar targets
4. During pregnancy for women with diabetes

Regular A1C testing allows healthcare providers to track trends in glucose control over time, adjust treatment plans as needed, and identify potential complications early. For those without diabetes, especially adults over 45, an initial A1C test can provide a valuable baseline for future comparisons.

Can lifestyle changes impact A1C levels between tests?

Absolutely. Lifestyle modifications such as improved diet, increased physical activity, and better stress management can significantly impact A1C levels. These changes can often be observed in A1C results within 3-4 months, highlighting the test’s utility in tracking the effectiveness of diabetes management strategies.

Accuracy and Limitations of A1C Testing

While A1C testing has greatly improved in accuracy over the years, it’s important to understand its limitations. The National Glycohemoglobin Standardization Program has played a crucial role in enhancing the consistency and reliability of A1C tests across different laboratories and manufacturers.

However, A1C results can still have a margin of error of up to 0.5 percentage points. This means an A1C result of 7.0% could indicate an actual range between 6.5% and 7.5%. Additionally, certain factors can affect the accuracy of A1C tests:

• Kidney failure
• Liver disease
• Severe anemia
• Certain hemoglobin variants more common in people of African, Mediterranean, or Southeast Asian descent
• Conditions affecting red blood cell lifespan

How do healthcare providers account for these limitations?

To ensure accurate diagnosis and management of diabetes, healthcare providers often use A1C in conjunction with other tests, such as fasting plasma glucose or oral glucose tolerance tests. In cases where A1C results are inconsistent with other findings or clinical presentation, alternative testing methods may be employed to confirm the diagnosis.

Beyond Numbers: The Impact of A1C on Diabetes Management

A1C testing has revolutionized diabetes care by providing a long-term view of glucose control. This perspective allows for more informed decision-making regarding treatment plans, lifestyle modifications, and overall diabetes management strategies.

For individuals with diabetes, regular A1C testing can:

• Help assess the effectiveness of current treatment regimens
• Guide adjustments to medication dosages or types
• Motivate adherence to lifestyle changes
• Aid in early detection of diabetes-related complications
• Facilitate better communication between patients and healthcare providers

How does improving A1C levels affect long-term health outcomes?

Numerous studies have demonstrated that maintaining A1C levels within target ranges can significantly reduce the risk of diabetes-related complications. Even small improvements in A1C can lead to substantial benefits, including reduced risk of cardiovascular disease, kidney problems, and neuropathy. This underscores the importance of regular A1C monitoring and striving for optimal glucose control.

Emerging Technologies and the Future of A1C Testing

As diabetes care continues to evolve, so too does the technology surrounding A1C testing. Recent advancements have made A1C testing more accessible and convenient for patients and healthcare providers alike.

What innovations are shaping the future of A1C testing?

Several exciting developments are on the horizon for A1C testing:

• Point-of-care A1C devices: These allow for rapid A1C testing in clinical settings, providing results in minutes rather than days.
• Home A1C test kits: Increasingly accurate home testing options enable patients to monitor their A1C levels between clinical visits.
• Continuous glucose monitoring (CGM) integration: Some CGM systems now provide estimated A1C based on continuous glucose data, offering real-time insights into long-term glucose control.
• Artificial intelligence and predictive analytics: Advanced algorithms are being developed to predict future A1C trends based on current data, potentially allowing for earlier interventions.

These innovations promise to make A1C testing more convenient, frequent, and informative, further enhancing its role in diabetes management.

Empowering Patients: Leveraging A1C for Better Diabetes Control

While A1C testing is a powerful tool for healthcare providers, its true potential is realized when patients are actively engaged in understanding and utilizing their A1C results. Educating individuals with diabetes about the significance of A1C and how it relates to their daily diabetes management can lead to improved outcomes and better quality of life.

How can patients use A1C results to improve their diabetes management?

Patients can take several steps to make the most of their A1C results:

1. Set personalized A1C goals in consultation with healthcare providers
2. Track A1C trends over time to identify patterns and areas for improvement
3. Use A1C results as motivation for maintaining or adjusting lifestyle habits
4. Discuss A1C results with healthcare providers to refine treatment plans
5. Combine A1C insights with daily glucose monitoring for comprehensive diabetes management

By actively engaging with their A1C results, patients can take a more proactive role in their diabetes care, leading to better glucose control and reduced risk of complications.

In conclusion, the Hemoglobin A1C test has become an indispensable tool in diabetes management, offering a comprehensive view of long-term glucose control. Its ability to reflect average blood glucose levels over 2-3 months provides valuable insights for both diagnosis and ongoing management of diabetes. As technology continues to advance, A1C testing is likely to become even more accessible and informative, further empowering patients and healthcare providers in the fight against diabetes. By understanding the significance of A1C levels and actively using this information to guide diabetes management strategies, individuals can work towards better health outcomes and improved quality of life.

All About the Hemoglobin A1C Test

A1C levels refer to the amount of hemoglobin in your blood that has glucose attached to it, which can be useful for monitoring blood sugar levels.

People with diabetes used to depend on daily finger pricks to measure their blood sugar levels. These tests are accurate, but only in the moment — they’re actually very limited as an overall measurement of blood sugar control.

This is because your blood sugar can vary wildly depending on the time of day, your activity levels, and even hormonal changes. Some people may have high blood sugar at 3 a.m. and be totally unaware of it. A1C tests became available in the 1980s and quickly became an important tool in monitoring diabetes control.

A1C tests measure average blood glucose over the past 2 to 3 months. So even if you have a high fasting blood sugar, your overall blood sugar may be normal, or vice versa. A normal fasting blood sugar may not eliminate the possibility of type 2 diabetes.

This is why A1C tests are now being used for the diagnosis and screening of prediabetes and diabetes. Because it doesn’t require fasting, the test can be given at any time as part of an overall blood screening.

The A1C test is also known as the hemoglobin A1c test or HbA1c test. Other names for the test include the glycosylated hemoglobin test, glycohemoglobin test, glycated hemoglobin test, or A1C.

A1C measures the amount of hemoglobin in the blood that has glucose attached to it. Hemoglobin is a protein found inside red blood cells that carries oxygen to the body. Hemoglobin cells are constantly dying and regenerating.

Their lifespan is approximately 3 months. Glucose attaches (glycates) to hemoglobin, so the record of how much glucose is attached to your hemoglobin also lasts for about 3 months. If there’s too much glucose attached to the hemoglobin cells, you’ll have a high A1C. If the amount of glucose is normal, your A1C will be normal.

Someone without diabetes will have about 5 percent of their hemoglobin glycated. A normal A1C level is 5.6 percent or below, according to the National Institute of Diabetes and Digestive and Kidney Diseases. A level of 5.7 to 6.4 percent indicates prediabetes. People with diabetes have an A1C level of 6.5 percent or above.

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The American Diabetes Association provides a calculator that shows how A1C levels correlate to glucose levels. To monitor overall glucose control, people with diabetes should have an A1C test at least twice a year.

More frequent measurements (e.g., every 3 months) should be taken if:

• you have type 1 diabetes
• your treatment is being adjusted
• you and your doctor are setting certain blood sugar targets
• you’re pregnant

The test is effective because of the lifespan of the hemoglobin cells. Let’s say your blood glucose was high last week or last month, but it’s normal now. Your hemoglobin will carry a “record” of last week’s high blood glucose in the form of more A1C in your blood.

The glucose that was attached to the hemoglobin during the past 3 months will still be recorded by the test, since the cells live for approximately 3 months. The A1C test provides an average of your blood sugar readings for the past 3 months. It’s not accurate for any given day, but it gives your doctor a good idea of how effective your blood sugar control has been over time.

Anyone who’s had diabetes for any length of time knows that A1C tests haven’t been reliable until recently. In the past, many different types of A1C tests gave different results depending on the lab that analyzed them. But the National Glycohemoglobin Standardization Program has helped improve the accuracy of these tests.

Manufacturers of A1C tests now have to prove that their tests are consistent with those used in a major diabetes study. Accurate home test kits are also now available for purchase.

But accuracy is relative when it comes to A1C or even blood glucose tests. The A1C test result can be up to half a percent higher or lower than the actual percentage. That means if your A1C is 6, it might indicate a range from 5.5 to 6.5.

Some people may have a blood glucose test that indicates diabetes but their A1C is normal, or vice versa. Before confirming a diagnosis of diabetes, your doctor should repeat the test that was abnormal on a different day. This isn’t necessary in the presence of unequivocal symptoms of diabetes (increased thirst, urination, and weight loss) and a random sugar over 200 mg/dl.

Some people may get false results if they have kidney failure, liver disease, or severe anemia. Ethnicity can also influence the test. People of African, Mediterranean, or Southeast Asian descent may have a less common type of hemoglobin that can interfere with some A1C tests. A1C can also be affected if red cell survival is decreased.

Adults over the age of 45 should take an A1C test to get a baseline reading. People under 45 years old should get the test if they’re overweight or have the following risk factors:

• a past diagnosis of gestational diabetes
• a diagnosis of prediabetes
• a diabetes diagnosis

High A1C levels are indicative of uncontrolled diabetes, which has been linked to an increased risk of the following conditions:

• cardiovascular diseases, like stroke and heart attack
• kidney disease
• nerve damage
• eye damage that may result in blindness
• numbness, tingling, and lack of sensation in the feet due to nerve damage
• slower wound healing and infection

If you’re in the early stages of type 2 diabetes, small changes in lifestyle can make a big difference and even put your diabetes in remission. Starting an exercise program can help. Type 1 diabetes needs insulin treatment as soon as it’s diagnosed.

For those who’ve had prediabetes or diabetes for a long time, higher A1C results may be a sign that you need to start on medication or change what you’re already taking.

Prediabetes can progress to diabetes. You may also need to make other lifestyle changes and monitor your daily blood glucose more closely. Talk with your doctor about the best treatment plan for you.

The A1C test measures the amount of hemoglobin in the blood that has glucose attached to it. The test provides an average of your blood sugar readings for the past 3 months.

It’s used to monitor blood sugar levels, as well as for diagnosis and screening of prediabetes and diabetes. People with diabetes should take an A1C test at least twice a year and more frequently in some cases.

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What is HbA1c? – Definition, Units, Conversion, Testing & Control

HbA1c is a term commonly used in relation to diabetes. This guide explains what HbA1c is, how it differs from blood glucose levels and how it’s used for diagnosing diabetes

What is HbA1c?

The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming ‘glycated’.

By measuring glycated haemoglobin (HbA1c), clinicians are able to get an overall picture of what our average blood sugar levels have been over a period of weeks/months.

For people with diabetes this is important as the higher the HbA1c, the greater the risk of developing diabetes-related complications.

HbA1c is also referred to as haemoglobin A1c or simply A1c

How does

haemoglobin A1c return an accurate average measurement of average blood glucose?

When the body processes sugar, glucose in the bloodstream naturally attaches to haemoglobin.

The amount of glucose that combines with this protein is directly proportional to the total amount of sugar that is in your system at that time.

Because red blood cells in the human body survive for 8-12 weeks before renewal, measuring glycated haemoglobin (or HbA1c) can be used to reflect average blood glucose levels over that duration, providing a useful longer-term gauge of blood glucose control.

If your blood sugar levels have been high in recent weeks, your HbA1c will also be greater.

HbA1c targets

The HbA1c target for people with diabetes to aim for is:

• 48 mmol/mol (6.5%)

Note that this is a general target and people with diabetes should be given an individual target to aim towards by their health team.

An individual HbA1c should take into account your ability to achieve the target based on your day to day life and whether you are at risk of having regular or severe hypos.

HbA1c in diagnosis

HbA1c can indicate people with prediabetes or diabetes as follows:

HbA1c	mmol/mol	%
Normal	Below 42 mmol/mol	Below 6. 0%
Prediabetes	42 to 47 mmol/mol	6.0% to 6.4%
Diabetes	48 mmol/mol or over	6.5% or over

What are the benefits of lowering your

haemoglobin A1c?

Two large-scale studies – the UK Prospective Diabetes Study (UKPDS) and the Diabetes Control and Complications Trial (DCCT) – demonstrated that improving HbA1c by 1% (or 11 mmol/mol) for people with type 1 diabetes or type 2 diabetes cuts the risk of microvascular complications by 25%.

Microvascular complications include:

• Retinopathy
• Neuropathy
• Diabetic nephropathy (kidney disease)

Research has also shown that people with type 2 diabetes who reduce their HbA1c level by 1% are: ^[1]

• 19% less likely to suffer cataracts
• 16% less likely to suffer heart failure
• 43% less likely to suffer amputation or death due to peripheral vascular disease

How does HbA1c differ from a blood glucose level?

HbA1c provides a longer-term trend, similar to an average, of how high your blood sugar levels have been over a period of time.

An HbA1c reading can be taken from blood from a finger but is often taken from a blood sample that is taken from your arm.

Blood glucose level is the concentration of glucose in your blood at a single point in time, i.e. the very moment of the test.

This is measured using a fasting plasma glucose test, which can be carried out using blood taken from a finger or can be taken from a blood sample from the arm.

However, fasting glucose tests provide an indication of your current glucose levels only, whereas the HbA1c test serves as an overall marker of what your average levels are over a period of 2-3 months.

HbA1c can be expressed as a percentage (DCCT unit) or as a value in mmol/mol (IFCC unit). Since 2009, mmol/mol has been the default unit to use in the UK.

Note that the HbA1c value, which is measured in mmol/mol, should not be confused with a blood glucose level which is measured in mmol/l. Use our HbA1c conversion tool to help with switching between the two measurement units.

When should HbA1c levels be tested?

Everyone with diabetes mellitus in the UK should be offered an HbA1c test at least once a year.

Some people may have an HbA1c test more often. This may be more likely if you have recently had your medication changed or your health team are otherwise wishing to monitor your diabetes control more than once a year.

Although HbA1c level alone does not predict diabetes complications, good control is known to lower the risk of complications

How do blood glucose levels compare with HbA1c readings?

The table on the right (figure 2) shows how average blood sugar levels in mmol/L would be translated into HbA1c readings , and vice versa.

It is important to note that because blood glucose levels fluctuate constantly, literally on a minute by minute basis, regular blood glucose testing is required to understand how your levels are changing through the day and learning how different meals affect your glucose levels.

Share your readings over on the forum

Interacting with other members of the diabetes community is a great way to broaden your understanding the technicalities of things like haemoglobin A1c levels and how to manage them. Head over to the HbA1c forum to let everyone know how you’re getting on.

Read more about HbA1c:

• Tests for HbA1c
• HbA1c in pregnancy

Take control of your HbA1c levels

A healthy diet and regular exercise can help you lower your HbA1c levels. After being diagnosed with type 2 diabetes, Simon felt like he wasn’t provided with enough advice to treat his condition and wanted to find out for himself how he could lose weight.

With the help of the Low Carb Program, Simon managed to get his HbA1c levels from 82 to 23mmol/mol.

By following the Low Carb Program’s structured modules and diet plan, Simon lost 9 stone, reducing his HbA1c levels in the process. Find out how he did it, and read more success stories here.

Glycated hemoglobin (HbA1С, Glycated Hemoglobin)

Synonyms: Blood test for glycated hemoglobin. Glycohemoglobin; HbA1c; Hemoglobin A1c; A1c; HgbA1c; Hb1c.

Brief description of the analyte Glycated hemoglobin

Formed as a result of slow non-enzymatic addition of glucose to hemoglobin A contained in erythrocytes. Glycated (the term “glycosylated” is also used) hemoglobin is present in the blood in healthy people. The rate of this non-enzymatic addition of glucose and the amount of glycated hemoglobin formed depend on the average blood glucose level over the lifetime of red blood cells. As a result of the reaction, several forms of glycated hemoglobins are formed: HbA1a, HbA1b, HbA1c. The latter form quantitatively predominates and more closely correlates with the severity of diabetes mellitus. Glycated hemoglobin reflects hyperglycemia that has occurred throughout the life of erythrocytes (up to 120 days). Erythrocytes circulating in the blood have different ages. Usually they are guided by an average period of 60 days. The level of glycated hemoglobin is an indicator of the compensation of carbohydrate metabolism during this period of time, and is used to evaluate the effectiveness of diet and treatment. Normalization of the level of glycated hemoglobin in the blood occurs 4-6 weeks after reaching a normal glucose level.

In patients with diabetes, the level of HbA1c may be increased by 2-3 times. In accordance with the recommendations of the World Health Organization (WHO), this test is recognized as optimal and necessary for the control of diabetes.

What determines the result of the test for Glycated hemoglobin

Glycated hemoglobin is used as an indicator of the risk of developing complications of diabetes. Clinical studies show that a 1% increase in the proportion of glycated hemoglobin (measured by certified methods) is associated with an increase in plasma glucose levels of approximately 2 mmol/L. Normalization of the level of glycated hemoglobin in the blood occurs 4-6 weeks after reaching a normal glucose level. Patients with diabetes are advised to conduct a study of the level of glycated hemoglobin twice a year if therapy is stable and target values ​​\u200b\u200bare achieved, but at least once a quarter if therapy is changed or target HbA1c values ​​\u200b\u200bare not achieved. The usual HbA1c targets for adults in diabetes therapy are below or near 7.0%. The physician’s choice of individual HbA1c targets may depend on the patient’s age, comorbidities, presence of complications, risk of severe hypoglycemia, and life expectancy.

In 2011, WHO approved the use of HbA1c to diagnose diabetes. The test must be performed using an HbA1c test certified by the National Glycohemoglobin Standardization Program (NGSP) or International Federation of Clinical Chemists (IFCC) and standardized by the Diabetes Control and Complications Trial (DCCT). The level of HbA1c ≥ 6.5% (48 mmol/mol) was chosen as a diagnostic criterion for diabetes mellitus. The level of HbA1c up to 6.0% (42 mmol/mol) is considered normal. In the absence of symptoms of acute metabolic decompensation, the diagnosis should be made on the basis of two numbers in the diabetic range, for example, a double HbA1c test or a single HbA1c test plus a single glucose test.

Glycated hemoglobin levels may be falsely affected by any condition that affects the average lifespan of red blood cells. Bleeding or hemolysis causes a false decrease in the result; blood transfusions naturally distort the result; with iron deficiency anemia, a false increase in the result of determining glycated hemoglobin is observed. Interpretation of the results can be hampered by the presence of variant forms of hemoglobin (including the presence of hemoglobin A2 in beta thalassemia, fetal hemoglobin in children under six months of age).

What is the purpose of determining glycated hemoglobin

Evaluation of glycated hemoglobin in whole blood is used for long-term control of blood glucose levels, in diagnosing diabetes mellitus, and identifying the risk of developing diabetes.

Interpretation of test results contains information for the attending physician and is not a diagnosis. The information in this section should not be used for self-diagnosis or self-treatment. An accurate diagnosis is made by the doctor, using both the results of this examination and the necessary information from other sources: history, results of other examinations, etc.

Units: % of total hemoglobin.

Reference values ​​

– <6% - in the absence of diabetes, in the absence of pregnancy;

– ≥6.5% – diagnostic criterion for diabetes mellitus;

– 6.0-6.5% – increased risk of developing diabetes mellitus and its complications according to WHO (5.7-6.5% – according to ADA, American Diabetes Association).

Interpretation of Glycated Hemoglobin 9 test results0007

Increased values ​​

1. Diabetes mellitus and other conditions with impaired glucose tolerance.
2. Iron deficiency.
3. Splenectomy. A false increase may be due to a high concentration of fetal hemoglobin (HbF).

Setback

1. Hypoglycemia.
2. Hemolytic anemia.
3. Bleeding.
4. Blood transfusion.

Topic 8. Compensation criteria for diabetes

In a person without diabetes, the fasting blood glucose level does not exceed 5.5 mmol / l in capillary blood, after eating – 7.8 mmol / l.

Ideally, a diabetic patient should aim for the same level of glycemia, allowing rises to 10 mmol/l at the peak of a meal. However, this is not always possible or necessary. Maintaining glucose levels close to normal is often associated with the risk of hypoglycemia. A diabetic patient receiving insulin therapy constantly balances the risk of complications due to high glycemia and the risk of hypoglycemia. And in some cases, this balance is shifted towards a higher level of glycemia. This is especially common in the elderly, for whom hypoglycemia is extremely dangerous.

Target glycemic levels are therefore individual!

The younger the patient, the less comorbidities he has, the closer to normal his glycemic control should be. But what is given to the young can be harmful to the elderly.

glycated hemoglobin ( HbA1c) is currently used as a criterion for diabetic compensation.

Glycated hemoglobin shows what was the compensation for the last 2-3 months. It must be determined at least 2 times a year.

Approximate targets for glycemic control by age and disease are shown in the table. Treatment goals may be less stringent under certain conditions

If glycated hemoglobin was initially high at diagnosis of diabetes (this is especially common in type 2 diabetes), glycemic control should not be quickly brought to the target level, especially in older people, as well as in people with changes in the eye day. Insulin-independent organs (brain, blood vessels, retina) are accustomed to a high level of glycemia, and if they suddenly “cut their rations”, they may not endure this without damage. Glycated hemoglobin in this case should decrease gradually, by about 0.5% in 3 months.

To assess compensation for the last 2-3 weeks, an analysis for fructosamines is prescribed. The normal level of fructosamines is up to 280 µmol/l. At a level of up to 320 µmol / l, diabetes is considered compensated in the last 2-3 weeks, 320-370 – subcompensated, more than 370 – decompensated.

However, even if you have ideal HbA1c, but there are daily blood sugar fluctuations of more than 5 mmol/l, this cannot protect you from complications.

Glycated hemoglobin is like the average temperature in a hospital. And if the target value of glycated hemoglobin is achieved due to frequent hypoglycemia, then this has a very bad effect on target organs.

Recently, TIR (time in range) has been used as the main indicator of diabetes compensation. TIR shows how many percent of the time a person had a blood glucose level within acceptable limits. There are also other indicators that reflect daily fluctuations in blood glucose levels. But all these indicators can only be determined by continuous monitoring of blood glucose.