What is the A1C test?
People with diabetes used to depend only on urine tests or daily finger pricks to measure their blood sugar levels. These tests are accurate, but only in the moment.
They’re actually very limited as an overall measurement of blood sugar control. This is because your blood sugar can vary wildly depending on the time of day, your activity levels, and even hormonal changes. Some people may have high blood sugar at 3 a.m. and be totally unaware of it.
A1C tests became available in the 1980s and quickly became an important tool in monitoring diabetes control. A1C tests measure average blood glucose over the past two to three months. So even if you have a high fasting blood sugar, your overall blood sugar may be normal, or vice versa.
How the Test Works
The sugar in your blood is called glucose. When glucose builds up in your blood, it binds to the hemoglobin in your red blood cells. The A1c test measures how much glucose is bound.
Red blood cells live for about 3 months, so the test shows the average level of glucose in your blood for the past 3 months.
What’s a Normal Hemoglobin A1c Test?
For people without diabetes, the normal range for the hemoglobin A1c level is between 4% and 5.6%. Hemoglobin A1c levels between 5.7% and 6.4% mean you have a higher chance of getting diabetes. Levels of 6.5% or higher mean you have diabetes.
What to expect
A person can take the A1C test at any time. They do not need to fast before taking it or do any other kind of preparation. A doctor or other healthcare professional will take some blood and send it to the laboratory for assessment.
Some doctors’ offices offer a point-of-care test, which means they analyze the blood themselves. This may be useful for managing diabetes, but the NIDDK note that it is not suitable for diagnosis.
Why is testing important?
Managing blood sugar and A1C levels is necessary because a number of complications can develop with diabetes, such as cardiovascular disease.
As A1C percentages rise, so does the risk of prediabetes becoming type 2 diabetes, and complications arising in those who already have a diagnosis.
For example, one research team found that people with an A1C of 6.0–6.5 percent frequently had a 20-times higher risk of developing diabetes within 5 years when investigators compared them with people who had an A1C score of less than 5 percent.
A large 2014 study of A1C testing concluded that testing once every 3 months can help people with diabetes keep their blood glucose levels steady, especially if their initial score was 7 percent or above.
The researchers found that individuals who tested four times a year saw an average 3.8 percent drop in their A1C result, and they were less likely to see rises in blood sugar levels.
Meanwhile, people who tested just once a year experienced an average 1.5 percent rise in A1C results. The ADA recommend A1C testing for people with a diagnosis of diabetes, as follows: At least twice a year for those with stable glucose levels who are meeting treatment goals.
More often when a person’s treatment plan changes or if they are not meeting blood glucose goals.
For those without diabetes, the ADA recommend that anyone who is 45 years of age or more, or who is under 45 years old but has risk factors for diabetes such as obesity, should seek a baseline test. An individual may need to attend further testing, depending on the result of their baseline test,
People who have had gestational diabetes during pregnancy may need to arrange screening every 3 years.
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