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Live a better life with Diabetes – know the role of HbA1c

Do you think that living with Diabetes is making your life cumbersome? You can live a better life with Diabetes through combined effort between you and your physician. You are required to know the skills and resources needed to manage your condition. We will review the role of HbA1c in management of Diabetes.

What is HbA1c and eAG?

 

HbA1c is measured as a percentage and provides an overview of your average blood glucose control for the past few months. Hemoglobin, the protein found in your red blood cells, carries oxygen from the lungs to all the cells of the body. It also links up with sugars such as glucose (glycation) as they enter your red blood cells. The more glucose in your blood, the more hemoglobin gets glycated. As your red blood cells die and get replenished every three months, HbA1c gives the measure of your blood sugar over that time.

 

eAG or average glucose is a calculated value based on HbA1c result. eAG may help you understand your HbA1c value because eAG uses same units (mg/dl) similar to what you see regularly through self-monitoring on your meter. The purpose of reporting eAG is to help you relate HbA1c results to glucose monitoring levels over a span of two to three months.

In what ways can HbA1c testing used?

HbA1c testing provides you information regarding how well your Diabetes is controlled. It is used to :

  • find your risk of developing Diabetes
  • to help diagnose Diabetes
  • to monitor a person's Diabetes
  • to aid in treatment decisions

Let’s review the utility of HbA1c testing here:

 Screening and diagnosis

The HbA1c test is used to find your risk for developing and diagnosing Diabetes. As per American Diabetes Association (ADA) guidelines, a nondiabetic person will have an HbA1c result less than 5.7%, a person with an increased risk of developing Diabetes in the future has HbA1c of 5.7% to 6.4% and that with Diabetes have HbA1c level equal to or greater than 6.5%.

 Your doctor may order this test if you have risk factors or signs or symptoms of Diabetes. Your risk factors include:

  • Obesity
  • Physical inactivity
  • First-degree relative, for instance, a sibling or a parent with Diabetes
  • High-risk race/ethnicity, for instance, African American, Latino, Native American, Asian American, Pacific Islander)
  • History of cardiovascular diseases including high blood pressure
  • Abnormal lipid profile involving low HDL cholesterol and/or high triglycerides
  • Women with polycystic ovary syndrome
  • Other clinical conditions associated with insulin resistance

 Signs or symptoms of Diabetes include:

  • Increased urination
  • Increased appetite
  • Fatigue
  • Blurred vision
  • Slow-healing infections

The ADA recommends to begin HbA1c testing at age 45 for overweight or obese people or those who have one or more Diabetes risk factor; if the result is normal, the testing should be repeated at a minimum of three-year intervals. More frequent testing must be considered according to initial results and risk status.

Monitoring

The HbA1c test is also used to monitor your glucose control of Diabetes over time. The aim of this test is to keep your blood glucose levels as close to normal as attainable. The complications caused by chronically elevated glucose levels, such as progressive damage to body organs like the kidneys, eyes, cardiovascular system and nerves are reduced by this. As the HbA1c test result gives a picture of the average amount of glucose in the blood over the last 2-3 months, it can assist you and your physician know if the measures that are being taken to control your Diabetes are successful or need to be adjusted.

The HbA1c test may be measured 2 to 4 times each year which largely depends on your type of Diabetes, how well its controlled and on your physician’s recommendations. The ADA recommends HbA1c testing for diabetics at least twice a year if they are meeting treatment goals and under stable glycemic control. When someone is first diagnosed with Diabetes or if control is not good, HbA1c may be ordered quarterly.

Making treatment decisions

 HbA1c testing helps your physician to select and decide the best treatment options for you. The decision of which agent to use should depend on the level of HbA1c and its degree of lowering.

The most recent recommendations from the ADA recognize that lifestyle changes alone are not always effective for long-term control of blood glucose due to failure to lose weight, the high rate of weight regain and progression of the disease. According to the new guidelines, a HbA1c of 7% or higher should be an indicator to initiate or change therapy with the goal of decreasing the HbA1c to less than 7%. Consequently, it is recommended that an initial anti-diabetic medication be started at the time of diagnosis along with lifestyle modification. If glucose control is not achieved with lifestyle modification and the maximal dose of initial agent tolerated by the patient within two to three months, a second medication should be added. In patients with an HbA1c of greater than 8.5% or those who are symptomatic, insulin should be considered.

Thus, initially HbA1c and eAG testing facilitates you to make choices in your lifestyle in terms of physical activity and nutrition management. The positive outcome of the testing rests in your own motivation to make changes in your lifestyle to live a better life. However, if your Diabetes is not well controlled by lifestyle changes, HbA1c testing assists your physician in deciding treatment options for you. In nut shell, HbA1C helps you to live a better life with Diabetes.