Starting Out - 101 Series

Glycated Haemoglobin or HbA1c Diabetes Range

Reviewed by

Shifa Fathima

HbA1c is one among the various tests done to measure blood glucose levels. In comparison with other tests done, HbA1c is unique and significant because it reflects the blood glucose levels averaged over the previous 2 to 3 months. The A1c test is the gold standard attestation of how well controlled your diabetes is. Let's delve deeper to figure out this enigma.

What is A1C, and how is it measured?

The A1C test is also known as glycated haemoglobin, glycosylated haemoglobin, or glycohemoglobin. Our blood has red blood cells, which contain haemoglobin (Hb), a protein pigment, which binds to oxygen and carries it throughout the body. HbA1C is a component of haemoglobin that binds with oxygen. Factually, haemoglobin is what gives a red colour to the blood. As the blood sugar levels rise, haemoglobin becomes more glycated. Well-controlled glucose levels lead to less sugar-coated haemoglobin.

A Fasting Blood Glucose (FBS) test is more likely to give false positives or false negatives as your glucose levels might vary depending on what you eat. On the other hand, an A1C test has been designed based on the chemical and size of the A1C molecule. Since Blood samples can be taken anytime, and fasting is not required, HbA1c always provides a clear and reliable representation of the sugar present inside your body as an average of the glycosylation or average plasma glucose concentration in the last 2 - 3 months.

What is considered a Normal Range for A1C?

The range of the A1C determines the control you have over your blood glucose levels. According to the Center for Disease Control and Prevention (CDC) and American Diabetes Association (ADA), the Normal Ranges across categories, for HbA1c Levels are as shown in the table below.

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A1c vs Blood Glucose Values

As an indicator of diabetes control, A1C measures Glycated Haemoglobin which is expressed as a percentage. This is not always easy to understand as it does not intuitively relate to the glucose measurements you see daily through home glucose monitoring for random, fasting and post-meal or lab values, and thus difficult to translate into action.

  1. By measuring your blood glucose levels regularly for 90 days and then calculating the average glucose levels for the 3-month duration.
  2. By using the Estimated Average Glucose (eAG) : Your estimated Average Glucose number is calculated from the result of your A1c test as recommended by ADA.  Like the A1c, the eAG shows what your average blood sugars have been over the previous 2 to 3 months. Instead of a percentage, the eAG is in the same units (mg/dl) as your blood glucose meter. eAG should not be the basis for treatment design but rather to get an idea of your body's sugar control.

            Reference : eAG/A1C Conversion Calculator by the ADA.

Who should get the A1C Test?

The AIC testing is routinely done along with Fasting Blood Sugar tests in individuals with both Type 1 and Type 2 diabetes.

Your doctor might recommend taking an A1C test every three months to assess the changes in blood glucose levels and can also compare the values to the previous tests to see the trend of the diabetes control. If the levels are within or close to the normal range, then the frequency of the test can be reduced to once in 6 months.

Persons aged more than 45 and with a family history of diabetes or with profound risk factors such as heart disease, high blood pressure, gestational diabetes, Polycystic Ovary Syndrome (PCOS) and abnormal lipid profile, etc. are also strongly recommended to undergo an A1C test to identify undiagnosed prediabetes or diabetes.

What are Various Tips to Lower A1C Levels?

Having learned the significance of A1C, you should try to follow all or most of the below-mentioned tips to manage your diabetes effectively and have well-controlled blood glucose levels, further preventing you from associated complications.

  1. Doctor Consultations : You should regularly book your specialist consultations to understand the need for any modifications in medication, insulin, or other dietary changes.
  2. Self-awareness and Routine : You should regularly monitor your blood glucose levels, take medicine as prescribed, and follow diet and exercise plans. Having awareness and motivation are the key to a healthy lifestyle.
  3. Dietary Control : You should maintain control on what you eat. Always look for food labels to analyze the number of calories and processed fats before munching on them. The aim should be to reduce the consumption of complex carbohydrates and increase antioxidants, nutrients, and fibre intake. Always try to split the snack in half and consume the half.
  4. Relieve Stress : Stress has been considered a critical cause to increase blood glucose levels. You should reduce the level of stress and live a more relaxed life. Listening to music, spending time with family, doing yoga or meditation, and distracting from routine, are considered a few effective stress busters.
  5. Get Active : Leading an active life is a boon even after retiring from work. While it keeps diseases at bay, it also helps to maintain the overall mental well-being. Involve yourself in one or the other activity at home, if nothing, go for a walk.
  6. Exercise Routine : Studies have shown better-controlled blood glucose levels in diabetics who exercise regularly. You should make exercise a part of your routine. If you do something for 21 days regularly, it becomes a habit. Now you know the mantra to exercise regularly.

Can HbA1c results be affected by Non-Diabetes Factors?

HbA1c tests can be affected by changes in RBCs or hemoglobin. The common factors that can affect the results are - 

  1. Blood loss 
  2. Sickle cell disease 
  3. Blood transfusions 
  4. Kidney failure
  5. Liver disease
  6. Early or Late Pregnancy
  7. Thalassemia
  8. Medications
  9. Iron deficiency anemia - A False High HbA1c result may be seen.

When you consult your doctor, be sure to reveal all medically relevant information. 

Bottom Line

To conclude, A1C levels give a measurement of how well managed your sugar levels are, and you should aim to keep the A1C value below 5.6%. If you are at risk, you should get tested as suggested by your doctor. Make healthy lifestyle habits a choice and not compulsion. Eating right, exercising regularly, getting active, and taking medication as prescribed can keep the A1C value in the normal range. It's the willingness to say "I will" that will help set things right. You are in charge of your body, and you understand what is best for you more than anyone else. So gear up and start adding healthy habits to your lifestyle to control your glucose levels better.

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