HbA1c (Glycosylated Hemoglobin)
Understanding HbA1c (Glycosylated Hemoglobin)
What is HbA1c (Glycosylated Hemoglobin)?
The HbA1c (Glycosylated Hemoglobin) test measures the average blood sugar levels over 2 to 3 months. It is used to diagnose diabetes as well as to monitor those under treatment. It is often done as part of routine health checkups.
Diabetes is a chronic disease that affects the processing of blood sugar by the body, thereby increasing the levels of blood sugar. Some individuals might not ever experience signs and symptoms of this condition while the common signs and symptoms will include the following:
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Being thirsty often
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Urination in excess
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Blurring of vision
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Weakness
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Slow healing of wounds, etc.
Hemoglobin is a protein found in red blood cells that transport oxygen into various parts of the body. When glucose (sugar) molecules in the bloodstream attach to hemoglobin, a process called glycation takes place, which essentially forms glycosylated hemoglobin, or HbA1c.
An HbA1c (Glycosylated Hemoglobin) test gives an overall picture of your long-term blood sugar control and thus is a very important test for screening and diagnosis of prediabetes and diabetes, and once an individual is diagnosed, it helps in monitoring the control of the disease, so that they can undergo timely interventions to prevent or delay the onset of complications such as nerve damage, kidney disease, and vision problems.
The American Diabetes Association (ADA) recommends keeping HbA1c levels below 7% to prevent the development of complications. Different goals may be set for specific individuals depending on age, duration of diabetes, and any other medical conditions present.
No special preparations are required for this test. Eat and drink as per your normal routine. However, inform your doctor about all the current medications or any underlying health conditions to ensure accurate interpretation of your test results.
Test result ranges may vary across the laboratories depending on the methodology and laboratory guidelines. Do not self-medicate, and always consult your doctor to understand your test results correctly.
Lifestyle Tips to Manage Your HbA1c Levels:
🥤Hydration: Stay hydrated! Drinking enough water supports overall health and helps maintain stable blood sugar levels.
🍲Eat (Diet): Focus on a balanced diet rich in fiber, lean proteins, and healthy fats. Include whole grains, vegetables, nuts, and seeds to help manage blood sugar.
🧘Activity (Exercise): Regular physical activity like walking, cycling, or strength training can improve insulin sensitivity and glucose control.
😴Lifestyle (Sleep): Prioritize quality sleep—poor sleep can affect blood sugar levels and insulin response
👩⚕️Talk to Your Doctor (Consult): Regularly consult your doctor to understand your HbA1c results and adjust your diabetes management plan if needed
💊Habits (Supplements): Consider supplements like magnesium, chromium etc. (if advised by your doctor) to support healthy blood sugar levels.
Relation between HbA1c Test and different types of diabetes:
What is HbA1c (Glycosylated Hemoglobin) used for?
A. As General Screening (American Diabetes Association (ADA) Recommendations, 2025)
- All adults ≽ 35 years
- Under 35 with risk factors -
- Overweight/obesity
- Family history of diabetes
- High blood pressure (BP), cholesterol, and heart disease
- Sedentary lifestyle
- History of gestational diabetes or polycystic ovary syndrome (PCOS)
B. If You Have Symptoms
- Frequent thirst, urination, or extreme hunger
- Unexplained weight loss, fatigue, or blurred vision
- Slow-healing wounds or frequent infections
C. High-Risk Groups (Monitoring)
- Prediabetes (HbA1c 5.7% – 6.4%)- Test every 1-2 years
- Diabetes (HbA1c ≥ 6.5% on two tests)- Test every 3-6 months for management
What does HbA1c (Glycosylated Hemoglobin) measure?
An HbA1c (Glycosylated Hemoglobin) test precisely measures the percentage of sugar-coated or glycated hemoglobin in your blood. The test results represent the proportion of hemoglobin in your blood that has been glycated.
Hemoglobin, a vital protein found in red blood cells, is responsible for transporting oxygen throughout the body. Hemoglobin A is the most abundant form of hemoglobin, and when blood sugar levels increase, a higher proportion of hemoglobin A becomes glycated. As red blood cells have a lifespan of approximately 120 days, the sugar molecules remain attached to the hemoglobin for the duration of the cell's life. Consequently, the HbA1c test offers insight into your average blood sugar levels over the past 8 to 12 weeks.
Interpreting HbA1c (Glycosylated Hemoglobin) 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 levels 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 (Glycosylated Hemoglobin)
Frequently Asked Questions about HbA1c (Glycosylated Hemoglobin)
Q. What is the full form of HbA1c, and why is it important?
Q. How often should you take the HbA1c test?
Q. Does the HbA1c test need fasting?
Q. Can the HbA1c test be used for both Type 1 and Type 2 diabetes?
Q. Is there any risk associated with the Hb1Ac test?
Q. Can my HbA1c be normal/low despite high blood sugar levels?
Q. When can false results appear in the HbA1c test?
Q. When is the HbA1c test insufficient to determine elevated blood sugar levels?
Q. Can the average blood glucose value (ABG) values be same for two people?
Q. How is the HbA1c blood test different from a fasting blood sugar (FBS) test?
Q. What are the benefits of lowering your HbA1c level?
Q. What is the normal range for HbA1c levels?
Q. What are the symptoms of prediabetes, and how is the HbA1c test related to it?
Q. What are the HbA1c ranges for diagnosing diabetes and prediabetes?
Q. Can I lower my HbA1c levels naturally?
Q. What does an HbA1c level of 6.0% mean?
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References
- Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients. Biomark Insights. 2016 Jul 3;11:95-104. [Accessed 22 May 2023]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4933534/
- Your Diabetes Care Schedule [Internet}. CDC; 19 Apr. 2023 [Accessed 22 May 2023]. Available from: https://www.cdc.gov/diabetes/managing/care-schedule.html
- Unnikrishnan R, Anjana RM, Mohan V. Drugs affecting HbA1c levels. Indian J Endocrinol Metab. 2012 Jul;16(4):528-31. [Accessed 22 May 2023]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401751/
- Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2022 [Internet]. Diabetes UK. [Accessed 7 Apr. 2025]. Available from: https://diabetesjournals.org/care/article/45/Supplement_1/S17/138925/2-Classification-and-Diagnosis-of-Diabetes
- Standards of Care in Diabetes [Internet]. Diabetes UK. [Accessed 7 Apr. 2025]. Available from: https://professional.diabetes.org/standards-of-care
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