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

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

Table of contents

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

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

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What is the HbA1c test?

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

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

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

What are normal HbA1c ranges?

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

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

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

Why do normal HbA1c ranges vary by age?

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

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

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

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

Controversy over updated HbA1c ranges for adults 65 years and older

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

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

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

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

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

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

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

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

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

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

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

At what age should you check your HbA1C?

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

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

Find out whether your HbA1c is normal for your age

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

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

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Prediabetic range for HbA1c

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References

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

What Is a Normal A1C Level? Brush Up on a Key Blood Sugar Indicator

Whether you’re seeking to prevent diabetes, find out whether you have it or, if you do, improve how you manage it, there’s a test that can shed light on your status and help guide your decisions: the A1C test. This test can show how your blood sugar levels are trending over time—priceless data for you and your primary care provider (PCP). What is the A1C test, and what is a normal A1C level? Let’s answer these questions and explore steps you can take to control diabetes and meet your A1C target.

A1C, Explained

If you have diabetes, testing your blood sugar, or blood glucose, levels daily can be an important part of managing the disease. A blood glucose test, however, only provides a snapshot of your blood sugar levels. The A1C test shows the bigger picture.

Sugar binds to hemoglobin, a protein in your red blood cells. This is normal, but if too much sugar attaches to hemoglobin, blood sugar can get too high, potentially leading to Type 2 diabetes. The A1C test measures the percentage of your red blood cells that contains hemoglobin that contains excess sugar.

What makes the A1C test valuable is that it measures your average blood sugar during the previous three months. That can reveal long-term trends—whether your blood sugar levels have been going up, declining or holding steady during that timeframe. Using your test results, your PCP can determine whether you have prediabetes—a potential precursor to diabetes—or Type 2 diabetes. If you have diabetes, the test results can help you and your PCP gauge how your management plan is working.

Defining a Normal A1C Level

Your A1C test result appears as a percentage.

• A result lower than 5.7% is a normal A1C level.
• If your result is 5.7% to 6.4%, you may have prediabetes.
• If you have an A1C level of 6.5% or higher, you may have diabetes.

It’s possible to have a high A1C result and not have diabetes. That’s because your A1C level can be increased by certain diseases and medications, such as sickle cell anemia, kidney failure, liver disease and opioids.

In general, people with diabetes should aim for an A1C of 7% or less, but that goal isn’t universal. Your PCP will determine a personal A1C goal for you based on your overall health, your age and other factors. As a result, an acceptable A1C level for an older adult with diabetes may be slightly higher than for a younger adult with the disease.

Putting Your A1C to the Test

Getting an A1C test is simple. You can visit your PCP’s office or the River’s Edge Hospital & Clinic Direct Access Lab to provide a blood sample. You don’t need to fast in advance of having blood drawn for this test. If your PCP ordered the test to diagnose diabetes, he or she will send your sample to a specially certified lab for analysis. Otherwise, your sample will undergo analysis in the office or a nearby lab.

How often should you have an A1C test? It depends on where you are in your health journey. The Centers for Disease Control and Prevention (CDC) recommends a baseline A1C test for adults older than 45 to test for prediabetes and diabetes. You can get your baseline test before age 45 if you have risk factors for those conditions.

If your A1C test result is normal and you’re older than 45, are at risk for prediabetes or diabetes, or developed diabetes during pregnancy, the CDC recommends repeating the test every three years. You’ll need to repeat the test more often if your result indicates prediabetes or diabetes.

Having regular A1C tests is an important part of managing diabetes. Your test results can show whether you’re on the right track with controlling the disease or need to change your strategy to manage it better. You’ll need to have an A1C test at least every six months. More frequent tests may be necessary if your health status or diabetes management plan changes.

You’re (Diabetes) Management Material

If you have diabetes, your goal is to manage it so you can stay active and independent and enjoy the things you love. With commitment, you can live well with diabetes.

A major part of your diabetes management plan is reaching and maintaining your A1C goal. To do that and protect your health, make some important changes to your lifestyle. To start:

• Control chronic heart conditions. Diabetes can increase your risk for heart disease. As a result, it’s important to control other heart disease risk factors. Chief among these are high blood pressure and unhealthy cholesterol levels. Work with your PCP to manage these conditions.
• Give up smoking. If you smoke, another way to protect your heart is to kick the habit. The combination of smoking and diabetes takes a toll on your cardiovascular system by narrowing your blood vessels and making your heart work harder than it needs to.
• Follow a healthy diet. This will help you control diabetes and protect your heart at the same time. Ensure your diet includes plenty of fruits and vegetables, whole grains, lean meat, poultry, fish, beans, lentils, and low- or non-fat dairy products. Minimize the number of processed, high-calorie and high-salt foods in your diet.
• Move more. Regular exercise can help you manage diabetes and meet your A1C goal. New to exercise and not sure how to start? Try visiting a fitness center where the staff can help design an exercise plan that works for you. Whatever you do, pick physical activities you enjoy, such as walking or swimming, so you’ll be more likely to stick with them.

Finally, take diabetes medications as prescribed and stay in touch with your greatest ally against diabetes: your PCP. Together, the two of you can shape a hopeful future in which diabetes doesn’t control your life.

Want to test your A1C without a trip to your PCP’s office? Schedule an appointment with the Direct Access Lab at River’s Edge Hospital & Clinic. The lab doesn’t require a physician’s order for testing. You can share the results of your test with your PCP.

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Blood test for glycated hemoglobin A1c

Glycated (or glycosylated) hemoglobin A1c reflects the sugar level over the previous 2-3 months. A test for its amount is one of the markers for the presence of diabetes. Its results are used both for diagnosing the disease and for monitoring its course, monitoring the effectiveness of treatment. The test gives the attending physician the opportunity to identify violations of carbon metabolism, to choose the best therapy.

General

Hemoglobin in erythrocytes is a protein whose main task is to transport oxygen. Among all the varieties of this protein, the A form predominates. One of its components is called A1c. Glucose in the bloodstream is able to spontaneously combine with hemoglobin. The resulting compound is glycated or glycosylated hemoglobin. Its formation directly depends on the amount of sugar. The compound remains stable throughout the life cycle of the erythrocyte. It is formed and broken down daily along with the renewal of red blood cells.

For patients with diabetes, controlling glucose levels and maintaining them at an optimal level makes it possible to avoid the development of complications that can lead to disability and death. Passing this test during a preventive examination makes it possible to detect diabetes in a timely manner.

The characteristic symptoms of diabetes include a constant feeling of thirst, weakness, decreased vision, frequent urination, and a high susceptibility to infectious diseases. If they appear, you should immediately consult a doctor, undergo an examination, and upon confirmation of the diagnosis, begin treatment.

Indications for examination

Patients with diagnosed diabetes are examined every four months (if necessary, more often, the frequency of a blood test for glycated hemoglobin HbA1c is selected by the doctor on an individual basis). Also, the study is prescribed for pregnant women and patients with suspected diabetes for its primary diagnosis. In the absence of health complaints, it is recommended to take the test during a preventive examination at least once every three years. If there is a history of significant bleeding or hemolysis, false results may be obtained. In such cases, it is recommended to consult a doctor before taking the test. If necessary, he will recommend an alternative analysis or this test will be carried out at a later date.

Study preparation

Blood for analysis must be taken strictly on an empty stomach. There is no need to observe a long hungry pause, it is enough not to eat food for three hours before the study. During this period of time, you can drink only sparkling water.

Interpretation of results

Reference values ​​are 4.8 – 5.9%. An increase in readings may indicate diabetes or a pre-diabetic condition. With iron deficiency or after a blood transfusion, the indicators may increase. For a competent interpretation of the results, it is necessary to consult a doctor. Only a specialist can make the correct diagnosis and, if necessary, prescribe treatment.

Glycated hemoglobin: price of analysis

The cost of this test is higher than a standard sugar test. For the most accurate diagnosis, it is recommended to undergo a study on A1c. The test determines the average sugar level for 3 months. Therefore, external factors (for example, stress) do not significantly affect the result. A single test for sugar in this case is less accurate, often it has to be repeated several times.

Clinical significance of the determination of glycated hemoglobin – article on the topic Diagnostics (laboratory)

Clinical significance of the determination of glycated hemoglobin
Glycated hemoglobin , or glycohemoglobin (shortly designated: hemoglobin A1c , HbA1c ) – biochemical a blood indicator that reflects the average blood sugar content over a long period (up to three months ), as opposed to blood glucose measurement, which gives an idea of ​​the blood glucose level only at the time of the test.
Glycated hemoglobin reflects the percentage of blood hemoglobin that is irreversibly bound to glucose molecules. Glycated hemoglobin is formed as a result of the Maillard reaction between hemoglobin and blood glucose. An increase in blood glucose levels in diabetes mellitus significantly accelerates this reaction, which leads to an increase in the level of glycated hemoglobin in the blood. The lifetime of red blood cells (erythrocytes), which contain hemoglobin, averages 120-125 days. That is why the level of glycated hemoglobin reflects the average level of glycemia for about three months.
Glycated hemoglobin is an integral indicator of glycemia for three months. The higher the level of glycated hemoglobin, the higher was the glycemia over the past three months and, accordingly, the greater the risk of developing complications of diabetes.
A glycated hemoglobin test is commonly used to assess the quality of diabetes care over the previous three months. With a high level of glycated hemoglobin, treatment should be corrected (insulin therapy or hypoglycemic tablets) and diet therapy.
HbA1c values ​​from 4% to 5.9% are considered normal. In diabetes, HbA1c levels rise, indicating a greater risk of developing retinopathy, nephropathy, and other complications. The International Diabetes Federation recommends keeping HbA1c below 6.5%. An HbA1c value greater than 8% indicates that diabetes is not well controlled and therapy should be changed.

Glycosylated or glycated hemoglobin (HbA1c) is an indicator that reflects the level of glucose in the blood over the past 1-2-3 months. The main indications for use are: control of the course of diabetes mellitus (1 time in 3 months), control of the effectiveness of diabetes treatment, an indicator of the risk of developing complications of diabetes mellitus.
Glycosylated or glycated hemoglobin (HbA1c) is a compound of hemoglobin A and glucose that is formed in the body in a non-enzymatic way. Approximately 5-8% of the hemoglobin in erythrocytes binds stably to a glucose molecule. The process of attaching glucose to a hemoglobin molecule is a normal process, but during the life of an erythrocyte, with an increased long-term glucose content in the blood, this percentage increases. Such hemoglobin molecules are called glycosylated. There are several types of glycosylated hemoglobins (HbAIa, HbAIb, HbAIc). It is believed that hemoglobin – HbA1c (due to its quantitative predominance) has the greatest clinical significance. The concentration of glycosylated hemoglobin depends on the concentration of glucose in the blood. Considering that the lifespan of an erythrocyte is on average 120 days, the determination of the HbA1c content will reflect the average content of glucose in the blood serum for 1-2-3 months before the study.
In addition to hemoglobin, albumin, collagen, eye lens proteins, transferrin, erythrocyte membrane proteins and many other proteins and enzymes are subject to glycation, which leads to disruption of their functions and aggravation of the course of diabetes mellitus.
The determination of glycosylated hemoglobin is recognized by the World Health Organization as necessary to control the course of diabetes mellitus once every 3 months.
The determination of HbA1c allows monitoring of glucose levels between visits to the doctor. The higher the HbA1c content in the patient’s blood serum, the worse the glucose concentration was controlled.
Normalization of the level of HbA1c in the blood occurs on the 4-6th week after reaching the normal level of glucose. When monitoring the treatment of diabetes, it is recommended to maintain the level of glycated hemoglobin less than 7% and to review therapy if its content is more than 8% (according to the method for determining HbA1c with normal values ​​in the range of 4-6%).
Glycated hemoglobin is used as an indicator of the risk of complications of diabetes mellitus.
Values ​​may vary between laboratories depending on the analytical method used, so monitoring over time is best done in the same laboratory, or at least by the same method.
The test results can be falsely changed in any condition that affects the average lifespan of red blood cells. Bleeding or hemolysis causes a false decrease in the HbA1c result. Blood transfusions also distort the result. With iron deficiency anemia, a false increase in HbA1c is observed.

Preparing for diagnostics

• Explain to the patient that the study will evaluate the effectiveness of antidiabetic therapy.
• You should warn him that a blood sample must be taken for the study, and tell who and when will take blood from a vein.

Procedures

• After vein puncture, blood is drawn into a tube with EDTA.
• Press down on the venipuncture site with a cotton ball until bleeding stops.
• If a hematoma forms at the venipuncture site, warm compresses are prescribed.
• The patient is scheduled for a follow-up study after 6-8 weeks.

Reference values

• Normally, the content of glycated hemoglobin is 4.0 – 5.2% of total hemoglobin.

Factors affecting the result of the study

• Confounding factors

Incorrect blood sampling – insufficient mixing of the blood with the anticoagulant (EDTA) in the test tube.

• Factors that increase results
• Carbamylated hemoglobin (formed in patients with uremia).
• Hydrochlorothiazide.
• Indapamide.
• Morphine.
• Propranolol.
• Factors causing a false increase

Hemoglobin F (fetal) and labile intermediates may cause a false increase in results.
Glycated hemoglobin. Analysis of glycosylated hemoglobin. Get tested for high blood sugar
Analysis Index Table
Glycated hemoglobin (HbA1c)

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Glucose interacts with proteins (including hemoglobin) with the formation of Schiff bases. Thus, any even short-term increase in the concentration of glucose in the blood leaves a kind of trace in the form of an increased content of glycosylated hemoglobin. HbA1 is made up of three components of HbA1a; HbA1b; HbA1c. HbA1c predominates quantitatively.

The HbA1c level reflects the hyperglycemia that has occurred during the lifetime of erythrocytes (up to 120 days). Erythrocytes circulating in the blood have different ages, therefore, for the average characteristics of the glucose level, they are guided by the half-life of erythrocytes – 60 days. Thus, the level of glycated hemoglobin shows what the concentration of glucose was in the previous 4-8 weeks and this is an indicator of the compensation of carbohydrate metabolism during this period. Measuring the concentration of HbA1 allows you to retrospectively assess the severity of hyperglycemia in diabetes mellitus. The effect of glycosylation does not depend on the daily rhythm of blood glucose fluctuations, on the physiological activity of the body, the nature of food, physical activity, and depends only on the magnitude and duration of hyperglycemia. In diabetic patients with persistent hyperglycemia, the concentration of HbA1c increases significantly. Treatment of diabetes is carried out with drugs that lower blood glucose for only a limited period of time, so it is very important to choose such treatment regimens that would achieve stable normalization of glycemia.