Medically Reviewed by Michael Dansinger, MD on November 06, 2020 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. It’s 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. Hemoglobin is a protein found in red blood cells. It gives blood its red color, and its job is to carry oxygen throughout your body. 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. If your glucose levels have been high over recent weeks, your hemoglobin A1c test will be higher. 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 prediabetes and a higher chance of getting diabetes. Levels of 6.5% or higher mean you have diabetes.
The target A1c level for people with diabetes is usually less than 7%. The higher the hemoglobin A1c, the higher your risk of having complications related to diabetes. Someone who has had untreated diabetes for a long time might have a level above 8%. If you have diabetes and your level is above your target, your doctor may change your treatment plan to get your level down. A combination of diet, exercise, and medication can bring your levels down. People with diabetes should have an A1c test every 3 months to make sure their blood sugar is in their target range. If your diabetes is under good control, you may be able to wait longer between the blood tests. But experts recommend checking at least two times a year. People with diseases affecting hemoglobin, such as anemia, may get misleading results with this test. Other things that can affect the results of the hemoglobin A1c include supplements such as vitamins C and E and high cholesterol levels. Kidney disease and liver disease may also affect the test. Your doctor probably will have you take the A1c test as soon as you’re diagnosed with diabetes. You’ll also have the test if your doctor thinks you may get diabetes. The test will set a baseline level so you can see how well you’re controlling your blood sugar. How often you’ll need the test after that depends on several things, like:
You’ll probably get tested once a year if you have prediabetes, which means you have a strong chance of developing diabetes. You may get tested twice each year if you have type 2 diabetes, you don't use insulin, and your blood sugar level is usually in your target range. You could get it three or four times each year if you have type 1 diabetes. You may also need the test more often if your diabetes plan changes or if you start a new medicine. It’s not a fasting test. You can take it any time of day, before or after eating. People with diseases affecting hemoglobin, such as anemia, may get misleading results with this test. Other things that can affect the results of the hemoglobin A1c include supplements, such as vitamins C and E, and high cholesterol levels. Kidney disease and liver disease may also affect the test.
It can identify prediabetes, which raises your risk for diabetes. It can be used to diagnose diabetes. And it's used to monitor how well your diabetes treatment is working over time. It's also a critical step in forming your game plan to manage diabetes with your diabetes care team. The big picture: monitoring treatmentThis relatively simple blood test can tell you a lot. The test results give you a picture of your average blood sugar level over the past two to three months. The higher the levels, the greater your risk of developing diabetes complications. Your doctor will tell you how often you need the A1C test, but usually you’ll have the test at least twice a year if you’re meeting your treatment goals. If you're not meeting your goals or you change treatments, you may need to get an A1C test more often.
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:
Finally: A1C is also defined as ‘estimated average glucose,’ or eAGAnother term you may come across when finding out your A1C is eAG. Your doctor might report your A1C results as eAG. eAG is similar to what you see when monitoring your blood sugar at home on your meter. However, because you are more likely to check your blood sugar in the morning and before meals, your meter readings will likely be lower than your eAG. More about A1C and eAG Learn how diabetes is diagnosed
If your blood sugar levels have remained stable and your A1C is within your target range, the American Diabetes Association (ADA) recommends getting the test two times a year. If your therapy has changed or you are not meeting your blood sugar targets, the ADA recommends getting the test four times per year. This simple blood draw can be done in your doctor’s office. The A1C test results provide insight into how your treatment plan is working and how it might be modified to better control the condition. Often, your blood sample is sent out to a lab, though some doctors can use a point-of-care A1C test, where a finger stick can be done in the office, with results available in about 10 minutes. While in-office tests can be used to monitor the disease, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) notes that most point-of-care tests should not be used for diagnosis. That can only be done by lab tests certified by the NGSP, an organization that standardizes A1C test results. Any in-office test results pointing to a change in your health should be confirmed by conventional lab tests. What Do Your A1C Results Mean?The A1C test measures the glucose (blood sugar) in your blood by assessing the amount of what’s called glycated hemoglobin. “Hemoglobin is a protein within red blood cells. As glucose enters the bloodstream, it binds to hemoglobin. The more glucose that enters the bloodstream, the higher the amount of glycated hemoglobin,” Dr. Dodell says. According to the ADA, an A1C level below 5.7 percent is considered normal; between 5.7 and 6.4 signals prediabetes; and over 6.5 percent indicates type 2 diabetes. For many people with type 2 diabetes, the goal is to reduce A1C levels. Your A1C goal is specific to you. Several factors come into play, such as your age, how advanced the diabetes is, and whether you have any other health conditions. If you can keep your A1C number below your goal — which, for many people with diabetes, is less than 7 percent, says Dodell — you can reduce the risk of complications, such as nerve damage and eye problems. What Are Some Top Tips for Lowering A1C?Your A1C score is a helpful tool, Dodell says, but it is not the only indicator of how healthy you are. For example, you could hit your A1C goal but still have wide fluctuations in your blood sugar levels, which is more common among people who take insulin. You’ll need to bring these day-to-day fluctuations under control, since they can lower your quality of life and increase your risk of complications, he says. Think of your diabetes as you would a job, Dodell says. It takes work, but the time and effort you put into it can result in good control and an improved quality of life. “The key to reaching your A1C goal is trying to follow a healthy lifestyle,” he says. Making these changes can help you improve your day-to-day blood sugar management and lower your A1C. 1. Start an Exercise Plan You Enjoy, and Do It RegularlyFind something you enjoy doing that gets your body moving, whether it’s taking your dog for a walk, playing a sport with a friend, or riding your bike. The ADA recommends getting 150 minutes of moderate exercise per week, says Jordana Turkel, a certified diabetes care and education specialist (CDCES) and registered dietitian at Park Avenue Endocrinology & Nutrition in New York City. Different types of exercise (both strength or resistance training and aerobic exercise) can lower your A1C by making your body more sensitive to insulin, Turkel says. She encourages her patients not to go more than two days in a row without exercising and to aim for two days of strength training per week. Be sure to check with your healthcare provider before embarking on an exercise plan, though. Together, you can come up with an individualized plan. And if you monitor your blood sugar daily, check it before and after exercise. As the ADA explains, exercise improves insulin sensitivity and lowers your blood sugar levels. In certain circumstances, though, stress hormones produced during more intense exercise can also increase blood sugar levels. In addition, other factors, such as what you eat before exercise and the timing of your workout, may also affect your numbers. 2. Eat a Balanced Diet With Proper Portion SizesIt’s best to check with a CDCES or registered dietitian/nutritionist to determine what a balanced diet and appropriate portion sizes mean for you. But a great rule of thumb is to fill half of your plate with veggies, a quarter with protein, and a quarter with whole grains, says Turkel. If you like fruit, limit your portion to a small cup, eaten with a little protein or lean fat to help you digest the carbohydrates in a way that is less likely to spike your blood sugar. Also, avoid processed foods as much as possible, and try to avoid 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. 3. Stick to a Regular Schedule, So You Can More Easily Follow a Healthy DietSkipping meals, letting too much time pass between meals, or eating too much or too often can cause your blood sugar levels to fall and rise too much, Cleveland Clinic points out. This is especially true if you are taking insulin or certain other diabetes drugs. Your doctor can help you determine the best meal schedule for your lifestyle. 4. Follow the Diabetes Treatment Plan Your Healthcare Team RecommendsDiabetes treatment is very individualized, noted a February 2022 article in Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. After all, factors including how long you’ve lived with the disease, your socioeconomic status, and any other conditions you’re living with can play a role in the best treatment approach for you. Your healthcare team will help you determine which steps to take to successfully manage diabetes. Always talk to your doctor before making any changes, such as starting a diet very low in carbohydrates or beginning a new exercise regimen. This is especially important before making any medication or insulin changes. 5. Check Your Blood Sugar Levels as Your Doctor Has DirectedWork with your doctor to determine if you should check your blood sugar — and how often. You may be tempted to pick up an A1C home testing kit, but Dodell says having your A1C checked by your doctor every three to six months is sufficient. A better idea is to use a continuous glucose monitor. He recommends checking your “time in range” to see if you are at the optimal level. For many people that is 70 to 180 milligrams per deciliter (3.9 to 10 millimoles per liter), according to ADA guidelines. Understanding your A1C levels is an important part of your overall diabetes management. If you have any questions about your A1C or what it means, don’t hesitate to ask your doctor. Additional reporting by Mikel Theobald |
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