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Hemoglobin A1c (HgbA1C) Most Popular

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Also known as: A1c, Glycated Hemoglobin, Glycohemoglobin, Glycosylated Hemoglobin, HA1c, HbA1c, Hemoglobin A1c, Hemoglobin A1c HgbA1C, Hgb A1c

Hemoglobin A1c

The A1c test evaluates the average amount of glucose in the blood over the last 2 to 3 months. It does this by measuring the concentration of glycated (also often called glycosylated) hemoglobin A1c. Hemoglobin is an oxygen-transporting protein found inside red blood cells (RBCs). There are several types of normal hemoglobin, but the predominant form – about 95-98% – is hemoglobin A. As glucose circulates in the blood, some of it spontaneously binds to hemoglobin A. The hemoglobin molecules with attached glucose are called glycated hemoglobin. The higher the concentration of glucose in the blood, the more glycated hemoglobin is formed. Once the glucose binds to the hemoglobin, it remains there for the life of the red blood cell – normally about 120 days. The predominant form of glycated hemoglobin is referred to as HbA1c or A1c. A1c is produced on a daily basis and slowly cleared from the blood as older RBCs die and younger RBCs (with non-glycated hemoglobin) take their place. This test is used to monitor treatment in someone who has been diagnosed with diabetes. It helps to evaluate how well their glucose levels have been controlled by treatment over time. This test may be used to screen for and diagnose diabetes or risk of developing diabetes. In 2010, clinical practice guidelines from the American Diabetes Association (ADA) stated that A1c may be added to fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) as an option for diabetes screening and diagnosis. For monitoring purposes, an A1c of less than 7% indicates good glucose control and a lower risk of diabetic complications for the majority of diabetics. However, in 2012, the ADA and the European Association for the Study of Diabetes (EASD) issued a position statement recommending that the management of glucose control in type 2 diabetes be more "patient-centered." Data from recent studies have shown that low blood sugar (hypoglycemia) can cause complications and that people with risk of severe hypoglycemia, underlying health conditions, complications, and a limited life expectancy do not necessarily benefit from having a stringent goal of less than 7% for their A1c. The statement recommends that people work closely with their doctor to select a goal that reflects each person's individual health status and that balances risks and benefits.
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The Hemoglobin A1c (HgbA1C) test contains 1 test with 1 biomarker .

Hemoglobin A1c Image Representation | Ulta Lab TestsBrief Description: The Hemoglobin A1c (HbA1c) test measures the average blood glucose level over the past two to three months. It provides valuable information about long-term blood sugar control in individuals with diabetes. The HbA1c test is considered a vital tool in managing and monitoring diabetes.

Also Known As: A1c Test, HbA1c Test, Glycated Hemoglobin Test

Testing Method: Enzymatic

Collection Method: Blood Draw Hemoglobin A1c HgbA1c Test Blood Draw | Ulta Lab Tests
Specimen: 1 mL Whole Blood Hemoglobin A1c HgbA1c Test Specimen Type Whole Blood | Ulta Lab Tests

Test Preparation: No preparation required

When is a Hemoglobin A1c test ordered?

A Hemoglobin A1c test may be ordered in several situations to assess blood glucose control:

  1. Diagnosis of Diabetes: The HbA1c test is used as a diagnostic tool for diabetes, particularly for individuals with symptoms of hyperglycemia or those at risk for developing the disease.

  2. Monitoring Diabetes Management: Individuals with diagnosed diabetes undergo regular HbA1c testing to monitor their blood sugar control over time. It helps assess the effectiveness of diabetes management strategies, including lifestyle modifications, medication, and insulin therapy.

  3. Assessment of Treatment Goals: The HbA1c test helps set and evaluate treatment goals for individuals with diabetes. It provides insight into long-term blood sugar control and aids in adjusting medication dosages or treatment plans.

What does a Hemoglobin A1c blood test check for?

Hemoglobin A1c, often known as A1c or glycated hemoglobin, is hemoglobin that has been attached to glucose. By assessing the proportion of glycated hemoglobin, the A1c test determines the average quantity of glucose in the blood during the previous 2 to 3 months.

Hemoglobin is a protein present inside red blood cells that transports oxygen.

Glycated hemoglobin is generated in proportion to the amount of glucose in the blood. Once glucose attaches to hemoglobin, it stays there for the duration of the red blood cell's life, which is usually about 120 days. The most common kind of glycated hemoglobin is known as A1c. A1c is created on a daily basis and is gradually removed from the bloodstream as older RBCs die and younger RBCs replace them.

This test can be used to detect and diagnose diabetes, as well as the risk of developing it. According to the American Diabetes Association's standards of medical care in diabetes, diabetes can be diagnosed using either A1c or glucose.

This test can also be used to track the progress of a diabetic patient's treatment. It aids in determining how well a person's glucose levels have been controlled over time by medication. An A1c of less than 7% suggests good glucose control and a lower risk of diabetic complications for the majority of diabetics for monitoring reasons.

Sample Ulta Lab Tests View of Hemoglobin A1c Test Results
Hemoglobin A1c Test Example Ulta Lab Tests Results

 

Sample Quest Result Report View of Hemoglobin A1c Test Results
Hemoglobin A1c Test Example Quest Diagnostics Results

Lab tests often ordered with a Hemoglobin A1c test:

When an HbA1c test is ordered, other tests may also be requested to provide additional information about a person's glucose control, potential complications of diabetes, or to evaluate other related health issues. Here are some commonly ordered tests alongside an HbA1c test:

  1. Glucose Tolerance Test (GTT):

    • Purpose: To assess how the body processes glucose after a defined amount of sugar is consumed.
    • Why Is It Ordered: Can be used to diagnose type 2 diabetes and gestational diabetes. It's a more sensitive test than FBS and can be ordered if HbA1c results are equivocal.

  2. Glucose Test:

    • Purpose: Measures blood sugar.
    • Why Is It Ordered: Can be used in the diagnosis of diabetes if the levels are high enough and symptoms of hyperglycemia are present.

  3. C-Peptide Test:

    • Purpose: Measures the level of C-peptide, which is a marker for insulin production.
    • Why Is It Ordered: To differentiate between type 1 and type 2 diabetes, as type 1 is characterized by low or absent insulin production.

  4. Fructosamine Test:

    • Purpose: Provides information about blood sugar levels over the past 2-3 weeks.
    • Why Is It Ordered: Can be used for checking blood sugar control in situations where HbA1c might not be reliable (e.g., in cases of hemoglobinopathies or recent changes in glucose control).

  5. Complete Blood Count (CBC):

    • Purpose: Provides a count of each type of cell in the blood, including red blood cells, white blood cells, and platelets.
    • Why Is It Ordered: To detect a range of disorders, including anemia, which is common in people with chronic diseases like diabetes.

  6. Lipid Profile:

    • Purpose: To measure blood levels of total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.
    • Why Is It Ordered: People with diabetes are at a higher risk for lipid abnormalities, which contribute to cardiovascular disease.

  7. Kidney Function Tests (such as serum creatinine, Blood Urea Nitrogen (BUN), and urine nitrogren-to-creatinine ratio):

    • Purpose: To assess kidney health, which can be compromised in diabetes.
    • Why Is It Ordered: To monitor for diabetic nephropathy, one of the complications of poorly controlled diabetes.

  8. Liver Function Tests (LFTs):

    • Purpose: To assess liver function, which can be affected by medications or co-existing conditions like nonalcoholic fatty liver disease.
    • Why Is It Ordered: To ensure that elevated blood glucose is not due to liver dysfunction, which can also affect glucose metabolism.

  9. Thyroid Function Tests:

    • Purpose: To measure thyroid hormone levels, as thyroid dysfunction can affect metabolic rate and glucose control.
    • Why Is It Ordered: Diabetes and thyroid disorders often co-exist, and uncontrolled thyroid function can make diabetes management more challenging.

These tests are ordered based on the individual’s medical history, risk factors, and treatment plan. Together with the HbA1c, they help provide a comprehensive picture of the patient's health, guide the management of diabetes, and monitor for potential complications.

Conditions where a Hemoglobin A1c test is recommended:

The Hemoglobin A1c test is commonly ordered for:

  1. Diabetes: The test is essential for diagnosing and monitoring blood sugar control in individuals with diabetes, including type 1 diabetes, type 2 diabetes, and gestational diabetes.

  2. Prediabetes: Individuals with prediabetes, a condition characterized by higher-than-normal blood glucose levels but not meeting the criteria for diabetes, may undergo HbA1c testing to assess their risk of progressing to diabetes.

How does my healthcare provider use a Hemoglobin A1c test?

Healthcare providers use the results of a Hemoglobin A1c test to:

  1. Diagnose Diabetes: The test is used as a diagnostic tool, with elevated HbA1c levels indicating the presence of diabetes.

  2. Monitor Blood Glucose Control: Regular HbA1c testing helps healthcare providers assess blood sugar control over time, allowing them to make necessary adjustments to treatment plans or interventions.

  3. Set and Evaluate Treatment Goals: The HbA1c test helps set realistic treatment goals for individuals with diabetes and provides feedback on the effectiveness of diabetes management strategies.

  4. Assess Diabetes-Related Complications: Long-term elevated HbA1c levels may indicate an increased risk of diabetes-related complications such as cardiovascular disease, kidney disease, or nerve damage.

By effectively utilizing the results of a Hemoglobin A1c test, healthcare providers can diagnose diabetes, monitor blood glucose control, set treatment goals, assess the risk of complications, and make informed decisions regarding patient care and treatment interventions related to diabetes management.

What does my Hemoglobin A1c test result mean?

HbA1c levels is currently reported as a percentage for monitoring glucose control, and it is suggested that most diabetics try to keep their hemoglobin A1c below 7%. The closer diabetics can keep their A1c to the therapeutic objective of less than 7% without experiencing abnormally low blood glucose, the better their diabetes is controlled. The risk of problems rises as the A1c rises.

However, a person with type 2 diabetes may have an A1c goal set by their healthcare professional. The length of time since diagnosis, the presence of other diseases as well as diabetes complications, the risk of hypoglycemia complications, life expectancy, and whether or not the person has a support system and healthcare resources readily available are all factors that may influence the goal.

For example, a person with heart disease who has had type 2 diabetes for many years without diabetic complications may have a higher A1c target set by their healthcare provider, whereas someone who is otherwise healthy and newly diagnosed may have a lower target set by their healthcare provider as long as low blood sugar is not a significant risk.

Key Diabetes Test Patterns for Hemoglobin A1c

This table simplifies the interpretation of key patterns in diabetes and metabolic disorders.

Hemoglobin A1c Glucose Insulin C-Peptide Possible Conditions
High High High High Type 2 Diabetes (Insulin Resistance with Hyperinsulinemia)
High High Low Low Type 1 Diabetes (Insulin Deficiency)
High High High Low Exogenous Insulin Use (e.g., Insulin Injection without Endogenous Production)
High Normal High High Poorly Controlled Diabetes (Elevated HbA1c Despite Normal Glucose At Time of Rest)
Normal High High High Prediabetes or early Insulin Resistance
Normal High Low Low Latent Autoimmune Diabetes in Adults (LADA)
Normal Normal High High Insulin Resistance (e.g., Metabolic Syndrome)
Normal Normal Low Low Hypoglycemia Due to Exogenous Insulin (e.g., Insulin Overdose)
Normal Low Low Low Non-Diabetic Hypoglycemia (e.g., Adrenal Insufficiency, Fasting Hypoglycemia)
Normal Low High High Insulinoma (Insulin-Secreting Tumor)

Interpretation of diabetes and metabolic tests should always be done in the context of the patient's clinical presentation, medical history, and additional diagnostic findings

Most Common Questions About the Hemoglobin A1c test:

Test Purpose and Basics

What does the Hemoglobin A1c test measure?

The Hemoglobin A1c (HbA1c) test measures the average blood glucose level over the past 2 to 3 months. This is accomplished by assessing the percentage of hemoglobin, a protein in red blood cells, that is coated with sugar (glycated).

Why is the Hemoglobin A1c test important for managing diabetes?

The HbA1c test is a vital tool for managing diabetes because it gives an overview of blood sugar levels over an extended period, helping to reveal how well a patient's diabetes management plan is working.

Test Results Interpretation

What is a normal result for the Hemoglobin A1c test?

For someone who doesn't have diabetes, a normal HbA1c result is below 5.7%. Prediabetes is diagnosed when the HbA1c level is between 5.7% and 6.4%, and diabetes is diagnosed when the HbA1c level is 6.5% or higher.

How does the Hemoglobin A1c test result relate to average blood sugar levels?

The HbA1c test result can be translated into an estimated average glucose (eAG) level, which is a number that directly corresponds to daily blood glucose readings. For example, an HbA1c level of 7% roughly corresponds to an eAG of 154 mg/dL.

Can certain conditions or factors affect Hemoglobin A1c levels?

Yes, conditions like anemia or kidney disease can affect HbA1c levels. Pregnancy and recent blood loss or transfusion can also influence the results.

Clinical Relevance

How often should the Hemoglobin A1c test be done in people with diabetes?

The American Diabetes Association recommends that people with diabetes have an HbA1c test at least twice a year. However, those who have changed their treatment plan or aren't meeting glycemic goals might need to be tested quarterly.

Can the Hemoglobin A1c test be used to diagnose type 1 and type 2 diabetes?

Yes, the HbA1c test can be used to diagnose both type 1 and type 2 diabetes as well as prediabetes. However, in some cases, additional tests might be necessary for a definitive diagnosis.

Can the Hemoglobin A1c test help to identify individuals at risk of developing diabetes?

Yes, elevated HbA1c levels can identify individuals with prediabetes, which is a condition that can lead to type 2 diabetes if not addressed.

Additional Questions

Can the Hemoglobin A1c test be used in pregnant women?

The HbA1c test can be used during pregnancy, but it's not typically used alone to diagnose gestational diabetes due to hormonal changes that can affect the results.

Why is the Hemoglobin A1c test not used to monitor day-to-day blood sugar levels?

The HbA1c test provides an average blood sugar level over several weeks, so it doesn't capture the day-to-day fluctuations or the effects of mealtime changes on blood sugar levels.

Can the Hemoglobin A1c test be used in people with sickle cell disease?

In people with sickle cell disease or other types of hemoglobinopathies, the HbA1c test may not be reliable.

Can the Hemoglobin A1c test be used in people with sickle cell disease?

In people with sickle cell disease or other types of hemoglobinopathies, the HbA1c test may not be reliable. Other tests, like the fructosamine test, might be used instead.

What are the implications of having a Hemoglobin A1c level above 9%?

An HbA1c level above 9% is considered poor control of diabetes, significantly increasing the risk of complications such as heart disease, kidney damage, nerve problems, and eye damage.

Can the Hemoglobin A1c test be used to assess the risk of heart disease?

Studies have shown a correlation between high HbA1c levels and an increased risk of heart disease in individuals with and without diabetes, suggesting it can serve as a risk indicator.

Does the Hemoglobin A1c test replace the need for daily blood glucose monitoring?

No, the HbA1c test doesn't replace daily blood glucose testing. The latter provides real-time blood sugar levels, enabling prompt adjustments to food, activity, or medication.

How can I lower my Hemoglobin A1c level?

HbA1c levels can be lowered by improving blood sugar control, which can involve diet modifications, increased physical activity, regular blood glucose monitoring, and appropriate use of medication.

Does stress affect the Hemoglobin A1c test result?

Chronic stress can elevate blood glucose levels and consequently increase HbA1c levels, but the test itself does not measure stress.

Can iron-deficiency anemia affect Hemoglobin A1c levels?

Yes, iron-deficiency anemia can falsely elevate or reduce HbA1c levels, potentially leading to over- or underestimation of average blood glucose control.

Is the Hemoglobin A1c test used in children?

Yes, the HbA1c test is used in children for both the diagnosis and management of type 1 and type 2 diabetes.

Why might someone without diabetes need a Hemoglobin A1c test?

The HbA1c test can be used to screen for prediabetes, which doesn't typically have noticeable symptoms but increases the risk of developing type 2 diabetes.

What could cause a discrepancy between daily blood glucose readings and Hemoglobin A1c results?

This can occur due to variations in red blood cell turnover. For instance, conditions that result in rapid red blood cell turnover (like hemolytic anemia or recent blood loss) may falsely lower HbA1c levels.

Does the Hemoglobin A1c test provide information on hypoglycemic episodes?

No, the HbA1c test does not provide information on hypoglycemic (low blood sugar) episodes as it measures average blood glucose over a period of weeks.

What is the role of the Hemoglobin A1c test in managing gestational diabetes?

While HbA1c isn't typically used to diagnose gestational diabetes, it can be helpful in managing pre-existing diabetes in pregnant women.

Can my Hemoglobin A1c level change if my diet or physical activity changes?

Yes, diet and physical activity can significantly impact blood sugar control, and hence HbA1c levels. A healthier diet and increased physical activity can lower HbA1c levels.

Can certain supplements or medications affect the Hemoglobin A1c test results?

Yes, certain medications like antiretrovirals, aspirin, and vitamins C and E can affect HbA1c results. Always inform your healthcare provider of any supplements or medications you're taking.

Is there a significant difference between the Hemoglobin A1c test and the Glycated Albumin test?

Both tests measure the amount of sugar attached to a specific protein in the blood to estimate blood sugar control over a period. However, while HbA1c reflects average blood glucose over 2-3 months, glycated albumin reflects control over a shorter period (about 2-3 weeks). They can be used together to provide a more comprehensive picture of blood sugar control.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

Diabetes Key Test Patterns Table Sources

  1. American Diabetes Association (ADA). (2021). Standards of medical care in diabetes—2021. Diabetes Care, 44(Supplement 1), S1–S232. https://doi.org/10.2337/dc21-Sint

  2. Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., ... & Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: A patient-centered approach. Diabetes Care, 38(1), 140–149. https://doi.org/10.2337/dc14-2441

  3. American Association of Clinical Endocrinologists (AACE). (2020). Comprehensive type 2 diabetes management algorithm. Endocrine Practice, 26(1), 107–139. https://doi.org/10.4158/CS-2020-0472

  4. Cryer, P. E., Axelrod, L., Grossman, A. B., Heller, S. R., Montori, V. M., Seaquist, E. R., & Service, F. J. (2009). Evaluation and management of adult hypoglycemic disorders: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism, 94(3), 709–728. https://doi.org/10.1210/jc.2008-1410

  5. U.S. National Library of Medicine. (2021). Hemoglobin A1c (HbA1c) test. MedlinePlus. Retrieved from https://medlineplus.gov/lab-tests/hemoglobin-a1c-hba1c-test/

  6. Nathan, D. M., & DCCT/EDIC Research Group. (2014). The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: Overview. Diabetes Care, 37(1), 9–16. https://doi.org/10.2337/dc13-2112

  7. DeFronzo, R. A., Ferrannini, E., Groop, L., Henry, R. R., Herman, W. H., Holst, J. J., ... & Alberti, K. G. (2015). Type 2 diabetes mellitus. Nature Reviews Disease Primers, 1, 15019. https://doi.org/10.1038/nrdp.2015.19

  8. Service, F. J. (1995). Hypoglycemic disorders. New England Journal of Medicine, 332(17), 1144–1152. https://doi.org/10.1056/NEJM199504273321707

  9. Cryer, P. E. (2007). Hypoglycemia, functional brain failure, and brain death. Journal of Clinical Investigation, 117(4), 868–870. https://doi.org/10.1172/JCI31669

  10. American Association of Clinical Endocrinologists (AACE). (2016). Hypoglycemia clinical practice guidelines. Endocrine Practice, 22(5), 622–626. https://doi.org/10.4158/EP161365.GL

Keywords: Glycosylated Hemoglobin Test, Glycohemoglobin Test 

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