Study Selection And Data Abstraction
We searched for published, English language, prospective cohort studies that used A1C to predict the progression to diabetes among those aged â¥18 years. We included studies with any design that measured A1Câwhether using a cutoff point or categoriesâand incident diabetes. Titles and abstracts were screened for studies that potentially met inclusion criteria, and relevant full text articles were retrieved. X.Z. and W.T. reviewed each article for inclusion and abstracted, reviewed, and verified the data using a standardized abstraction template. If A1C measurement was standardized by the National Glycohemoglobin Standardization Program and both standardized and unstandardized A1C values were reported, standardized values were used in the analyses. A sensitivity analysis, however, was conducted using both standardized and unstandardized A1C values. Relative measures of diabetes incidence including relative risk, odds ratio, hazard ratio, likelihood ratio, and incidence ratio were examined and cumulative incidences were converted to annual incidences . In studies reporting no measure of relative incidence, the incidence ratio was estimated as the absolute incidence in each A1C category divided by the incidence in the lowest A1C category.
Take Advantage Of Tech
There are lots of apps out there to help patients manage their diabetes. What may work for one person may not work for anothertry out a few to find a good fit. You may want to talk to your doctor about getting a continuous glucose monitor to help you track your progress. These tiny sensors, which are inserted under the skin, are a great way to see your glucose levels in real timesome can even send your results to your tablet or smartphone.
What Is A Good A1c Level
Levels between 5.7 and 6.4 are considered prediabetes. For most people with diabetes, the general A1C goal is to have a level between 6.0 and 6.9. While it might sound like the ideal A1C target is under 6.0, for those with diabetes, this level can indicate low blood sugar levels, which can be just as dangerous as high blood sugar levels. If A1C results fall between 7.0 and 8.9, a doctor might suggest lifestyle changes or medications to help lower the levels to what is considered controlled. However, for some people, these levels might be appropriate, such as:
- Those with a limited life expectancy
- People with long-standing diabetes who have trouble reaching a lower goal
- Those with severe hypoglycemia or the inability to sense hypoglycemia
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Why Is It Important
Your red blood cells have something called hemoglobin that carries oxygen from your lungs to cells all over your body. Glucose goes into your red blood cells and coats molecules of hemoglobin. The more glucose you have in your blood, the more coated hemoglobin molecules you have.
The A1c measures how much of your hemoglobin is coated with sugar. The higher your level, the greater your chance for problems down the road. That means your blood sugar control plan isn’t working at its best.
A1c And Cardiovascular Risk
By this point you hopefully have a better understanding of what HbA1c is, how to interpret the number, and what is considered a healthy range. Now its time to talk about why all this matters.
Having an elevated A1c demonstrates poor glucose control, which puts you at an increased risk for diabetic complications such as cardiovascular disease.
Chronically high levels of sugar in your blood will cause damage to the tiny blood vessels throughout your body. Over time, this can lead to stroke, heart attack, or other adverse events from altered blood flow.
The good news is that one of the best things you can do as a prediabetic to prevent heart disease is to maintain good control of your sugar.
A 1% reduction in A1c is associated with a 21% reduction in diabetes related death, 14% reduction in heart attacks and 37% reduction in microvascular complications!
This means reducing your A1c from 8 to 7 is a great accomplish. While 7 may not be your ultimate A1c goal, its still an admirable reduction that means great things for your overall health!
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What Does Hba1c Mean
HbA1c is whats known as glycated haemoglobin. This is something thats made when the glucose in your body sticks to your red blood cells. Your body cant use the sugar properly, so more of it sticks to your blood cells and builds up in your blood. Red blood cells are active for around 2-3 months, which is why the reading is taken quarterly.
A high HbA1c means you have too much sugar in your blood. This means youre more likely to develop diabetes complications, like serious problems with your eyes and feet.
Knowing your HbA1c level and what you can do to lower it will help you reduce your risk of devastating complications. This means getting your HbA1c checked regularly. Its a vital check and part of your annual review. Youre entitled to get this test at least once a year. But if your HbA1c is high or needs a little more attention, itll be done every three to six months. It’s really important not to skip these tests, so if you haven’t had one in over a year contact your healthcare team.
Once you know your HbA1c level, its important that you understand what the results mean and how to stop them from getting too high. Even a slightly raised HbA1c level makes you more at risk of serious complications, so get all the facts here and be in the know about HbA1c.
What Does This Mean For People Wondering About Their Diabetes Risk
For individuals who havent received a diagnosis of diabetes, Dr. Villacreses says, one important lesson from these fidings is that ”you should not feel 100% reassured if your A1c number is less than 6.5% that you are do not have diabetes. A test result that is greater than 6.4% defines the beginning of diabetes, so you may have prediabetes or have already progressed to type 2 diabetes.
The sooner you receive a diagnosis regarding your diabetes status, the earlier treatment can begin. This is important because by understanding your risks, and making the necessary lifestyle changes, you can prevent prediabetes from progressing or even reverse the type 2 diabetes.
In addition, she says, patients should feel comfortable asking their doctor about the choice of tests and indicate your desire to skip the A1c, and have one of the other more reliable screening methods, while more time consuming, to determine if you are at risk for pre-diabetes or diabetes.
Dr. Villacreses has received research funding and speaking fees from a variety of pharmaceutical companies but none that pose a conflict in this research. Dr. Christofides has no relevant financial disclosures.
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What Is An A1c Test
The hemoglobin A1c test tells you your average level of blood sugar over the past 2 to 3 months. It’s also called HbA1c, glycated hemoglobin test, and glycohemoglobin. Itâs a lot like a baseball player’s season batting average. A single game doesn’t tell you how a player is performing in their career. And 1 day’s test results don’t give you the complete picture of how your treatment is working.
People who have diabetes need this test regularly to see if their levels are staying within range. It can tell if you need to adjust your diabetes medicines. The A1c test is also used to diagnose diabetes.
So What Do The Numbers Mean
When it comes to the numbers, there’s no one-size-fits-all target. A1C target levels can vary by each person’s age and other factors, and your target may be different from someone else’s. The goal for most adults with diabetes is an A1C that is less than 7%.
A1C test results are reported as a percentage. The higher the percentage, the higher your blood sugar levels over the past two to three months. The A1C test can also be used for diagnosis, based on the following guidelines:
- If your A1C level is between 5.7 and less than 6.5%, your levels have been in the prediabetes range.
- If you have an A1C level of 6.5% or higher, your levels were in the diabetes range.
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A1c Tests Can Be Affected By Changes In Red Blood Cells Or Hemoglobin
If youre 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 interferencea falsely high or low resultwhen your A1C and blood glucose test results dont match.
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.
The 411 On A1c: Normal A1c Levels And 15 Ways To Lower High A1c
The hemoglobin A1C test is the closest thing to a diabetes scorecard you can find. Whether someone has had diabetes mellitus for years or if they have just been diagnosed, they have probably heard about this test. Unlike blood sugar meters people use at home, the A1C measures an average blood sugar level over the past several months by analyzing how many of a patients hemoglobin cells have glucose attached to them. The test results keep track of how well a person is managing his or her diabetes.
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What Tools Are Available If An A1c Test Is Not Accurate Or Sufficient
Besides A1c tests, the most common measures of blood sugar are the oral glucose tolerance test , CGM, and self-monitored blood glucose tests.
The OGTT is a diagnostic tool diabetes and prediabetes, assessing a persons response to consuming a fixed amount of sugar. After taking the sugar drink, blood sugar levels are measured two hours later. Below 140 mg/dl is considered normal, between 140 mg/dl and 200 mg/dl points to prediabetes or impaired glucose tolerance, and above 200 mg/dl indicates diabetes. It is not useful for tracking diabetes management.
For those with established diabetes, CGM has the advantage of monitoring blood sugar levels consistently throughout the day , providing more detailed insight into time spent in-range, low blood sugars, and high blood sugars. Examples of CGM include:
Senseonics implantable Eversense CGM
If CGM is not available, taking frequent fingersticks with a blood glucose meter when waking up, before and after meals, and before bed can also indicate when blood sugar levels are going low, high, and staying in range.
Eat A Balanced Diet With Proper Portion Sizes
Its best to check with a certified diabetes care and education specialist or a registered dietitian-nutritionist to determine what a balanced diet and appropriate portions mean for you. But a great rule of thumb is to visualize your plate for every meal and aim to fill one-half of it with veggies, one-quarter with protein, and one-quarter with whole grains, says Turkel. If you like fruit, limit your portions to a small cup, eaten with a little protein or lean fat to help you digest the fruit carbohydrates in a manner that is less likely to spike your blood sugar level.
Also, avoid processed foods as much as possible, and say no to sugary sodas and fruit juice, which are high in carbs and calories, and thus can lead to spikes in blood sugar and contribute to weight gain, according to the ADA.
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Normal Blood Sugar Levels Chart
Every substance present in our body has an optimum level. Above or below that specific range, that particular substance is harmful to our health. And so is sugar. There is a certain range of blood sugar which is considered as standard for almost all age. However, there might be some changes in the level considering different factors like age and other co-morbidities. Lets look at the chart:
|2 hours after the meal||< 140 mg/dl|
Sometimes, random blood is also taken. In this case, the glucose level of 200 mg/dl is considered a diabetic condition.
Going through the chart you will notice certain terms regarding blood sugar which you need to understand in order to evaluate your own glucose level. So, I will just give a small brief regarding those:
- Fasting blood glucose: Here, blood sugar is tested after abstaining from food and drink for at least 8 hours.
- Postprandial blood sugar:In this case, blood sugar is tested 2 hours after a meal to access if its at the optimum level after having a meal or not.
- Random blood glucose: Blood is tested at any time of the day.
- HbA1c: It refers to a blood test which is done to evaluate the average level of blood glucose over the past 3 months. HbA1c is also known as glycosylated haemoglobin or A1C. Moreover, fasting is not required before carrying out the test.
When Should I Call The Doctor
A urine test for ketones should always be negative. Report a positive result to your doctor immediately. You should also let them know right away if your blood sugar remains high or if you have stomach pain, nausea, vomiting, rapid breathing, sweet-smelling breath, or if youâre peeing a lot.
The doctor may tell you to:
- Drink plenty of water and fluids to lower the amounts of ketones and stay hydrated.
- Continue to check your blood sugar. If itâs high, you may need to give yourself a small amount of rapid-acting insulin.
- Go to the local emergency room so you can get intravenous fluids and insulin.
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Heart Disease And Stroke
People living with diabetes have high blood sugar, and over time this can damage the blood vessels and nerves that control the heart, leading to heart disease. It has been found that people with diabetes tend to develop heart disease at a younger age than people without diabetes. Also, the longer you have diabetes, the more likely you are to have heart disease.
The most common type of heart disease is coronary artery disease, which is caused by the buildup of plaque in the walls of the coronary arteries, the blood vessels that supply oxygen and blood to the heart. Plaque is made of cholesterol deposits, which make the inside of arteries narrow and decrease blood flow. This process is called atherosclerosis, or hardening of the arteries. Decreased blood flow to the heart can cause a heart attack.
Decreased blood flow to the brain can also cause a stroke. Patients with diabetes are particularly at a significantly higher risk of stroke and have a higher mortality.
Those who have diabetes are also more likely to have other conditions that raise the risk for heart disease, including:
- High blood pressure: This increases the force of blood through your arteries and can damage artery walls.
- Too much low-density lipoprotein cholesterol: Also, known as bad cholesterol, this can lead to the formation of plaque on damaged artery walls.
- High triglycerides: This combined with a low HDL cholesterol or high LDL cholesterol is thought to contribute to hardening of the arteries.
For Those Diagnosed With Diabetes You Can Reduce The Risk Of Complications:
- Monitor blood glucose levels with appropriate testing and an A1C blood test every three months to measure the average amount of sugar in your blood
- If you smoke, its never too late to quit
- Be physically active
- Examine feet and skin every day
- Have an eye exam at least once a year
- Have a kidney function test at least once a year
- Visit your healthcare provider regularly
How Do You Lower A1c
You lower your A1c in the same way you lower your blood sugar through diet and lifestyle changes, and medication if necessary.
Gloria G shares:
I wanted to share my great results having been on this plan for only one month. 3 months ago my A1C was 8.7 and my recent blood work showed it at 7.4. My endocrinologist was very impressed and thinks I will be at the target level by my next testing in 3 months.
After about 3 months on your plans, my doctors report was best ever: A1c was normal for the first time since I was diagnosed diabetic in 2007! After one year I now am taking fewer medications and am maintaining an A1C of 5.8! Keep up what you do! You have earned my trust!
Get proactive and you can also achieve the same A1c improvements many of our members see.
Changing habits can be challenging, but with a little commitment, determination, and work , you can lower A1c levels.
The good news is, lowering your A1c levels is well worth the effort for the great health benefits you receive!