What is a1c?

Contents

5 Ways to Lower Your A1C

Some doctors can use a point-of-care A1C test, where a finger stick can be done in the office, with results available in about 10 minutes. The A1C test results provide insight into how your treatment plan is working, and how it might be modified to better control the condition. Your doctor may want to run the test as often as every three months if your A1C is not within your target range.

What the A1C Results Mean

The A1C test measures the glucose (blood sugar) in your blood by assessing the amount of what’s called glycated hemoglobin. “Hemoglobin is a protein within red blood cells. As glucose enters the bloodstream, it binds to hemoglobin, or glycates. The more glucose that enters the bloodstream, the higher the amount of glycated hemoglobin,” Dr. Dodell says.

An A1C level below 5.7 percent is considered normal. An A1C between 5.7 and 6.4 percent signals prediabetes. Type 2 diabetes is diagnosed when the A1C is over 6.5 percent. For many people with type 2 diabetes, the goal is to lower A1C levels to a healthier percentage.

Your A1C goal is specific to you. Several factors come into play, such as your age, how advanced the diabetes is, and any other heath conditions you have. A common A1C goal for people with diabetes is less than 7 percent, Dodell says. If you can keep your A1C number below your goal, you help to reduce the risk of diabetes complications, such as nerve damage and eye problems.

Tips for a Lower A1C

Your A1C score is a valuable part of the diabetes control picture, Dodell says, but it is not the only indicator of your health. Someone who has wide fluctuations in blood sugar levels (which is more common among patients who are taking insulin) may have an A1C at goal because the average is good. But the day-to-day fluctuations can lower your quality of life and increase your risk of complications, he says.

Diabetes can be a tough condition to manage, Dodell says. He tells his patients to view diabetes management like a job. It takes work, but the time and effort you put into it can result in good control and an improved quality of life. “The key to reaching your A1C goal is trying to follow a healthy lifestyle,” he says.

Making these healthy changes can help you improve your day-to-day blood sugar management and lower your A1C:

1. Move more. Try to get at least 30 minutes of exercise five days a week. This doesn’t have to be formal exercise, Dodell says. Find something you enjoy doing that gets your body moving — take your dog for a walk, play a sport with a friend, or ride a stationary bike indoors or a regular bike outdoors.

2. Eat a balanced diet with proper portion sizes. You can load up on nonstarchy vegetables, but be mindful of serving sizes when eating fruits, lean proteins, fats, and complex carbohydrates, like bread, potatoes, and other starches. Using a salad plate instead of a full-sized dinner plate can help prevent overeating. Avoid processed foods as much as possible, and say no to sugary sodas and fruit juice. A diabetes educator or dietitian may be able to help if you’re unsure about a good diabetes diet.

3. Stick to a schedule. Skipping meals, letting too much time pass between meals, or eating too much or too often can cause your blood sugar levels to fall and rise too much. Your doctor can help you determine the best meal schedule for your lifestyle.

4. Follow your treatment plan. Diabetes treatment is very individualized. Your doctor will help you determine the steps you need to take to successfully manage diabetes. Always talk to your doctor before making any changes.

5. Check your blood sugar as directed. Work with your doctor to determine if, and how often, you should check your blood sugar.

Understanding your A1C levels is an important part of your overall diabetes management. If you have any questions about your A1C levels or what they mean, don’t hesitate to ask your doctor.

Assessment of glycemic control in patients with type 2 diabetes can be achieved through patient self-monitoring of blood glucose (SMBG) and A1C determinations.1,2 The American Diabetes Association (ADA) recommends regular A1C testing to evaluate the effectiveness of current management strategies, but the target A1C goal can vary depending on the individual patient profile as well as the set of professional consensus recommendations—and associated management philosophy—to which the treating clinician adheres.

According to the ADA, the generally accepted standard A1C goal for adult patients with type 2 diabetes is 7.0%.1,2 Driving A1C below this level has been shown to reduce microvascular complications. In addition, if achieved quickly after a diabetes diagnosis, this A1C goal has been associated with a long-term reduction in macrovascular disease as well.1,2

The ADA suggests that physicians may lower the A1C target to 6.5% for some individuals with short duration of diabetes, a long life expectancy, and no significant cardiovascular disease if the target can be achieved without significant adverse effects of therapy, most notably hypoglycemia.2

Conversely, the ADA suggests a target A1C of closer to 8.0% for individuals with any of the following:

  • history of severe hypoglycemia
  • limited life expectancy
  • advanced microvascular or macrovascular complications
  • multiple comorbidities

The higher target A1C is also recommended for patients for whom long-term management of diabetes with behavior modification, SMBG, and glucose-lowering therapy has not helped attain a lower target goal.1,2

These ADA recommendations are partly based on studies showing that in some patients, the risks of trying to achieve A1C levels below 6.5% or 6.0% may outweigh the benefits. The ADA guidelines cite the ACCORD study (among others), which enrolled participants with either known cardiovascular disease (CVD) or 2 or more major CVD risk factors and who had had diabetes for a median of 10 years. The intensive therapy arm (A1C goal of 3,4

Despite the findings from the ACCORD trial and others, debate remains as to whether the ADA’s A1C target recommendations are too conservative. One argument from those who advocate for a more aggressive A1C target goal is that newer classes of drugs introduced after the ACCORD trial—which was discontinued in February 2008—are safer than the therapies used in the intensive arm of that study. “With good patients and good physicians, using the right medications, we should be able to get under 6.5% without hypoglycemia,” says Stanley Schwartz, MD, Emeritus, Clinical Associate Professor at the University of Pennsylvania, and a senior author on the 2009 American Association of Clinical Endocrinologists ? American College of Endocrinology (AACE?ACE) guidelines for glycemic control in patients with type 2 diabetes.

Dr. Schwartz believes that the ADA guidelines are flawed because they’re based on clinical trials that rely on older treatments associated with a significant risk of hypoglycemic events. He says that with current treatment options, clinicians can “aim for the lowest A1C possible without undue hypoglycemia.”

However, the ACCORD investigators argued that severe hypoglycemia could not be implicated as the reason for the difference in mortality between treatment arms because the standard and intensive therapy groups had similar rates of severe hypoglycemia.4 The investigators do, however, leave open the possibility that particular drug regimens may have had something to do with the outcomes of the trial.4

The 2009 AACE/ACE Consensus Statement is considerably more aggressive than the ADA guidelines.5 The AACE?ACE recommendations set the goal of therapy at an A1C ?6.5% to minimize the risk of diabetes-related complications, without setting any goals for pre- and postprandial glucose levels.

Dr. Schwartz believes that less reliance on sulfonylureas or bolus insulin will allow for the more aggressive A1C targets because of the lower risk of hypoglycemia and weight gain. However, more studies are needed to determine the long-term safety and efficacy of A1C goals that are below the ADA’s current recommendation of 7.0%. Future studies may inform comprehensive and individualized management strategies necessary to reduce morbidity and mortality in patients with type 2 diabetes. Until large clinical trials utilizing newer therapies are done to evaluate the risks and benefits of intensive therapy, it is likely that the ADA and AACE/ACE recommendations will continue to differ.

Published: March 01, 2017

A1C

A1C is a blood test for type 2 diabetes and prediabetes. It measures your average blood glucose, or blood sugar, level over the past 3 months. Doctors may use the A1C alone or in combination with other diabetes tests to make a diagnosis. They also use the A1C to see how well you are managing your diabetes. This test is different from the blood sugar checks that people with diabetes do every day.

Your A1C test result is given in percentages. The higher the percentage, the higher your blood sugar levels have been:

  • A normal A1C level is below 5.7 percent
  • Prediabetes is between 5.7 to 6.4 percent. Having prediabetes is a risk factor for getting type 2 diabetes. People with prediabetes may need retests every year.
  • Type 2 diabetes is above 6.5 percent
  • If you have diabetes, you should have the A1C test at least twice a year. The A1C goal for many people with diabetes is below 7. It may be different for you. Ask what your goal should be. If your A1C result is too high, you may need to change your diabetes care plan.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

The A1C Test & Diabetes

On this page:

  • What is the A1C test?
  • Why should a person get the A1C test?
  • How is the A1C test used to diagnose type 2 diabetes and prediabetes?
  • Is the A1C test used during pregnancy?
  • Can other blood glucose tests be used to diagnose type 2 diabetes and prediabetes?
  • Can the A1C test result in a different diagnosis than the blood glucose tests?
  • Why do diabetes blood test results vary?
  • How precise is the A1C test?
  • How is the A1C test used after diagnosis of diabetes?
  • What A1C goal should I have?
  • How does A1C relate to estimated average glucose?
  • Will the A1C test show short-term changes in blood glucose levels?
  • Clinical Trials for the A1C Test and Diabetes

What is the A1C test?

The A1C test is a blood test that provides information about your average levels of blood glucose, also called blood sugar, over the past 3 months. The A1C test can be used to diagnose type 2 diabetes and prediabetes.1 The A1C test is also the primary test used for diabetes management.

An A1C test is a blood test that reflects your average blood glucose levels over the past 3 months.

The A1C test is sometimes called the hemoglobin A1C, HbA1c, glycated hemoglobin, or glycohemoglobin test. Hemoglobin is the part of a red blood cell that carries oxygen to the cells. Glucose attaches to or binds with hemoglobin in your blood cells, and the A1C test is based on this attachment of glucose to hemoglobin.

The higher the glucose level in your bloodstream, the more glucose will attach to the hemoglobin. The A1C test measures the amount of hemoglobin with attached glucose and reflects your average blood glucose levels over the past 3 months.

The A1C test result is reported as a percentage. The higher the percentage, the higher your blood glucose levels have been. A normal A1C level is below 5.7 percent.

Why should a person get the A1C test?

Testing can help health care professionals

  • find prediabetes and counsel you about lifestyle changes to help you delay or prevent type 2 diabetes
  • find type 2 diabetes
  • work with you to monitor the disease and help make treatment decisions to prevent complications

If you have risk factors for prediabetes or diabetes, talk with your doctor about whether you should be tested.

You may be able to prevent or delay type 2 diabetes with lifestyle changes such as weight loss or being physically active most days of the week.

How is the A1C test used to diagnose type 2 diabetes and prediabetes?

Health care professionals can use the A1C test alone or in combination with other diabetes tests to diagnose type 2 diabetes and prediabetes. You don’t have to fast before having your blood drawn for an A1C test, which means that blood can be drawn for the test at any time of the day.

If you don’t have symptoms but the A1C test shows you have diabetes or prediabetes, you should have a repeat test on a different day using the A1C test or one of the other diabetes tests to confirm the diagnosis.2

A1C results and what the numbers mean

*Any test used to diagnose diabetes requires confirmation with a second measurement, unless there are clear symptoms of diabetes.

Diagnosis* A1C Level
Normal below 5.7 percent
Prediabetes 5.7 to 6.4 percent
Diabetes 6.5 percent or above

When using the A1C test for diagnosis, your doctor will send your blood sample taken from a vein to a lab that uses an NGSP-certified method. The NGSP, formerly called the National Glycohemoglobin Standardization Program, certifies that makers of A1C tests provide results that are consistent and comparable with those used in the Diabetes Control and Complications Trial.

Blood samples analyzed in a doctor’s office or clinic, known as point-of-care tests, should not be used for diagnosis.

The A1C test should not be used to diagnose type 1 diabetes, gestational diabetes, or cystic fibrosis-related diabetes. The A1C test may give false results in people with certain conditions.

Having prediabetes is a risk factor for developing type 2 diabetes. Within the prediabetes A1C range of 5.7 to 6.4 percent, the higher the A1C, the greater the risk of diabetes.

Is the A1C test used during pregnancy?

Health care professionals may use the A1C test early in pregnancy to see if a woman with risk factors had undiagnosed diabetes before becoming pregnant. Since the A1C test reflects your average blood glucose levels over the past 3 months, testing early in pregnancy may include values reflecting time before you were pregnant. The glucose challenge test or the oral glucose tolerance test (OGTT) are used to check for gestational diabetes, usually between 24 and 28 weeks of pregnancy. If you had gestational diabetes, you should be tested for diabetes no later than 12 weeks after your baby is born. If your blood glucose is still high, you may have type 2 diabetes. Even if your blood glucose is normal, you still have a greater chance of developing type 2 diabetes in the future and should get tested every 3 years.

Can other blood glucose tests be used to diagnose type 2 diabetes and prediabetes?

Yes. Health care professionals also use the fasting plasma glucose (FPG) test and the OGTT to diagnose type 2 diabetes and prediabetes. For these blood glucose tests used to diagnose diabetes, you must fast at least 8 hours before you have your blood drawn. If you have symptoms of diabetes, your doctor may use the random plasma glucose test, which doesn’t require fasting. In some cases, health care professionals use the A1C test to help confirm the results of another blood glucose test.

Can the A1C test result in a different diagnosis than the blood glucose tests?

Yes. In some people, a blood glucose test may show diabetes when an A1C test does not. The reverse can also occur—an A1C test may indicate diabetes even though a blood glucose test does not. Because of these differences in test results, health care professionals repeat tests before making a diagnosis.

People with differing test results may be in an early stage of the disease, when blood glucose levels have not risen high enough to show up on every test. In this case, health care professionals may choose to follow the person closely and repeat the test in several months.

Why do diabetes blood test results vary?

Lab test results can vary from day to day and from test to test. This can be a result of the following factors:

Blood glucose levels move up and down

Your results can vary because of natural changes in your blood glucose level. For example, your blood glucose level moves up and down when you eat or exercise. Sickness and stress also can affect your blood glucose test results. A1C tests are less likely to be affected by short-term changes than FPG or OGTT tests.

The following chart shows how multiple blood glucose measurements over 4 days compare with an A1C measurement.

Blood Glucose Measurements Compared with A1C Measurements over 4 Days

Blood glucose (mg/dL) measurements were taken four times per day (fasting or pre-breakfast, pre-lunch, pre-dinner, and bedtime).

The straight black line shows an A1C measurement of 7.0 percent. The blue line shows an example of how blood glucose test results might look from self-monitoring four times a day over a 4-day period.

A1C tests can be affected by changes in red blood cells or hemoglobin

Conditions that change the life span of red blood cells, such as recent blood loss, sickle cell disease, erythropoietin treatment, hemodialysis, or transfusion, can change A1C levels.

A falsely high A1C result can occur in people who are very low in iron; for example, those with iron-deficiency anemia. Other causes of false A1C results include kidney failure or liver disease.

If you’re of African, Mediterranean, or Southeast Asian descent or have family members with sickle cell anemia or a thalassemia, an A1C test can be unreliable for diagnosing or monitoring diabetes and prediabetes. People in these groups may have a different type of hemoglobin, known as a hemoglobin variant, which can interfere with some A1C tests. Most people with a hemoglobin variant have no symptoms and may not know that they carry this type of hemoglobin. Health care professionals may suspect interference—a falsely high or low result—when your A1C and blood glucose test results don’t match.

If you’re of African, Mediterranean, or Southeast Asian descent, you could have a different type of hemoglobin that affects your diabetes care.

Not all A1C tests are unreliable for people with a hemoglobin variant. People with false results from one type of A1C test may need a different type of A1C test to measure their average blood glucose level. The NGSP provides information for health care professionals about which A1C tests are appropriate to use for specific hemoglobin variants.

Read about diabetes blood tests for people of African, Mediterranean, or Southeast Asian descent. The NIDDK has information for health care providers on Sickle Cell Trait & Other Hemoglobinopathies & Diabetes.

Small changes in temperature, equipment, or sample handling

Even when the same blood sample is repeatedly measured in the same lab, the results may vary because of small changes in temperature, equipment, or sample handling. These factors tend to affect glucose measurements—fasting and OGTT—more than the A1C test.

Your health care professional can help you understand your test results.

Health care professionals understand these variations and repeat lab tests for confirmation. Diabetes develops over time, so even with variations in test results, health care professionals can tell when overall blood glucose levels are becoming too high.

How precise is the A1C test?

When repeated, the A1C test result can be slightly higher or lower than the first measurement. This means, for example, an A1C reported as 6.8 percent on one test could be reported in a range from 6.4 to 7.2 percent on a repeat test from the same blood sample.3 In the past, this range was larger but new, stricter quality-control standards mean more precise A1C test results.

Health care professionals can visit www.ngsp.org to find information about the precision of the A1C test used by their lab.

How is the A1C test used after diagnosis of diabetes?

Your health care professional may use the A1C test to set your treatment goals, modify therapy, and monitor your diabetes management.

Experts recommend that people with diabetes have an A1C test at least twice a year.4 Health care professionals may check your A1C more often if you aren’t meeting your treatment goals.4

What A1C goal should I have?

People will have different A1C targets, depending on their diabetes history and their general health. You should discuss your A1C target with your health care professional. Studies have shown that some people with diabetes can reduce the risk of diabetes complications by keeping A1C levels below 7 percent.

Managing blood glucose early in the course of diabetes may provide benefits for many years to come. However, an A1C level that is safe for one person may not be safe for another. For example, keeping an A1C level below 7 percent may not be safe if it leads to problems with hypoglycemia, also called low blood glucose.

Less strict blood glucose control, or an A1C between 7 and 8 percent—or even higher in some circumstances—may be appropriate in people who have

  • limited life expectancy
  • long-standing diabetes and trouble reaching a lower goal
  • severe hypoglycemia or inability to sense hypoglycemia (also called hypoglycemia unawareness)
  • advanced diabetes complications such as chronic kidney disease, nerve problems, or cardiovascular disease

How does A1C relate to estimated average glucose?

Estimated average glucose (eAG) is calculated from your A1C. Some laboratories report eAG with A1C test results. The eAG number helps you relate your A1C to daily glucose monitoring levels. The eAG calculation converts the A1C percentage to the same units used by home glucose meters—milligrams per deciliter (mg/dL).

The eAG number will not match daily glucose readings because it’s a long-term average—rather than your blood glucose level at a single time, as is measured with a home glucose meter.

Will the A1C test show short-term changes in blood glucose levels?

Large changes in your blood glucose levels over the past month will show up in your A1C test result, but the A1C test doesn’t show sudden, temporary increases or decreases in blood glucose levels. Even though A1C results represent a long-term average, blood glucose levels within the past 30 days have a greater effect on the A1C reading than those in previous months.

Clinical Trials for the A1C Test and Diabetes

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Scientists are conducting research to learn more about diabetes, including studies about A1C. For example

  • how the relationship between A1C and blood glucose may vary in different racial and ethnic groups
  • to find other tests that may be better than A1C for some people
  • to look for ways to further improve A1C test results. Because the A1C value depends on the average life span of your red blood cells, knowing whether the life span of your red blood cells is longer or shorter may give your doctor helpful information.

Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

How can you lower your A1C levels?

Food that takes longer to digest, such as whole grains, will have a slower and less significant impact on blood sugar levels.

A person will digest simple sugars — present in candies and white bread — more quickly. This can trigger a blood sugar spike.

Frequent glucose spikes can speed up the development of diabetes and increase the risk of complications.

Carbohydrates

A person with diabetes needs to manage their carb intake, but they do not need to avoid carbs altogether. Carbohydrates are the body and brain’s main fuel source and contain important nutrients.

Tips for a healthful carb intake include:

  • spreading carb intake throughout the day
  • choosing the right kinds of carb

There are three types of carbohydrate:

  • Sugars: The body absorbs these quickly, causing blood glucose level to spike.
  • Starch: These take longer to absorb, and are less likely to cause a glucose spike.
  • Fiber: This is essential for health. Its benefits include reducing the risk of high blood sugar levels.

Fiber

Fiber is complex and takes longer to break down, so it provides more sustainable energy and decreases the risk of a spike in blood sugar. Fiber also helps keep the digestive tract healthy.

Research has found that when women consume at least 25 grams (g) of fiber a day and men 38 g or more, the chance of developing type 2 diabetes can fall by 20–30 percent.

Sources of fiber include whole grains, nuts, and whole fruits and vegetables. Fresh, whole fruit contains more fiber than fruit juice made with fresh fruits.

Natural sugar

The body absorbs refined sugars, such as candies, quickly, and this can lead to dangerous rises in blood glucose.

Fruits, vegetables, and low-fat dairy products contain less processed sugars that are more healthful than refined sugars.

Whole fruits, vegetables, and dairy products all contain far higher levels of vital nutrients than most processed foods and less sugar.

All whole fruits and vegetables contain natural sugars, but they also tend to be rich in other nutrients, including fiber.

Low-sugar options

Low-sugar fruit and vegetable options include:

Share on PinterestMany berries are considered to be relatively low in sugar.

  • lemon
  • rhubarb
  • lime
  • guava
  • kiwifruit
  • tangerines, nectarines, and plums
  • olives
  • avocados
  • grapefruit
  • broccoli and cauliflower
  • kale, cabbage, bok choy, and Brussels sprouts
  • lettuce
  • spinaches, collard greens, and Swiss chard
  • cucumbers and zucchini
  • tomatoes
  • mushrooms
  • celery
  • cranberries, raspberries, blackberries, and strawberries

People with diabetes do not need to avoid fruits, but they should account for the carbohydrates and sugars they contain. They should also eat fruits in moderation.

Dried fruits contain more sugar than fresh fruits.

Lactose

Lactose is the sugar that occurs in dairy products. One cup of 1-percent fortified milk contains 12.8 grams of carbohydrate, which is mostly lactose.

Low-sugar, dairy-free options include unflavored, fortified soy, rice, almond, flax, and coconut milk or products

Lactose levels are similar in full-fat, reduced-fat, and non-fat milk, but people with type 2 diabetes often need to take care of their weight. For this reason, a low-fat version may be a better option.

Whole grains

Starches or complex carbohydrates include:

  • grains
  • starchy vegetables
  • legumes

Most of a person’s carbohydrate consumption should consist of these. For most grains and starches, half a cup contains one 15 gram serving of carbohydrates.

Starches are better carbohydrate choices than simple sugars, but the body can absorb highly processed starches rapidly, leading to increases in blood sugar levels.

Whole-grain breads, cereals, pastas, and rices contain B and E vitamins, minerals, essential fatty acids, and fiber.

Bleached or processed grains and cereals generally contain fewer nutrients and higher levels of sugar than whole-grain products.

Some products that claim to contain whole wheat still have high levels of refined grains, and they may contain added sugar.

The best whole-grain options include:

  • whole-wheat flour
  • buckwheat or buckwheat flour
  • cracked wheat
  • whole-grain barley
  • whole rye
  • millet
  • sorghum
  • whole oats
  • brown rice
  • wild rice
  • quinoa
  • whole faro
  • popcorn
  • whole-grain corn or corn meal
  • triticale
  • amaranth

A healthcare professional will advise on how much carbohydrate a person should consume each day.

Starchy vegetables and legumes

Share on PinterestVegetables are a good source of fiber and other nutrients.

Plenty of starchy vegetables and legumes also contain high levels of nutrients and fiber in their skins or pods.

Some vegetables have higher concentrations of starch than others. These include root vegetables like potatoes. People should monitor their consumption of these vegetables more closely than others.

Healthful, starchy vegetable and legume options include:

  • corn
  • green peas
  • black, lima, and pinto beans
  • butternut, acorn, and spring squash
  • pumpkin
  • parsnip
  • plantain
  • dried black-eyed or split peas
  • lentils
  • low-fat refried beans or baked beans
  • yams or sweet potatoes
  • taro
  • palm hearts
  • garlic

Diabetes awareness: How to control your A1C

The A1C test is an important part of managing your diabetes. It shows your average level of blood sugar over the past two to three months.

The sugar in your blood is called glucose. When glucose builds up in your blood, it binds to a protein in your red blood cells called hemoglobin. The A1C test measures how much glucose, or sugar, is in your blood.

Everybody has some sugar in their blood, but higher blood sugar levels are linked to diabetes complications. That’s why maintaining a healthy A1C level is important if you have diabetes. How often you need the A1C test depends on the type of diabetes you have and how well you’re managing your blood sugar.

Recommended testing:

  • Twice a year if you have Type 2 diabetes, you don’t use insulin and your blood sugar level is consistently within your target range.
  • Every three months if you have Type 1 diabetes.
  • Every three months if you have Type 2 diabetes, you use insulin to manage your diabetes or you have trouble keeping your blood sugar level within your target range.

A1C test results are reported as a percentage. A higher percentage corresponds to higher average blood sugar levels. The higher your A1C level, the higher your risk of developing complications of diabetes.

If your A1C level is between 5.7% and 6.4%, you have prediabetes. A level of 6.5% or higher means you have diabetes. An A1C level of 7% or less is a common treatment target.

A1C is an important tool for managing diabetes, but it doesn’t replace regular blood sugar testing at home. Blood sugar goes up and down throughout the day and night, which isn’t captured by your A1C.

Adults with diabetes are twice as likely to die from heart disease or stroke. This is because over time high blood sugar can damage your blood vessels and the nerves that control your heart. The good news is you can take steps now to manage your diabetes and help lower your chances of heart disease or stroke.

Tips for A1C control

  1. Eat well: Take time to cook. Look online for budget-friendly, easy recipes. Limit fast food, prepackaged and processed foods. Eat more veggies. Write down all your meals and snacks to be more aware of what you eat.
  2. Be active: Exercise is one of the best tools for managing diabetes. Find ways to be more active throughout the day, like walking and taking the stairs. Work out with a friend. Use an activity tracker. Look online for workout videos.
  3. Manage stress: Try meditation or yoga to relax. Go for a walk. Get together with a friend.
  4. Medications: Take medications as prescribed by your doctor and continue your regular A1C testing.

Sources:
“All About Your A1C.” www.cdc.gov, Centers for Disease Control and Prevention, 21 August 2018.
“Living Well with Diabetes.” www.cdc.gov, Centers for Disease Control and Prevention, 17 October 2018.
“A1C test.” www.mayoclinic.org, Mayo Clinic, Mayo Foundation for Medical Education and Research (MFMER), 18 December 2018.
“National Diabetes Month 2019.” www.niddk.nih.gov, National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health, U.S. Department of Health and Human Services, 2019.
“Hemoglobin A1c (HbA1c) Test for Diabetes.” www.webmd.com, WebMD LLC, 1 November 2018.

“Treat the patient, not the number.” This is a very old and sound medical school teaching. However, when it comes to blood sugar control in diabetes, we have tended to treat the number, thinking that a lower number would equal better health.

Uncontrolled type 2 diabetes (also known as adult-onset diabetes) is associated with all sorts of very bad things: infections, angry nerve endings causing chronic pain, damaged kidneys, vision loss and blindness, blocked arteries causing heart attacks, strokes, and amputations… So of course, it made good sense that the lower the blood sugar, the lower the chances of bad things happening to our patients.

Tracking blood sugar control over time

One easy, accurate way for us to measure a person’s blood sugar over time is the hemoglobin A1c (HbA1c) level, which is basically the amount of sugar stuck to the hemoglobin molecules inside of our blood cells. These cells last for about three months, so, the A1c is thought of as a measure of blood sugars over the prior three months.

Generally, clinical guidelines have recommended an A1c goal of less than 7% for most people (not necessarily including the elderly or very ill), with a lower goal — closer to normal, or under 6.5% — for younger people.

We as doctors were supposed to first encourage diet and exercise, all that good lifestyle change stuff, which is very well studied and shown to decrease blood sugars significantly. But if patients didn’t meet those target A1c levels with diet and exercise alone, then per standard guidelines, the next step was to add medications, starting with pills. If the levels still weren’t at goal, then it was time to start insulin injections.

While all this sounds very orderly and clinically rational, in practice it hasn’t worked very well. I have seen firsthand how enthusiastic attention to the A1c can be helpful as well as harmful for patients.

And so have experts from the Clinical Guidelines Committee of the American College of Physicians, a well-established academic medical organization. They examined findings from four large diabetes studies that included almost 30,000 people, and made four very important (and welcome!) new guidelines around blood sugar control. Here’s the big picture.

Doctors and patients should discuss goals of treatment together and come up with an individual plan

Blood sugar goals should take into account a patient’s life expectancy and general health, as well as personal preferences, and include a frank discussion of the risks, benefits, and costs of medications. This is a big deal because it reflects a change in how we think about blood sugar control. It’s not a simply number to aim for; it’s a discussion. Diabetes medications have many potential side effects, including dangerously low blood sugar (hypoglycemia) and weight gain (insulin can cause substantial weight gain). Yes, uncontrolled blood sugars can lead to very bad things, but patients should get all the information they need to balance the risks and benefits of any blood sugar control plan.

An A1c goal of between 7% and 8% is reasonable and beneficial for most patients with type 2 diabetes…

…though if lifestyle changes can get that number lower, then go for it. For patients who want to live a long and healthy life and try to avoid the complications of diabetes, they will need to keep their blood sugars as normal as possible — that means an A1c under 6.5%. However, studies show that using medications to achieve that goal significantly increases the risk of harmful side effects like hypoglycemia and weight gain. To live longer and healthier and avoid both the complications of diabetes as well as the risks of medications, there’s this amazing thing called lifestyle change. This involves exercise, healthy diet, weight loss, and not smoking. It is very effective. Lifestyle change also can help achieve healthy blood pressure and cholesterol levels, which in turn reduce the risk for heart disease. And heart disease is a serious and common complication of diabetes.

Lifestyle change should be the cornerstone of treatment for type 2 diabetes. The recommendations go on to say that for patients who achieve an A1c below 6.5% with medications, we should decrease or even discontinue those drugs. Doing so requires careful monitoring to ensure that the person stays at the goal set with his or her doctor, which should be no lower than 7%, for the reasons stated above.

We don’t even need to follow the A1c for some patients

Elderly patients, and those with serious medical conditions, will benefit from simply controlling the symptoms they have from high blood sugars, like frequent urination and incontinence, rather than aiming for any particular A1c level. Who would be included in this group? People with a life expectancy of less than 10 years, or those who have advanced forms of dementia, emphysema, or cancer; or end-stage kidney, liver, or heart failure. There is little to no evidence for any meaningful benefit of intervening to achieve a target A1c in these populations; there is plenty of evidence for harm. In particular, diabetes medications can cause low blood sugars, leading to weakness, dizziness, and falls. There is the added consideration that elderly and sick patients often end up on a long list of medications that can (and do) interact, causing even more side effects.

The bottom line

There is no question that type 2 diabetes needs to be taken seriously and treated. But common sense should rule the day. Lifestyle changes are very effective, and the side effects of eating more healthfully and staying more active are positive ones. Every person with type 2 diabetes is an individual. No single goal is right for everyone, and each patient should have a say in how to manage their blood sugars and manage risk. That means an informed discussion, and thoughtful consideration to the number.

Sources

Hemoglobin A1c targets for glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus: A guidance statement update from the American College of Physicians. Annals of Internal Medicine, March 2018.

An overview of the management of diabetes in non-pregnant adults. MGH Primary Care Office Insite, updated June 2016.

Management of persistent hyperglycemia in type 2 diabetes mellitus. UpToDate, updated April 2017.

We are always told that having a low A1c is an important goal in our diabetes management, but do you know why? Do you know what a good A1c target is, how to lower your A1c, and how quickly you can lower your A1c safely?

These are the questions I will answer in this comprehensive guide on what A1c is, how to lower your A1c, and why achieving a low A1c isn’t the only (or necessarily the best) goal when it comes to diabetes management.

Table of Contents

What is A1c?

A1c, hemoglobin A1c, HbA1c or glycohemoglobin test (all different names for the same thing) is a blood test that measures your average blood sugar over the last 2-3 months. It’s not an “even average,” but an average where your blood sugars over the last few weeks count a little more than your blood sugars 2-3 months ago.

According to the National Institute of Diabetes & Digestive & Kidney Diseases:

“The A1c test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen. In the body, red blood cells are constantly forming and dying, but typically they live for about three months. Thus, the A1c test reflects the average of a person’s blood glucose levels over the past three months. The A1c test result is reported as a percentage. The higher the percentage, the higher a person’s blood glucose levels have been. A normal A1c level is below 5.7 percent.”

It’s important to note here that the term “normal A1c level” in this context refers to people without diabetes. I will get back to what a “normal A1c level” is for people living with diabetes below.

How to test your A1c

Your doctor or endocrinologist should test your A1c regularly (typically every 3-6 months). The doctor simply pricks your finger (or ear if you prefer) and takes a tiny blood sample. If the doctor’s office has an A1c kit, you should get your result before your consultation is over.

You can also buy home A1c kits (no prescription required) and do the test yourself. Home A1c kits can be useful if you go for more than three months between doctor visits and want to keep an eye on how your A1c is developing yourself.

The home kits are generally accurate within plus/minus 0.5 percentage points, which is more than good enough to give you a trustworthy result. The downside of the home kits is that they require a larger amount of blood (four large drops) than a regular blood sugar test, and if you don’t apply enough blood, you’ll get an error message and will have lost a test strip.

You can find home test kits on Amazon and in some pharmacies.

Why you should care about your A1c

Multiple studies have shown that high average blood sugars increase the risk of diabetes-related complications. Lowering your A1c to the recommended range will reduce the risk of diabetes-related complications significantly:

  • Eye disease risk is reduced by 76%
  • Kidney disease risk is reduced by 50%
  • Nerve disease risk is reduced by 60%
  • Any cardiovascular disease event risk is reduced by 42%
  • Nonfatal heart attack, stroke, or risk of death from cardiovascular causes is reduced by 57%

Achieving an A1c in the recommended range is, therefore, one of the most important things you can do to improve your long-term health when you live with diabetes.

However, the closer you get to the recommended A1c target, the less benefit you will get from lowering your A1c further. Taking your A1c from 12% to 11% makes a big difference while lowering your A1c from 7% to 6% provides a much smaller benefit. In fact, lowering your A1c too much may not be a good idea if it means that you increase how often you experience hypoglycemia (low blood sugar).

I will explain why “time-in-range” is just as important as a low A1c later in this guide.

What is a “normal” A1c?

Now that you have your A1c number, let’s look at what that number actually tells you. The American Diabetes Association has established the following guidelines:

This does NOT mean that you need an A1c of less than 5.7% if you’re living with diabetes. It means that if you do NOT live with diabetes, your A1c is expected to be below 5.7%. There are different recommendations for what an appropriate A1c is for people living with diabetes.

I had a chance to asked Dr. Anne Peters, MD, Director, USC Clinical Diabetes Program and Professor of Clinical Medicine Keck School of Medicine of USC as well as Gary Scheiner, MS, CDE, owner and Clinical Director of Integrated Diabetes Services and author of Think Like a Pancreas, what their perspectives are on a good A1c target:

Dr. Peters:

“The A1c target should be whatever is best given the person’s clinical situation. For athletes, too many lows can limit performance, for someone who is pregnant it should be <6%, for an older person the target should be higher. I generally think an A1c target of 6.0 – 7.0% is ideal and data shows that going below 7% has fairly little impact on complications. Basically, I’d rather see someone with an A1c of 6.9% and low blood sugar variability than an A1c of 6.2% with lots of variability”

Gary Scheiner, MS, CDE:

“A1c goals should be individualized based on the individual capabilities, risks, and prior experiences. For example, we generally aim for very tight A1c levels during pregnancy and more conservative targets in young children and the elderly. Someone with significant hypoglycemia unawareness and a history of severe lows should target a higher A1c than someone who can detect and manage their lows more effectively. And certainly, someone who has been running A1c’s in double digits for quite some time should not be targeting an A1c of 6%… better to set modest, realistic, achievable goals.”

In their Standards of Medical Care in Diabetes, the American Diabetes Association recommends an A1c target of below 7% for adults living with diabetes. An A1c of 7% roughly translates to an average blood sugar of 154 mg/dl (8.6 mmol/L) as you can see from this conversion chart.

To learn more about blood sugar levels, please read “What are Normal Blood Sugar Levels“.

A1c vs. Time-in-Range

A1c has long been considered the best measure of diabetes management because it was the most accurate tool to observe long-term blood sugar trends. This has changed with the introduction of Continuous Glucose Monitoring (CGM). By using a CGM, you can now get a very accurate picture of not only your average blood sugar, but your blood sugar fluctuations as well.

This makes it possible to track another key component of diabetes management: Time-in-Range.

Time-in-range refers to the percentage of time in which your blood sugar is within a specific range. To see why time-in-range is important, take a look at the three lines in the graph below. All three lines show an average blood sugar of about 154 mg/dl (which equals an A1c of about 7%) but with very different fluctuations. I think we would all prefer our blood sugar to follow line 3 rather than line 1.

Graph used with permission from Diatribe

Some guidelines state that your blood sugar range should be set to 70-180 mg/dl (3.9-10 mmol/l), but you may find that to be too large or small of a range for you. According to this interview with several diabetes experts, most recommend that you spend less than 3% of the time below 70 mg/dl (3.9 mmol/l) and less than 1% of the time below 53 mg/dl (3 mmol/l). However, they also agree that the actual time spent in range needs to be individualized.

On average, the experts didn’t expect the general diabetes population to be in range more than 50% of the time at most, so talking about incremental improvement probably makes more sense than setting a fixed number.

How to measure Time-in-Range

If you wear a Continuous Glucose Monitor (CGM), your time-in-range should be listed when you download your data (as in the example from a Dexcom CGM below). If you don’t use a CGM, all you can do is look at your manual blood sugar tests and pay attention to your amount of high and low blood sugars. What’s an acceptable high and low is something you have to discuss with your medical team.

What is more important: a low A1c or a high Time-in-Range?

Optimally, you’d have an A1c below 7% accompanied by a low blood sugar variance (high time-in-range). A good general guideline is:

  • The higher your A1c, the more important it is to focus on getting it down.
  • The lower your A1c, the more important time-in-range becomes.

If your A1c is below 6-7%, focusing on increasing your time-in-range will probably have a larger positive health impact than lowering your A1c further.

So is A1c a bad way to gauge whether your diabetes management is on track? Not necessarily, but to quote Gary Scheiner, MS, CDE:

“I’ve never been a huge fan of using A1c to gauge the “quality” of a person’s glucose control, simply because it represents an average… and an average can reflect lots of highs and lows rather than time spent within one’s target range. However, it’s not something we can ignore either since there is a correlation between A1c and the risk of long-term complications.”

Can your A1c be too low?

As described above, the answer to this question depends almost entirely on how often you experience hypoglycemia (low blood sugar). If you (almost) never experience hypoglycemia, your A1c technically cannot be too low. Some people achieve A1c levels below 5% by following a very strict diabetes management and diet regimen and have almost no blood sugar fluctuations.

HOWEVER, if you often experience hypoglycemia, that will result in an “artificial” low A1c reading because your hypoglycemia events are lowering your blood sugar average. In that case, focusing on increasing time-in-range is much more important than further lowering your A1c. In fact, you may even benefit from a slightly higher A1c with fewer blood sugar fluctuations.

It’s also important to note that lowering your A1c below the recommended range of 6-7% hasn’t been proven to provide any health benefits. Therefore, a very low A1c shouldn’t be a goal in itself.

How to lower your A1c

Now that you have a thorough understanding of A1c and time-in-range, as well as why looking at your A1c in isolation isn’t optimal, the obvious question is:

How do you lower your A1c while improving or sustaining your time-in-range?

I will cover the four most important things you can do below but it’s always recommended that you start by having a conversation with your medical team before making changes to your diabetes management.

Identify the main “pain points”

Whether you are self-managing your diabetes or work closely with your medical team, the first step should always be to try to identify the main “pain points” or reasons why your A1c is higher than you’d like. The only real way of doing this is by tracking your blood sugars very closely.

If you wear a Continuous Glucose Monitor, you can look at your 7-day, 30-day, and 90-day data to see if you can spot any trends. For example, you might find that you are running high from 1-5 AM every night, every morning (hello Dawn Phenomenon) or every day after meals. Or perhaps you always go low after exercise. We all have different blood sugar patterns.

It’s also very possible that you simply are running your blood sugar a little too high all the time and could benefit from adjusting your diabetes medication. Identifying patterns like that makes it possible to pinpoint areas of potential improvement so you can start making a plan for how to limit your high and low blood sugars.

If you rely on manual blood sugar testing, it’s a little trickier since most people don’t test every five minutes. What I would recommend is increasing how often you test for a while, and maybe even test during the night if you wake up anyway. Most meters allow you to download data to your computer, or you can upload the data to app-based platforms like One Drop or mySugr. This can help you see the data in a more cohesive way so you can start looking for trends.

Create a plan for your diabetes management

Now that you have a better idea of what your “pain points” are, you can start making changes to your diabetes management.

Your doctor may suggest a different medication regime. For example, some people (regardless of their type of diabetes) are prescribed Metformin to help with Dawn Phenomenon (morning blood sugar spikes not related to eating). Others may need adjustments to insulin dosing, etc.

If you’re insulin dependent and consistently have high blood sugars in the morning, getting your blood sugar fluctuations and A1c down might be as simple as adjusting your nighttime basal insulin. Or, if you run high every day after meals, your carb-to-insulin ratio might be off and adjusting that could be what sets you on a path of a lower A1c. Until you collect the data and do the analysis, you have no way of knowing this.

I want to make an important point here: increasing your diabetes medication is not a sign of failure! It’s often the best (and sometimes only) way to control your blood sugar and bring down your A1c.

I adjust my insulin up and down all the time when I change my diet or exercise routine. Adjusting your medication is an important tool in your diabetes toolbox and something you should always discuss with your medical team.

Understand nutrition and adjust your diet

What you choose to eat and drink can have a major impact on not only your waistline, mood, and well-being, but also on your blood sugar levels.

All macronutrients (carbohydrates, proteins, and fats) can affect the blood sugar to some degree so developing a good understanding of how they affect your blood sugar will enable you to be proactive and prevent blood sugar swings.

Carbohydrates (carbs)

Carbohydrates have the greatest impact on your blood sugar, which is why many people with diabetes can benefit from following a low- to medium-carb diet (or even a ketogenic diet). The fewer carbs you eat, the less insulin you need to take, which makes diabetes management easier.

However, you don’t have to follow a low-carb diet if it doesn’t work for you – physically or mentally. As I wrote in my post about which diet is best for people with diabetes, it is very possible to have great blood sugar control on a medium (or even high) carb diet, as long as you experiment, take notes, and learn to take the right amounts of insulin for the carbs you are eating.

It is very important to realize that we all react differently to carbs so you have to find the diet and foods that are right for you.

As an example, people react very differently to carbs like oats or sweet potato. Some people can eat oats with only a small increase in blood sugar while others see a quick spike. By simply knowing this, people struggling with a certain type of carb can choose to reduce their consumption or cut it out of their diet altogether.

Protein & fats

While carbs affect blood sugar most significantly, protein and fat also have an impact. Some, like Dr. Sheri Colberg, even think that simply looking at carbs when estimating blood sugar impact (and dosing insulin) is an outdated and inefficient way to perceive diabetes management and that you should focus more on total calories (read more here).

The key thing to be aware of is that when protein and especially fat is consumed with carbohydrates, the energy from the meal will be released more slowly, which means that your blood sugars will be impacted more slowly as well.

While I don’t believe your diabetes management should completely dictate how you live your life and which diet you choose to follow, it can be worth evaluating what food choices make life easier for you. By making a conscious choice of which type of nutrition plan to follow (the majority of the time), you can more easily establish healthy habits that will benefit not only your overall health but also your daily blood sugar levels, and thereby your A1c.

Increase activity (exercise)

While exercise is essential for building and maintaining good health and improving insulin sensitivity, it can be a double-edged sword if it constantly throws your blood sugars for a loop. Not only is that very frustrating, scary, and annoying, but it can also affect your A1c and time-in-range negatively.

The key is to understand how different types of exercise affect blood sugars and, if you use insulin, learn your formula for insulin and food around workouts.

Cardio

Cardio, such as brisk walking, jogging, swimming, biking, or dancing, are all excellent types of exercise, and as little as 20-30 minutes a day can make a significant difference when it comes to improving insulin resistance and managing blood sugar levels.

Not only does exercise reduce blood glucose during exercise, but it also improves your insulin sensitivity for hours after your workout, meaning that you need less insulin.

If you treat your diabetes with insulin, you will have to manage your insulin levels so you don’t experience exercise-induced hypoglycemia. This comes down to reducing your insulin significantly or consuming carbs before your workout.

In general, it should not be needed to “carb up” to do up to 60 minutes of steady-state cardio, but there can be situations where reducing insulin before exercise can’t be done, so additional carbohydrates must be consumed.

Resistance training

Adding resistance training to your daily routine, even if it’s just bodyweight exercise, can be instrumental in increasing your insulin sensitivity and lowering your A1c.

Whereas cardio will lower blood sugar during exercise and potentially up to 36 hours after exercise, resistance training can increase insulin sensitivity for much longer since muscles work as little “glucose tanks” and you’ll store more glucose in your muscles rather than sending it directly to your bloodstream. The more muscles you have, the better your insulin sensitivity.

Just be aware that most people will see an increase in blood sugars during resistance training (research was mainly done on people living with type 1 diabetes) rather than a decrease. The reason for the increase in blood sugar is that the improved insulin sensitivity from exercising is surpassed by your body’s increased glucose production. Your body is producing glucose faster than you can use it!

For a detailed guide to resistance training and diabetes, please see my article “How Resistance Training Affects Your Blood Sugar.”

Because resistance training is so effective at increasing your insulin sensitivity, it’s a great way to lower your blood sugar consistently. If you exercise regularly, the effect of exercising overlaps from one workout to the next and you essentially achieve a permanent increase in insulin sensitivity.

How quickly can you lower your A1c?

Because A1c is simply a measure of your average blood sugar over 2-3 months, it can (in theory) decrease by any amount over that time period. If you, from one day to the next, decreased your daily average blood sugar from 300 mg/dl (16.7 mmol/l) to 120 mg/dl (6.7 mmol/l), your A1c would decrease from 12% to 6% in around two months.

However, it may not be a good idea to lower your A1c so quickly, as I will explain below.

Why you shouldn’t lower your A1c too quickly

It can be a good idea to approach lowering your A1c with a bit of caution. Just as crash dieting isn’t healthy, there can be some serious health risks associated with lowering your A1c too quickly. I turned to Dr. Peters for an explanation:

“If you lower your A1c too quickly, many bad things can happen. First, weight gain and total body swelling. Next, it can cause bleeding in the retina (back of the eyes) which can lead to blindness, and third, it can cause painful neuropathy that never goes away. It’s slightly different for newly diagnosed patients, but, in general, no one should try to go from an A1c of 10% to 6% quickly. Take slow steps. Wanting to get to a “low” number very fast only causes harm. Diabetes is a long-term disease, so slow steps to establish new habits that can last a lifetime is the way to go. Anything too sudden and the body reacts badly.”

My perspective on A1c as a person living with diabetes

I have a very ambivalent relationship with my A1c myself. I’ve been living with type 1 diabetes for over 20 years, and my A1c is not something I think about in my daily life. However, every three months when I see my endo, I get a little anxious because receiving your A1c can feel a lot like getting your diabetes report card.

And, quite honestly, that’s really silly. My A1c number doesn’t reflect what’s been going on in my life for the last three months. It doesn’t tell me how much effort I’ve put into managing my diabetes and it does not define me as a person. It’s a good source of information, nothing more.

Still, we tend to look at it and judge, good or bad, how we’ve done with our diabetes management. But we really shouldn’t!

That doesn’t mean that I think we shouldn’t get our A1c checked. I absolutely think we should, but we also need to understand what it means as well as why we should look beyond the A1c number. I hope this guide has given you the knowledge and tools to do so!

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Suggested next posts:

  • Diabetes and High Blood Pressure: What is the relationship?
  • Diabetes & Ketones: Everything You Need to Know

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Hemoglobin A1c definition is – a stable glycoprotein formed when glucose binds to the level of hemoglobin A1c in the blood as a means of determining the average blood sugar Medical Definition of hemoglobin A1c If a member of the audience describes your speech as bombastic, does that person mean it is. home/medterms medical dictionary a-z list / hemoglobin a1c definition Hemoglobin A1c: A minor component of hemoglobin to which glucose is bound. You may have heard of a diabetes test called a hemoglobin A1c, sometimes You don’t need to fast or change medicine schedules for an A1C test. That level will still put you at risk for long-term complications, though.

eAG stands for Estimated Average Glucose. This term is a measurement that directly relates to the A1c blood test. The A1c has been the standard measure of . Looking for online definition of A1C or what A1C stands for? A1C is listed in the Beaver Medical Group Improves Diabetic Patient Care. After four months of. If you have diabetes, you should have an A1C test at least twice each year to find out your long-term blood glucose control. The A1C test measures your average.

A hemoglobin A1C blood test provides a three-month average of in the moment, not long-term information, says Gregory Dodell, MD, assistant clinical professor of medicine, endocrinology, diabetes, If you have any questions about your A1C levels or what they mean, don’t hesitate to ask your doctor. Mayo Clinic does not endorse companies or products. An A1C level above 8 percent means that your diabetes is not well-controlled and you. How does A1C relate to estimated average glucose? for an A1C test, which means that blood can be drawn for the test at any time of the day. A1C tests are less likely to be affected by short-term changes than FPG or OGTT tests. . Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes — Medical Author: Facts and Definition of Hemoglobin A1c (HbA1c); What Is Hemoglobin A1c? How HbA1c levels are reflective of blood glucose levels over the past six to eight weeks and do not reflect daily ups and downs of blood glucose. Information about short term and long term assessment of glycemic control. The American Diabetes Association Standards of Medical Care in.

An A1c level of less than % means a 48% lower risk of diabetes and about in the March 4 issue of the New England Journal of Medicine. Find out why the hemoglobin A1c test (HbA1c) is so important for Levels of % or higher mean you have diabetes. WebMD Medical Reference Reviewed by Michael Dansinger, MD on What to Do About DPN By clicking “Submit,” I agree to the WebMD Terms and Conditions and Privacy Policy. Here, we break down A1C numbers into a simple green-light, yellow-light, The simple fact of the matter is that if you have an A1C below six, it means you may be having low blood sugar, and lows are “Standards of Medical Care in Diabetes — Editorial Policy · Privacy Policy · Terms of Use. A1C. Does this test have other names? Hemoglobin A1c; HbA1c; glycosylated A1C is a blood test that shows average blood sugar (glucose) levels over the last 3 months. This means you have a higher risk for diabetes in the future. A1C of.

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