What is HbA1c and How does it relate to Diabetes?

The diagnosis of diabetes is usually straightforward. Any one of the following tests may be diagnostic for the presence of diabetes:

- If one has a persistently elevated fasting blood sugar (> 126 mg/dl).
- If the non fasting blood sugar is > 200 mg/dL or greater in people with symptoms
- The individual has an abnormal oral glucose tolerance test, with a 2-hour glucose value of 200 mg/dL or greater.

Once the diagnosis of diabetes is made, all individuals undergo other tests to ensure that they have not developed any complications of diabetes. Your doctor may order a glycated Hemoglobin A1C test (HbA1c).

HbA1c is simply hemoglobin which has been attached to glucose molecules. Hemoglobin is found in red blood cells which have a life span of about 8-12 weeks. Normally if the blood glucose levels are normal or well controlled, the sugar does not bind to hemoglobin.

However, if the sugars have been poorly controlled and are high, they get attached to the hemoglobin and this is known as glycation of the hemoglobin molecule. So measuring HbA1c gives an idea how well the glucose levels have been over the long term. The higher the glucose levels, the greater will be the levels of HbA1c. Some patients come to see their physician and tell them that their blood sugars have been great and well controlled. Well, by measuring the HbA1c levels, the physician can immediately tell how well the glucose levels have been over the last 3-4 months.

The test is simple to perform and requires some blood. Results are usually available within an hour. The normal HbA1c ranges from 3.5-5.5%. In diabetes about 6.5%-7% is good.

Measuring HbA1c indicates your average blood sugar level over the past 2-3 months. Generally a target level of HbA1c less than 7% is preferred.

The current guidelines recommend routine screening for type 2 diabetes beginning at age 45, especially if you're overweight. If the results are normal, the test should be repeated every three years. If the results are borderline, the test should be repeated every year.

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