What should your a1c numbers be: Understanding A1C | ADA
Understanding Your A1C: FAQs for Better Diabetes
Hemoglobin A1c is a test used to measure your average blood sugar levels over the past 3 months. It can be a useful tool for managing diabetes and can be used to make adjustments to your treatment plan and goals.
The hemoglobin A1c is a cornerstone blood test used in diabetes management since the 1990s. This test is taken at a physician’s office or diagnostic lab, either by fingerstick or blood draw from your vein. The A1C looks at your past 3 months or so of glucose levels, providing an average over that period of time to provide a more bird’s-eye view of how your diabetes management has been overall.
As diabetes technology and management tools advance, the reliance on A1C has become less of a focus than it once was when considered the only “gold standard” in diabetes care.
This article will answer some of the most common frequently asked questions (FAQs) relating to A1C and how it makes a difference in your diabetes management each day.
A1C is a simple blood test that measures your average blood glucose (blood sugar) levels as a percentage of hemoglobin over the previous quarter. You can think of it as sort of a summary of where your glucose levels have been during the last 3 months.
Once you’ve received a diagnosis of diabetes or prediabetes, the A1C is used to monitor your glucose management. Higher A1C readings are associated with a higher likelihood of developing diabetic complications.
As a summary of glucose levels over time, it presents a rough read on where a person’s glucose levels have been and an opportunity to make adjustments to diabetes care routines and set new goals.
You’re more than just a number
Managing diabetes includes actively measuring and monitoring glucose levels. It involves collecting a lot of numbers. But none of these numbers truly tells the whole diabetes story.
In the past, diabetes care focused primarily on A1C as a measure of “good” diabetes management.
And sometimes having “good numbers” was equated with being “good” in your life with diabetes.
But this singular focus also created some negative impacts. People who couldn’t reach or keep up the ideal A1C level were often judged and stigmatized. They were labeled “bad” or “noncompliant” despite their best efforts.
As a result, some became too closely identified with their numbers. They felt good about themselves and their diabetes management only if they had “good” numbers. Faced with the impossible task of perfect glucose management, some became discouraged and lost motivation to actively manage their diabetes.
The American Diabetes Association (ADA)’s current Standards of Care call for individualized targets that take into account the person’s stage of life, health history, social determinants of health, and personal health goals.
This more modern approach recognizes and validates what people living with diabetes realized long ago: Our (glucose) numbers don’t tell the whole story when it comes to how well we’re managing our diabetes.
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A1C was recognized as an effective way to measure glycemic control as far back as the late 1960s. But it wasn’t until the late 1980s when the ADA began recognizing it, and then in the mid-1990s that the organization formally recommended adding A1C to a diabetes diagnosis.
The landmark Diabetes Control and Complications Trial (DCCT) published in 1993 followed a decade of research on the A1C, and it set the stage for this becoming the “gold standard” in diabetes care. DCCT demonstrated that a lower A1C generally means a lower risk of diabetes complications (eye, kidney, and nerves) developing.
Follow-up research known as the Epidemiology of Diabetes Interventions and Complications (EDIC) study confirmed those earlier results and showed the value of measuring glucose levels consistently over time.
Yes. The glucose levels measured during an A1C test are also important for people with type 2 diabetes. They can help see how glucose levels have been managed over the past 3 months and determine whether any diabetes care or medication changes are needed.
Generally, after you receive a diagnosis of diabetes, your A1C is checked twice a year. Sometimes, an A1C test every 3 months (or four times a year) might be prescribed if your glucose level goals aren’t being met or other health concerns arise. A1C tests can be done at any time of the day. They don’t require fasting.
The ADA’s Standards of Care 2022 and guidelines in recent years have shifted away from a one-size-fits-all target toward more individualized care. The current Standards of Care advise an A1C for most nonpregnant adults should be 7% or lower without significant hypoglycemia. Factors that might influence specific targets include:
- whether the person is pregnant
- the person’s age and life expectancy
- how long ago the person received the diagnosis
- comorbidities present
- heart disease or vascular complications present
- resources and support systems available to the person
The A1C goal of less than 7% is a starting point.
Everyone should discuss their particular goal with their diabetes care team.
Since the A1C is based on an average over time, it’s difficult to see how it relates to glucose readings taken throughout the day. Scientists have come up with a calculation of estimated average glucose (eAG).
The eAG characterizes the mathematical relationship between a set of glucose readings (similar to the A1C) and “translates” it into a single number (similar to one glucose reading). For example, an A1C of 7% translates into an eAG of 154 mg/dL.
Even though it’s simply a calculation of the relationship, eAG can be one more tool used to track and manage your glucose levels. You can find an eAG calculator and table here.
The A1C is seen as generally accurate. But several factors can impact results.
- Certain health conditions affect A1C results. These include:
- kidney failure
- liver disease
- severe anemia
- blood loss
- blood transfusions
- pregnancy
- sickle cell anemia
- thalassemia
- Medications, including opioids and HIV medications, can affect A1C results.
It’s also important to remember that A1C doesn’t reflect fluctuations in your blood sugar or your glucose variability. That means you can see a lower or higher A1C result, but it doesn’t give you any insight as to whether your blood sugars drop to low or go high at different times of day.
Glucose levels from the past month (30 days) influence A1C results more than the levels from the previous 2 months. Because of this, dramatic and sustained changes in your most recent glucose levels will have an effect on A1C results. That means you can see an inaccurately higher or lower A1C based on those recent trends.
Don’t be surprised if there’s some difference between A1C results and the averages calculated from a fingerstick meter or continuous glucose monitor (CGM).
A1C is based on a single blood sample and reflects the impact of glucose levels over time. Those other averages are based on individual readings taken over time. With a CGM, the average can be labeled (in its app) as glucose management indicator (GMI).
It’s still an average of glucose readings.
Time in range (TIR) calculates the percentage of time a person’s glucose readings are within their target range. This look goes beyond the average reported with A1C to show how much time the person’s glucose levels were either above or below their target range. The baseline target for well-managed glucose levels is to be in range at least 70% of the time.
This more nuanced view of glucose level management gives the person with diabetes and their healthcare team more information to base their care plans on.
Traditionally, A1C tests have required a blood draw taken in a clinic or lab. But newer tests that only require a fingerstick are more often available. These tests can be easily done in a doctor or healthcare professional’s office or at home. Both methods have been shown to be accurate and precise.
A1C remains a useful tool in managing diabetes overall. As CGM use becomes more common and more complete sets of glucose level data become available, A1C will move from being the dominant method for managing diabetes to one of a set of measures used for ongoing monitoring and goal setting in diabetes.
How to Calculate A1C — and Why It Matters
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Metabolic Health
Written by: Sarah Jayawardene, MS
Reviewed by: Emily Johnson, MSc RD
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6 minutes
The A1C test is a simple blood test that indicates a person’s average blood sugar levels over a three-month period. While it’s a good marker of blood sugar trends and can be used to help diagnose diabetes, measuring A1C doesn’t provide a picture of daily fluctuations.
Measuring blood sugar is key to understanding your individual metabolic health — but there are many ways to measure blood sugar, all of which vary in method and accuracy.
One popular method used to measure and track blood sugar over time is A1C. While it’s considered the gold standard for monitoring blood glucose, does A1C really give you the whole picture of your blood sugar and metabolic health?
What is the A1C test?
A1C (also called hemoglobin A1C or HbA1C) is a type of hemoglobin — a protein that carries oxygen in your blood [1].
A1C is formed when the glucose in your blood binds to the hemoglobin in your red blood cells. Because of this, measuring A1C can give you a picture of your average blood sugar levels.
A1C is calculated based on the amount of hemoglobin in the blood that had glucose attached to it in the prior 3 months [2]. This means that the more glucose there is in the blood, the more glucose each hemoglobin will be carrying. Test results are expressed as a percentage — a higher A1C equals higher average blood sugar levels.
Since glucose can stay bound to hemoglobin for up to 120 days, the A1C test gives us an approximate measurement of blood sugar levels over the last 3 months [3].
There are over 30 different ways to calculate A1C, all of which are based on four biochemical analysis techniques [4]. Because of this, there can be a lot of variability in the results of the A1C test. For this reason, standardizing the results can be tricky [5].
While using an A1C test can be helpful in some circumstances, A1C levels are not always the best indicator of metabolic health for non-diabetics.
Individuals who are not diabetic may have “healthy” A1C levels but may not be or feel healthy — that is why metabolic health is considered a spectrum and not an on/off switch.
Ranges for A1C levels – what is considered healthy?
Although it may not apply to everyone, A1C is used as a crucial diagnostic tool for diabetes. High A1C levels indicate long-term, elevated blood sugar levels.
The percentage ranges for A1C levels are [3]:
- Normal: 4-5.7%
- Prediabetes: 5.7-6.4%
- Diabetes: 6.5% or higher
The A1C prediabetes range of 5.7-6.4% reflects an average blood sugar level of 117-137 mg/dl (6.5-7.6mmol/l) and means you are at an increased risk of developing diabetes. An A1C level of 6.5% (140 mg/dl or 7.8 mmol/l average) or higher on two separate tests indicates diabetes.
A dangerous A1C level can vary depending on the individual, but in general, very high levels of A1C, such as those above 10%, can indicate poor blood sugar control and a higher risk of developing serious complications from diabetes, heart disease, nerve damage, and kidney disease.
How often should I get an A1C test and why?
Healthcare providers often use the A1C test as part of regular annual health check-ups and to identify any potential health risks. A1C is typically favored over a fasting glucose test because A1C is more accurate at giving an average of your blood glucose level [6]. Fasting glucose only gives you an indication of your blood glucose levels at the moment [1, 2].
Generally, it is recommended that people with diabetes get an A1C test at least two times a year to monitor their blood sugar control [7].
For people without diabetes, A1C testing may be less frequent and can depend on individual health concerns and risk factors. It is important to follow the recommended testing schedule from a healthcare provider, as regular A1C testing can help to identify potential health problems early and allow for prompt and appropriate medical intervention.
If you are experiencing symptoms of insulin resistance, asking your doctor to test your A1C levels at your next appointment can give you insight into your current metabolic health status.
What are the limitations of A1C?
While A1C testing is a useful diagnostic tool for identifying diabetes, and can tell you your average blood sugar levels, it does have limitations.
Second, the A1C test is less accurate in people who do not have diabetes. In these individuals, the amount of glucose attached to hemoglobin may be lower, making it more difficult to accurately measure average blood sugar levels [9].
Research also suggests that A1C levels vary between racial and ethnic groups — in fact, one study of 4,000 participants found that Black, Hispanic, American Indian, and Asian individuals had higher levels of A1C compared to white participants, even after adjusting for factors like age, sex, education, insulin resistance, etc. [10].
The lack of standardized testing for A1C levels due to a large number of available tests is also an issue [11, 9]. This can lead to unreliable results depending on the test and method used.
The A1C test does not provide a clear picture of what is working and what is not in terms of managing blood sugar levels.
For example, the test does not differentiate between high blood sugar levels caused by diet, exercise, sleep, stress, or other medical conditions [9]. This can make it difficult for you and your healthcare providers to determine the best course of action for improving blood sugar control.
The A1C is a good benchmark to be used intermittently, but to better understand daily variability, weekly trends, and lifestyle patterns, a continuous glucose monitor (CGM) is a useful tool for getting a comprehensive picture of blood sugar control.
A1C doesn’t give you a complete picture of your metabolic health. Three individuals with the same A1C can have different risk profiles based on their glucose levels and variability.
Continuous glucose monitoring vs. A1C
Continuous glucose monitoring provides real-time blood sugar levels by measuring glucose levels in the interstitial fluid (the fluid found between cells that bring nutrients and oxygen from the blood to cells).
Compared to the A1C test, CGMs can be useful — especially for non-diabetics — because they provide more detailed information about blood sugar levels and how they are affected by lifestyle habits.
While it is undoubtedly useful for diagnosing diabetes and monitoring populations of people, A1C alone does not give much information on what’s actually going on with an individual’s blood sugar. Changes in blood glucose levels, even throughout a single day, can impact almost every aspect of your life, including fertility (in both men and women) and heart health. Regular monitoring provides a more complete picture of how blood sugar is affecting your metabolic function and health outcomes.
One of the big advantages of CGM over A1C is that it captures the variability of blood sugar levels and time in range [12]. CGMs provide a continuous stream of data on glucose levels throughout the day and night, which can help you identify patterns and trends in blood sugar control [13].
Since metabolic health is a spectrum, the information a CGM provides can be particularly useful for non-diabetics who are looking to increase their healthspan and prevent the development of chronic health conditions, as daily monitoring can alert you of metabolic dysfunction much more quickly than a single A1C test every year.
Even the “healthiest” people can learn about how stabilizing your blood sugar can improve your health.
Another advantage of CGM over A1C is that it provides real-time information on how different factors affect glucose levels. This can be useful for non-diabetics looking to change their lifestyle to improve their health. For example, by seeing the immediate impact of a meal on blood sugar levels, you can make more informed decisions about what and how much you eat.
By seeing the impact of exercise, sleep, and stress on blood sugar levels, individuals can make more informed decisions about how they manage these factors to optimize their health. Knowing your body’s unique blood sugar responses to different stimuli can help you decide the best time to exercise, whether you should eat before or after a workout, and how to align your biological clock to optimize sleep and nutrition.
Key Takeaways
The A1C test is a useful tool for monitoring blood sugar as it provides a picture of a person’s average blood glucose control over a long period of time, but it has some limitations that make it less suitable for non-diabetics.
- A1C can help you detect patterns in your blood sugar levels over long periods of time, which can be helpful for diagnosis and monitoring diseases. The more glucose that’s in your blood, the more A1C will be produced.
- Testing your A1C is not a perfect indicator of your blood sugar control, as there are many factors that can affect the accuracy of the test. It’s important to interpret A1C test results in the context of an individual’s overall health. We’re not saying the test is useless or unhelpful, but that it’s an incomplete measurement that doesn’t give you insights into your glucose fluctuations.
- Measuring blood glucose levels regularly is typically considered useful only for people with diabetes. However, knowing more about your blood sugar — how it fluctuates and what makes it change — can help you navigate your health. Continuous glucose monitoring can capture daily variability of blood sugar levels and provide real-time information on how different factors affect glucose levels, offering a more comprehensive picture when combined with A1C.
References:
- https://www.niddk.nih.gov/health-information/diagnostic-tests/a1c-test
- https://www.cdc.gov/diabetes/managing/managing-blood-sugar/a1c.html
- https://diabetes.org/diabetes/a1c
- https://www.sciencedirect.com/science/article/abs/pii/S0009898115001680
- https://www.ngsp.org/docs/methods.pdf
- https://www.niddk.nih.gov/health-information/diagnostic-tests/a1c-test#diagnose
- https://europepmc.org/article/med/23804802
- https://www.sciencedirect.com/science/article/pii/S0002962918303732
- https://diabetesjournals.org/care/article/34/2/518/39254/A1C-Versus-Glucose-Testing-A-Comparison
- https://academic.oup.com/jcem/article/97/4/1067/2833118
- https://jcp.bmj.com/content/57/4/344
- https://www.nature.com/articles/nrendo.2017.3
- https://diabetesjournals.org/spectrum/article/34/2/102/32985/Beyond-A1C-Standardization-of-Continuous-Glucose
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Web designers
UX designers
Art directors
Designers
Project managers
Product owners
and others
Service Design
Data Driven Design
UI/UX
Create efficient and useful solutions with a new and unique design approach.
During the course, you will learn how to make not only visually appealing projects, but also
radically change the thinking of business in digital, digitize any product and make it
the most competitive.
What will you learn in the course?
In this course, you will learn the materials and skills that form the user experience design process. From research and design ideas to visual solutions, analytics and testing.
Modern designer skills
Design is not only a visual display of information. Design is first and foremost thinking. Therefore, during the course, you gain an understanding of how users interact with the product (through interviewing, observing, and testing).
This allows you to create a product that fully meets the needs of end users
The visual component of the product
How the right meaning takes shape and visual accents.
We understand how the designer should prepare and present the concept to the customer. Every little thing matters, so we carefully work with visual elements, images, interactive components and typography
Large and complex projects
In our course you will learn all the subtleties and nuances of working on large projects. Feedback from the working group, interviews with customer representatives, testing and protection of prototypes and designs – all this and much more.
We have specially prepared an analysis of our well-known cases: “Gosuslugi”, 1C-Bitrix and NTV-Plus
The main stages of the project
In practice, we analyze the classical understanding of the project and its key stages. We lay out the process of creating a product, which allows you to create solutions and online services that users will truly love.
In addition, we study in detail modern project management methodologies, such as Service Design / Data-Driven Design
Perfect presentation
A good presentation is the key to success at any stage of communication with the customer.
Whether it’s preparing for a tender or a weekly sprint report.
How to make a presentation not only beautiful, but also meaningful? Techniques, tools and much more – we understand the course
View the course program
View course page
Regular price
40,000 ₽
Price with a 30% discount
Order this course with a discount
or book a consultation
You will gain skills in assessing the quality of traffic, building the economy of your digital
product and analyzing the sales funnel.
Learn to see bottlenecks and failures, build hypotheses, and conduct A/B tests.
And, of course, stop arguing which
the color of the button is better or which girl to put on the banner.
In addition, you will learn how to communicate with
users and improve the user experience.
For each homework assignment, get the teacher’s comments.
After completing the course, you will receive a diploma in UX Analyst.
Who is the course for?
Internet marketers
What we will teach:
Understand and analyze the value of customer acquisition channels. Calculate the economy and make decisions to improve business performance based on data
Analysts
What we will teach:
Make effective decisions based on the right data. See real patterns, trends and make sure they are statistically correct
Executives
and product managers
What we’ll teach you:
Feel the pulse of your products with the help of analytics tools. Understand what is happening with your company here and now and quickly respond to any external changes
Designers
and art directors
What we will teach:
Move away from mindless drawing of gray and colored squares and draw ideas and hypotheses from real research.
Test ideas and solutions through A/B testing and usability research
What will you learn in the course?
In this course, you will learn the materials and skills needed to design user experience. We go from research and ideas for design to visual solutions, collection of analytical data and testing.
Analyst’s current skills
Design is not only a visual display of information. First of all, it is thinking. Therefore, during the course, through interviewing, observation and testing, we learn to understand how users interact with the product.
This allows you to create a product that fully meets the needs of end users.
Large and complex projects
On our course you will learn all the subtleties of working on large projects. Feedback from the working group, interviews with customer representatives, testing and protection of prototypes and designs – all this and much more.
We have specially prepared an analysis of our well-known cases: “Gosuslugi”, 1C-Bitrix and NTV-Plus.
The main stages of the project
On our course you will learn all the subtleties and nuances of working on large projects. Feedback from the working group, interviews with customer representatives, testing and protection of prototypes and designs – all this and much more.
We have specially prepared an analysis of our well-known cases: “Gosuslugi”, 1C-Bitrix and NTV-Plus
View the course program
Regular price
40 000 ₽
Price with 30% discount
29 000 ₽
or 2 900 ₽/month .
Order this course with a discount
or book a consultation
You will learn how to create high-quality and
live prototypes of your sites and applications. We will explore the most advanced tools in existence, from the simple InVision to the advanced and advanced Principle.
You will be able to create unique animated icons, preloaders and video backgrounds on your own.
You’ll finally learn After Effects, which
lets you do everything from high-quality video presentations of your projects to
show reels that showcase your design potential.
Each homework assignment is checked by a teacher.
At the end of the course, each student will receive a certificate of completion.
Who is the course for?
UI-UX designers
What we will teach:
Animate interfaces, create live prototypes of applications and websites. Improving the microinteraction experience
Motion designers
What we’ll teach you:
UI animation is a separate world. Here their rules, requirements, nuances. We will teach you how to correctly place accents and manage the user’s attention. You will explore a new direction that will allow you to expand the range of your animation possibilities
For art directors
What we will teach:
How to build the work “Designer – UI designer” correctly.
Write a video script, prepare a storyboard, make an animatic for the future showreel, prepare materials for animation
What will you learn on the course?
You will be able to create any animation in the interfaces and effectively convey the concepts of projects to clients. We’ll start by animating the simplest elements like icons and work our way up to creating full-fledged cases and showreels.
Current Animation Skills
Creating animation has become a common thing for a UI/UX professional, even in the absence of a motion designer.
The course will help you quickly master the necessary skills. Creating a visual example of element transformation for a layout designer is no longer a problem!
Homework assignments are more than just test steps: when completed under the guidance of teachers, you will receive an excellent portfolio that showcases your new skills.
Bonus program
Analysis of spectacular cases on Behance and Dribbble.