HBA1c

HBA1c is a form of hemoglobin that is chemically linked to a sugar. The formation of the sugar-
hemoglobin linkage indicates the presence of excessive sugar in the bloodstream, often indicative
of diabetes. A1C is of particular interest because it is easy to detect. A1c is measured primarily to
determine the three-month average blood sugar level and can be used as a diagnostic test for diabetes
mellitus and as an assessment test for glycemic control in people with diabetes.[4] Measuring glycated
hemoglobin assesses the effectiveness of therapy by monitoring long-term serum glucose regulation.
HbA1c analysis is used for monitoring, screening for and diagnosing diabetes and prediabetes.

AIC has several advantages compared with FPG and OGTT, including greater convenience (fasting is not
required), greater preanalytical stability, and less day-to-day perturbations during stress, diet, or illness.
However, thee advantages may be offset by the lower sensitivity of of AIC at the designated cut point,
greater cost, limited availability of A1C testing in certain regions of the developing world, and the
imperfect correlations between AI1 and average glucose in certain individuals. In addition, factors such as
age, race/ethnicity, pregnancy status, genetic background, and anemia or hemoglobinopathies should be
considered when using HBA1c as these impact hemoglobin glycation independently of glycemia.

Recommendations
2.1 To avoid misdiagnosis or missed diagnosis, the A1C test should be performed using a method that is
certified by the NGSP and standardized to the Diabetes Control and Complications Trial (DCCT) assay.
B
2.2 Marked discordance between measured A1C and plasma glucose levels should raise the possibility of
A1C assay interference due to hemoglobin variants (i.e., hemoglobinopathies) and con- sideration of
using an assay with- out interference or plasma blood
glucose criteria to diagnose di-abetes. B
2.3 In conditions associated with an altered relationship between A1C and glycemia, such as sickle cell
disease, pregnancy (second and third trimesters and the postpar- tum period), glucose-6-phosphate
dehydrogenase deficiency, HIV, hemodialysis, recent blood loss or transfusion, or erythropoietin therapy,
only plasma blood glucose criteria should be used to diagnose diabetes

The test is limited to a three-month average because the average lifespan of a red blood cell is four
months. Once a hemoglobin molecule is glycated, it remains that way. A buildup of glycated hemoglobin
within the red cell, therefore, reflects the average level of glucose to which the cell has been exposed
during its life-cycle.