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 e ectiveness 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 o set 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 certi ed 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 de ciency, 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, re ects the average level of glucose to
which the cell has been exposed during its life-cycle.
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