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Dr. Betina Chandolia
BDS, MDS - Oral Pathology and Microbiology
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Dr. Ashish Ranjan
MBBS, MD (Pharmacology)
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Glycosylated Hemoglobin

(HbA1c)
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Overview


What is Glycosylated Hemoglobin?

A glycosylated Hemoglobin (HbA1c) is a lab test to measure how much sugar has been in your blood over the past 2-3 months. It is used to detect prediabetes, diagnose diabetes as a part of health checkups, and monitor treatment efficacy. HbA1c values are considered normal if <5.7%, while values ≥ 6.5% are indicative of diabetes.

The higher the HbA1c, the greater the risk of complications. People having diabetes should take this test regularly to monitor their glucose levels and regulate the treatment decision. A proper schedule of exercise, healthy eating, and medication can assist in bringing down the level.

Why is HbA1c done?

The Glycosylated Hemoglobin test is performed to:

  • Monitor Diabetes treatment efficacy by measuring glycosylated hemoglobin regularly

  • Screen for Diabetes as part of regular health checkup, as well as in patients with high risk of developing diabetes

  • Diagnose and confirm diabetes with a combination of other tests if blood sugar levels have been  high over a long period of time

 
 
 

        

What does HbA1c Measure?

Glycosylated Hemoglobin Test measures the percentage of glycosylated hemoglobin in blood which reflects the average blood glucose over a period of past two to three months (8 - 12 weeks).

Hemoglobin is the protein found in Red Blood Cells and is responsible for transporting oxygen. Of the different types of hemoglobin, Hemoglobin A is predominant. With the elevation of blood sugar levels, some glucose binds spontaneously to Hemoglobin A (this binding is called Glycosylation or Glycation) and remains bound for the complete lifetime of the RBC, which is 120 days normally. Higher the level of glucose in the blood, greater is the amount of it binding to Hemoglobin A. Hemoglobin A1c is the dominant form of Glycated Hemoglobin. As RBCs die and are replaced, Hemoglobin A1c is cleared and slowly replaced with non-glycosylated hemoglobin. Measurement of HbA1c level over a period of time gives an indication of the level of glucose in the blood over the specified period of time. This helps in the diagnosis of Diabetes and is useful for monitoring the effectiveness of measures taken to reduce blood sugar levels.

Interpreting HbA1c results


Interpretations

Normal: Below 5.7% (39 mmol/mol approx.)

Prediabetic: 5.7% - 6.4% (39 to 46 mmol/mol approx.)

Diabetic: Above 6.5% (above 48 mmol/mol approx.)

 

Less than 5.7% Glycated Hemoglobin indicates normal levels of blood sugar. Increased risk of developing Diabetes is found in Prediabetic patients with blood sugar level between 5.7% and 6.4%. Patients with a HbA1c level greater than 6.5% are usually diagnosed with Diabetes.

Answers to Patient Concerns & Frequently Asked Questions (FAQs) about HbA1c


Frequently Asked Questions about Glycosylated Hemoglobin

Q. Why is an HbA1c test performed?
An HbA1c test helps to measure a person's average blood sugar levels over the past 8 to 12 weeks. This test is essential for diagnosing and monitoring diabetes, assessing the effectiveness of diabetes treatment plans, and helping to prevent or manage potential complications.
Q. How often should I get the HbA1c test done?
The HbA1c test can be done as part of a routine health check-up. For individuals with diabetes, it's generally recommended to get this test done every 3 to 6 months, depending on your specific treatment plan and blood sugar control. If you have been recently diagnosed or have made significant changes to your treatment, your doctor may recommend more frequent testing.
Q. Can an HbA1c test be used for both Type 1 and Type 2 diabetes?
Yes, an HbA1c test is suitable for monitoring blood sugar control in individuals with both Type 1 and Type 2 diabetes. This test provides valuable information to the doctor, allowing them to assess the effectiveness of treatment plans and make necessary adjustments to optimize blood sugar control.
Q. What factors can affect the accuracy of an HbA1c test?
Certain factors such as anemia, recent blood transfusions, pregnancy, or specific genetic variants can potentially affect the accuracy of an HbA1c test. If you have any concerns about the reliability of your test results, consult the doctor, who may recommend additional testing or adjustments to your treatment plan.
Q. Is there any risk associated with the Hb1Ac test?
There is usually no risk associated with this test. However, some people may feel a slight sting while the needle is pricked and may experience some bleeding that is normal and usually not bothersome. Rarely some people may experience slight swelling or bruising at the site of the needle prick. Applying ice 3-4 times a day for about a week may help reduce swelling and bruising. If it does not get better, consult your doctor.
Q. Can my HbA1c be normal/low despite high blood sugar levels?
Yes, it is possible for someone's HbA1c level to be normal or low, despite having high blood sugar levels. This is because HBa1c is a measure of average blood sugar levels over a period of two to three months, rather than a measurement of current blood sugar levels.
Q. What are the symptoms of Hypoglycemia?
Symptoms of Hypoglycemia include: Excessive sweating, frequent hunger, shivering or trembling, confusion and blurring of vision
Q. What are the risk factors for Diabetes?
Diabetes can be caused by various reasons. The most common risk factors for diabetes include being obese or overweight with low physical activity, having a blood relative diagnosed with Diabetes, or having been diagnosed with hypertension. Other reasons which can cause diabetes could be low High-Density Lipoproteins or high triglyceride levels, being diagnosed with Polycystic Ovarian Syndrome, or having been diagnosed with gestational diabetes and cardiovascular diseases.
Q. When can false results appear in the HbA1c test?
False results can appear in patients of hemolysis, anemia, and Iron deficiency. False results may also appear in patients who have undergone blood transfusion recently.
Q. When is the HbA1c test insufficient to determine elevated blood sugar levels?
The HbA1c test cannot determine acute changes in blood glucose levels that trigger a glucose shock. It also cannot determine any recent change in blood glucose level. The test is also insufficient to determine elevated blood sugar levels in people with variant hemoglobin like Hemoglobin S or Sickle Cell Hemoglobin since they have lower amount of Hemoglobin A in their blood.
Q. What are the common complications of diabetes?
Diabetes causes an increase in blood sugar levels. Increased sugar levels, if not controlled, can cause severe damage to the muscles and nerves. This may give rise to a number of complications over a period of time. Some common complications of uncontrolled diabetes include heart diseases like coronary artery disease, heart attack, diabetic retinopathy (damage to the retina) which may cause blindness, diabetic neuropathy (damage to the nerves) at various parts of the body. It may also cause diabetic nephropathy (damage to the kidneys) resulting in chronic loss of kidney function and diabetic foot which can cause foot ulcers that may turn gangrenous. Apart from these, uncontrolled diabetes may also lead to other severe conditions like hearing impairment, a number of skin conditions, and may even lead to death.
Q. What other tests can be prescribed by your doctor in case of abnormal result?
Additional tests that may be prescribed to diagnose diabetes in case of abnormal results are: Urine Glucose Test, Blood Glucose - Post prandial (PP), Random Blood Glucose Test, Fasting Blood Glucose Test and Oral Glucose Tolerance Test.
Q. Can the ABG values be same for two people?
HbA1c measurement gives an average of blood sugar value for past 3 months. The average blood glucose value (ABG) is a calculated parameter from the reported HbA1c value. If HbA1c is same for two people then ABG will automatically be the same.
Q. How is the HbA1c test different from blood glucose test?
The blood glucose tests are performed to directly measure the concentration of glucose in your blood at the time of testing (single point in time). The HbA1c test indicates the trend of your blood glucose levels over a period of time (8-12 weeks), similar to an average, by measuring the percentage of glycated hemoglobin persisting in blood.
Q. What are the benefits of lowering your HbA1c level?
Lowered HbA1c level is an indication of sustained lowered or reduced blood glucose levels over a period of time. Long term reduced blood glucose levels in diabetic patients successfully prevents future complications of diabetes, including kidney complications, nerve damage, damage to the retina, cardiovascular diseases, and diabetic foot among others. Research has shown that a reduction of just about 1% in HbA1c level reduces the risk of death due to cardiovascular diseases by 45%.
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