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Hemoglobin A1c, also called A1c or glycated hemoglobin, is hemoglobin with glucose attached. The A1c test evaluates the average amount of glucose in the blood over the last 2 to 3 months by measuring the percentage of glycated (glycosylated) hemoglobin.
Hemoglobin is an oxygen-transporting protein found inside red blood cells (RBCs). There are several types of normal hemoglobin, but the predominant form ? about 95-98% ? is hemoglobin A. As glucose circulates in the blood, some of it spontaneously binds to hemoglobin A.
The higher the level of glucose in the blood, the more glycated hemoglobin is formed. Once the glucose binds to the hemoglobin, it remains there for the life of the red blood cell ? normally about 120 days. The predominant form of glycated hemoglobin is referred to as A1c. A1c is produced on a daily basis and slowly cleared from the blood as older RBCs die and younger RBCs (with non-glycated hemoglobin) take their place.
This test may be used to screen for and diagnose diabetes or risk of developing diabetes. Standards of medical care in diabetes from the American Diabetes Association (ADA) state that diabetes may be diagnosed based on A1c criteria or plasma glucose criteria, either the fasting plasma glucose (FPG) or the 2-hour plasma glucose value after a 75-g oral glucose tolerance test (OGTT).
This test is also used to monitor treatment for someone who has been diagnosed with diabetes. It helps to evaluate how well the person's glucose levels have been controlled by treatment over time. For monitoring purposes, an A1c of less than 7% indicates good glucose control and a lower risk of diabetic complications for the majority of diabetics.
A1c; HbA1c; Glycohemoglobin; Glycated Hemoglobin; Glycosylated Hemoglobin; Hemoglobin A1c.
HbA1C is tested to help identify those at an increased risk of developing diabetes and to help diagnose diabetes; to monitor a person's diabetes and to aid in treatment decisions. As part of a health checkup or when you have risk factors for or symptoms of diabetes; after first diagnosis with diabetes, 4 times per year if glycemic goals are not met or when therapy plan has changed; at least 2 times a year if meeting treatment goals and under stable glycemic control.
Screening and diagnosis
HbA1c may be ordered as part of a health checkup or when someone is suspected of having diabetes because of classical signs or symptoms of increased blood glucose levels (hyperglycemia) such as:
The A1c test may also be considered in adults who are overweight with the following additional risk factors:
The American Diabetes Association (ADA) recommends to begin HbA1c testing at age 45 for overweight or obese people; if the result is normal, the testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results and risk status.
People who are not diagnosed with diabetes but are determined to be at increased risk for diabetes (prediabetes) should have HbA1c testing yearly.
Depending on the type of diabetes that a person has, how well that person's diabetes is controlled, and on the healthcare provider's recommendations, the A1c test may be measured 2 to 4 times each year. The ADA recommends A1c 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.