GuidetoHbA1c

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HbA1cisatermcommonlyusedinrelationtodiabetes.ThisguideexplainswhatHbA1cis,
howitdiffersfrombloodglucoselevelsandhowit'susedfordiagnosingdiabetes.

WhatisHbA1c?
ThetermHbA1creferstoglycatedhaemoglobin.Itdevelopswhenhaemoglobin,aprotein
withinredbloodcellsthatcarriesoxygenthroughoutyourbody,joinswithglucoseintheblood,
becoming'glycated'.
Bymeasuringglycatedhaemoglobin(HbA1c),cliniciansareabletogetanoverallpictureof
whatouraveragebloodsugarlevelshavebeenoveraperiodofweeks/months.
ForpeoplewithdiabetesthisisimportantasthehighertheHbA1c,thegreatertheriskof
developingdiabetesrelatedcomplications.

HbA1cformswhenhaemoglobin
joinswithglucoseintheblood

HbA1cisalsoreferredtoashaemoglobinA1corsimplyA1c.
DefinitionofHbA1c
HbA1creferstoglycatedhaemoglobin(A1c),whichidentifies
averageplasmaglucoseconcentration.

HowdoesHBA1creturnanaccurateaveragemeasurementofaverageblood
glucose?
Whenthebodyprocessessugar,glucoseinthebloodstreamnaturallyattachestohaemoglobin.
Theamountofglucosethatcombineswiththisproteinisdirectlyproportionaltothetotalamountofsugarthatisinyoursystem
atthattime.
Becauseredbloodcellsinthehumanbodysurvivefor812weeksbefore
renewal,measuringglycatedhaemoglobin(orHbA1c)canbeusedtoreflect
averagebloodglucoselevelsoverthatduration,providingausefullongerterm
gaugeofbloodglucosecontrol.
Ifyourbloodsugarlevelshavebeenhighinrecentweeks,yourHbA1cwillalso
begreater.

HbA1ctargets
TheHbA1ctargetforpeoplewithdiabetestoaimforis:
48mmol/mol(6.5%)
Notethatthisisageneraltargetandpeoplewithdiabetesshouldbegivenan
individualtargettoaimtowardsbytheirhealthteam.
AnindividualHbA1cshouldtakeintoaccountyourabilitytoachievethetargetbasedonyourdaytodaylifeandwhetheryou
areatriskofhavingregularorseverehypos.

HbA1cindiagnosis
HbA1ccanindicatepeoplewithprediabetesordiabetesasfollows:
HbA1c

mmol/mol

Normal

Below42mmol/mol

Below6.0%

Prediabetes

42to47mmol/mol

6.0%to6.4%

48mmol/molorover

6.5%orover

Diabetes

WhatarethebenefitsofloweringHbA1c?
TwolargescalestudiestheUKProspectiveDiabetesStudy(UKPDS)andtheDiabetesControl
andComplicationsTrial(DCCT)demonstratedthatimprovingHbA1cby1%(or11
mmol/mol)forpeoplewithtype1diabetesortype2diabetescutstheriskofmicrovascular
complicationsby25%.
Microvascularcomplicationsinclude:
Retinopathy
Neuropathy
Diabeticnephropathy(kidneydisease)
Researchhasalsoshownthatpeoplewithtype2diabeteswhoreducetheirHbA1clevelby1%
are:[1]

HbA1cintheForum

HighHbA1cHelp
Unsure,hadHbA1C
test,notdiabetic
PleaseinterpretmyA1c
result
3monthsdiagnosed
andHbA1ctest
excellentcontrol

19%lesslikelytosuffercataracts
16%lesslikelytosufferheartfailure
43%lesslikelytosufferamputationordeathduetoperipheralvasculardisease

HowdoesHbA1cdifferfromabloodglucoselevel?
HbA1cprovidesalongertermtrend,similartoanaverage,ofhowhighyourbloodsugarlevelshavebeenoveraperiodof
time.
AnHbA1creadingcanbetakenfrombloodfromafingerbutisoftentakenfroma
bloodsamplethatistakenfromyourarm.
Bloodglucoselevelistheconcentrationofglucoseinyourbloodatasingle
pointintime,i.e.theverymomentofthetest.
Thisismeasuredusingafastingplasmaglucosetest,whichcanbecarriedout
usingbloodtakenfromafingerorcanbetakenfromabloodsamplefromthe
arm.
However,fastingglucosetestsprovideanindicationofyourcurrentglucose
levelsonly,whereastheHbA1ctestservesasanoverallmarkerofwhatyour
averagelevelsareoveraperiodof23months.
HbA1ccanbeexpressedasapercentage(DCCTunit)orasavalueinmmol/mol
(IFCCunit).Since2009,mmol/molhasbeenthedefaultunittouseintheUK.
NotethattheHbA1cvalue,whichismeasuredinmmol/mol,shouldnotbeconfusedwithabloodglucoselevelwhichis
measuredinmmol/l.UseourHbA1cconversiontooltohelpwithswitchingbetweenthetwomeasurementunits.

What is HbA1c (A1c)?

TRANSCRIPT

GetaFREEHbA1cchartand50ShadesofHbA1cInfographicforyour
phone,desktoporasaprintout.
Emailaddress:

WhenshouldHbA1clevelsbetested?
EveryonewithdiabetesmellitusintheUKshouldbeofferedanHbA1ctestatleastonceayear.
SomepeoplemayhaveanHbA1ctestmoreoften.Thismaybemorelikelyifyouhaverecentlyhadyourmedicationchanged
oryourhealthteamareotherwisewishingtomonitoryourdiabetescontrolmorethanonceayear.
AlthoughHbA1clevelalonedoesnotpredictdiabetescomplications,
goodcontrolisknowntolowertheriskofcomplications.

Howdobloodglucoselevelscomparewith
HbA1creadings?

Fig2:HbA1c&GlucoseBloodLevels

HbA1c
(%)

Thetableontheright(figure2)showshowaveragebloodsugar
levelsinmmol/LwouldbetranslatedintoHbA1creadings,andvice
versa.
Itisimportanttonotethatbecausebloodglucoselevelsfluctuate
constantly,literallyonaminutebyminutebasis,regularbloodglucose
testingisrequiredtounderstandhowyourlevelsarechangingthrough
thedayandlearninghowdifferentmealsaffectyourglucoselevels.

HbA1c
(mmol/mol)

Ave.Blood
Glucose
(mmol/L)

13

119

18mmol/L

12

108

17mmol/L

11

97

15mmol/L

10

86

13mmol/L

75

12mmol/L

64

10mmol/L

53

8mmol/L

42

7mmol/L

31

5mmol/L

ReadmoreaboutHbA1c:
TestsforHbA1c
HbA1cinpregnancy

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