HbA1c results from patients with HbSS, HbCC, and HbSC must be interpreted with caution given the pathological processes, including anemia, increased red cell turnover, and transfusion requirements, that adversely impact HbA1c as a marker of long-term glycemic control.

Alternative forms of testing such as glycated serum protein or glycated albumin should be considered for these patients.

Iron deficiency anemia, a major public health problem in developing countries, is associated with higher HbA1c and higher fructosamine [3]. Consistent with these observations, iron replacement therapy lowers both HbA1c and fructosamine concentrations in diabetic and non-diabetic individuals [].

HbA1c , but not glycated albumin, is increased in late pregnancy in nondiabetic individuals owing to iron deficiency [6]. Insight into the mechanism was recently obtained by the observation that malondialdehyde, which is increased in patients with iron deficiency anemia [3], enhances the glycation of hemoglobin [7].

Alternative measures of glycemic assessment e. Chronic renal failure develops in many diabetic patients. The role of glycemic control and the value of HbA1c in diabetic subjects with renal disease are controversial. While interference from carbamylated Hb can be evaluated, the role of renal anemia, erythropoietin intake, and other factors in chronic renal failure is more difficult to evaluate.

Recent reports suggest HbA1c underestimates glycemic control in diabetic patients on dialysis and that glycated albumin is a more robust indicator of glycemic control [].

Further studies are needed to clarify the role of HbA1c in diabetic patients with chronic renal failure. Table 1: Effects of frequently encountered Hb variants and derivatives on HbA1c measurement.

Beckman HbA1c Advanced B Online Application on DxC AU. Beckman HbA1c Advanced B Manual Application on DxC AU. In the absence of specific method data, it can generally be assumed that immunoassay methods do not have clinically significant interference from HbE and HbD because the E and D substitution are distant from the N-terminus of the hemoglobin beta chain When HbE trait is detected there is no significant interference.

In cases where the presence of HbE trait is not detected, HbA1c results are artificially lowered. The indicator in bold is the opinion of the NGSP based on review of the literature cited.

A comprehensive approach that includes rapid diagnostic testing is necessary to get your diabetes patients under control. Many studies have looked at the potential benefits of implementing point-of-care testing in clinical practice, and show that the processes involved in patient management can be simplified, more time efficient and increase staff satisfaction Meeting treatment goals requires understanding and action.

With point-of-care test results in-hand, you can have informed discussions with your patients and engage them in their own care. Studies show that having test results during the consultation increases both patients motivation and understanding 13, Point-of-care testing has other benefits for patients as well, including:.

Lenters-Westra E, English E. Investigating the Quality of POCT Devices for HbA1c: What Are Our Next Steps? J Diabetes Sci Technol. Sobolesky PM, Smith BE, Saenger AK et al.

Multicenter assessment of a hemoglobin A1c point-of-care device for diagnosis of diabetes mellitus. Clin Biochem. Nathan DM, Griffin A, Perez FM et al. Accuracy of a Point-of-Care Hemoglobin A1c Assay. Arnold WD, Kupfer K, Swensen MH et al.

Fingerstick Precision and Total Error of a Point-of-Care HbA1c Test. Stavelin A, Flesche K, Tollaanes M, Christensen NG, Sandberg S. Performance of Afinion HbA1c measurements in general practice as judged by external quality assurance data. Clin Chem Lab Med.

Arnold WD, Kupfer K, Little RR et al. Accuracy and Precision of a Point-of-Care HbA1c Test. Sølvik UØ, Røraas T, Christensen NG, Sandberg S. Diagnosing Diabetes Mellitus: Performance of Hemoglobin A1c Point-of-Care Instruments in General Practice Offices.

Clin Chem. Delatour V, Clouet-Foraison N, Jaisson S, Kaiser P, Gillery P. Trueness assessment of HbA1c routine assays: processed EQA materials up to the job?

The EurA1c Trial Group. EurA1c: The European HbA1c Trial to Investigate the Performance of HbA1c Assays in Laboratories across 17 Countries and 24 Manufacturers by Use of the IFCC Model for Quality Targets. Evaluation of Four HbA1c Point-of-Care Devices Using International Quality Targets: Are They Fit for the Purpose?

Press Release: Abbott launches first-ever rapid point-of-care HbA1c test to aid in the diagnosis of diabetes.

Abbott Park, Ill. Accessed May 15, Lewandrowski EL, Yeh S, Baron J, Crocker B, Lewandrowski K. Implementation of point-of-care testing in a general internal medicine practice: A confirmation study. Clin Chim Acta.

Patzer K, Ardjomand P, Göhring K et al. Implementation of HbA1c Point of Care Testing in 3 German Medical Practices: Impact on Workflow and Physician, Staff, and Patient Satisfaction.

Laurence CO, Gialamas A, Bubner T et al. Patient satisfaction with point-of-care testing in general practice. Br J Gen Pract. Tollånes M, Jenum AK, Berg TJ, Løvaas KF, Cooper JG, Sandberg S. Miller CD, Barnes CS, Phillips LS, et al. Rapid A1c Availability Improves Clinical Decision-Making in an Urban Primary Care Clinic.

Diabetes Care. Rust G, Gailor M, Daniels E. Point of care testing to improve glycemic control. Int J Health Care Qual Assur. Egbunike V, Gerard S. The Impact of Point-of-Care A1C Testing on Provider Compliance and A1C Levels in a Primary Setting.

Diabetes Educator. Moffet HH, Parker MM, Sarkar U, et al. Adherence to laboratory Test Requests by Patients With Diabetes: the Diabetes Study of Northern California DISTANCE.

Am J Manag Care. El-Osta A, Woringer M, Pizzo E et al. Does use of point-of-care testing improve cost-effectiveness of the NHS Health Check programme in the primary care setting? A cost minimization analysis BMJ Open. Torres E, Vasquez-Parraga AZ, Barra C. The Path of Patient Loyalty and the Role of Doctor Reputation.

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Abstract Glycated hemoglobin HbA1c is an invaluable tool in diabetes mellitus DM management. Published by Oxford University Press on behalf of the Endocrine Society. For commercial re-use, please contact journals. permissions oup. Issue Section:. Download all slides. Views They could be caused by individual differences in red blood cell age.

The researchers point out possible problems beyond diabetes misdiagnosis that can arise from mismatches between the two tests. When HbA1c levels are high relative to actual glucose levels in patients with diabetes, doctors may inappropriately intensify diabetes treatment, which could lead to dangerously low glucose levels.

Conversely, when HbA1c levels are lower than expected, patients may not receive adequate treatment intensification. The study was supported by the Veterans Health Administration, Emory University, and the National Institutes of Health.

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Photo by Lisa Pessin Study suggests a more accurate approach to diabetes diagnosis February 12, By Tristan Horrom VA Research Communications "HbA1c mismatches are not widely appreciated, but we found that they are not uncommon, and can have important clinical implications.

Email the Web Team Any health information on this website is strictly for informational purposes and is not intended as medical advice.

It should not be used to diagnose or treat any condition. More VA resources VA forms VA health care access and quality Accredited claims representatives VA mobile apps State Veterans Affairs offices Doing business with VA Careers at VA VA outreach materials Your VA welcome kit.

Get VA updates VA news Press releases Email updates Facebook Instagram Twitter Flickr YouTube All VA social media. In other words, it states the ratio of glycated hemoglobin in the blood to the total amount of hemoglobin present, which is then expressed as a percentage.

A higher percentage connotes the blood sugar level is higher than usual, while a lower rate is vice versa. However, this test is no substitute for standard blood glucose tests, which you can do as often as possible using a glucometer.

The HbA1c test is designed for long-term control to help your doctor monitor your progress and, if need be, adjust your management plans. The HbA1c test is recommended by the Center for Disease Control CDC to test for prediabetes and diabetes if you are more than 45 years of age.

In cases when the results are normal, you can repeat the test every three years, but if there are traces of prediabetes, every 1 or 2 years. Also, this test is not only limited to individuals older than As a younger adult, you should take this test if:.

Several risk factors or conditions affect the result of the HbA1c test when taken. A few of them are discussed below:. Have you ever heard of gestational diabetes?

It is merely a type of diabetes that happens during pregnancy and raises the possibility of the mother later having the disease. Hormonal changes during pregnancy alter insulin production, which leads to elevated blood sugar levels. This usually occurs during the second or third trimester, but after delivery, it goes away.

On the other hand, in other women, pregnancy results in a low blood sugar level, especially in the second trimester. So if the HbA1c test is taken on a pregnant woman, there is no telling if the results are accurate as pregnancy hormones could have altered the sugar level.

If you recently lost a lot of blood or even some of it, it can also affect the result of the Hb1Ac test taken in that period. When one loses blood, the number of red blood cells in circulation is significantly reduced, and remember that hemoglobin is present in these cells.

So if the concentration of this protein in the blood has decreased, there will be few left for sugar to bind to, which means that the blood sugar level in that period will appear reduced. This means false lower HbA1c levels.

If you recently lost blood, you should take more time for your body to produce new red blood cells before you take the test. When blood gets transfused into the body, the new blood replenishes the red blood cells that have been lost.

So, the recipient will likely have red blood cells with different lifespans and glucose levels. Imagine testing a blood sample with varying cells containing different HbA1c levels; you might not get an accurate result from such a test. A condition known as anemia results in a reduction in the number of hemoglobin or red blood cells in the blood.

So when the amount of hemoglobin present for glycation is reduced, it lowers the HbA1c result even when the blood glucose levels over the past few months have been elevated. There are different types of anemia based on their causes, and they include:.

Iron is an essential component of hemoglobin, so if it is deficient in the body, it leads to iron-deficiency anemia. If there is an iron overload in the body, too, it could lead to a higher red blood cell count, which elevates the HbA1c test result even when the blood glucose levels are within the normal range.

All this means the amount of iron in the body, the presence or absence of a medical condition like anemia, and the HbA1c level in the body are interlinked. So these must be checked before the test to ensure an accurate result.

There are different variants of hemoglobin. The variant you would have is usually inherited from a gene or trait in your biological parents. HbA is the most common form of hemoglobin. However, there are HbC, HbD, HbE, and HbS, which are present in people from different regions across the globe.

carbamylated Hb in patients with renal failure can affect the accuracy of HbA1c measurements. The effects vary depending on the specific Hb variant or derivative and the specific HbA1c method. Table 1 contains information for most of the commonly used current HbA1c methods for the four most common Hb variants, elevated HbF and carbamylated Hb.

The criteria for interference varies depending on the data source. Interferences from less common Hb variants and derivatives are discussed in Bry, et al [1] and Little, et al [69]. All entries in Table 1 are based on published information.

When selecting an assay method, laboratories should take into consideration characteristics of the patient population served, e. high prevalence of hemoglobinopathies or renal failure. Factors that affect interpretation of HbA1c Results: Any condition that shortens erythrocyte survival or decreases mean erythrocyte age e.

HbA1c results from patients with HbSS, HbCC, and HbSC must be interpreted with caution given the pathological processes, including anemia, increased red cell turnover, and transfusion requirements, that adversely impact HbA1c as a marker of long-term glycemic control.

Alternative forms of testing such as glycated serum protein or glycated albumin should be considered for these patients. Iron deficiency anemia, a major public health problem in developing countries, is associated with higher HbA1c and higher fructosamine [3].

Consistent with these observations, iron replacement therapy lowers both HbA1c and fructosamine concentrations in diabetic and non-diabetic individuals []. HbA1c , but not glycated albumin, is increased in late pregnancy in nondiabetic individuals owing to iron deficiency [6].

Insight into the mechanism was recently obtained by the observation that malondialdehyde, which is increased in patients with iron deficiency anemia [3], enhances the glycation of hemoglobin [7]. Alternative measures of glycemic assessment e. Chronic renal failure develops in many diabetic patients.

The role of glycemic control and the value of HbA1c in diabetic subjects with renal disease are controversial. While interference from carbamylated Hb can be evaluated, the role of renal anemia, erythropoietin intake, and other factors in chronic renal failure is more difficult to evaluate.

Hemoglobin A1C HbA1c Test. What is a hemoglobin A1C HbA1C test? An A1C test can show your average glucose level for the past three months because: Glucose sticks to hemoglobin for as long as the red blood cells are alive.

Red blood cells live about three months. Other names: HbA1C, A1C, glycohemoglobin, glycated hemoglobin, glycosylated hemoglobin. What is it used for? An A1C test may be used to screen fo r or diagnose: Type 2 diabetes.

With type 2 diabetes your blood glucose gets too high because your body doesn't make enough insulin to move blood sugar from your bloodstream into your cells, or because your cells stop responding to insulin.

Prediabetes means that your blood glucose levels are higher than normal, but not high enough to diagnosed as diabetes. Lifestyle changes, such as healthy eating and exercise , may help delay or prevent prediabetes from becoming type 2 diabetes.

Why do I need an HbA1C test? The Centers for Disease Control CDC recommends A1C testing for diabetes and prediabetes if: You are over age If your results are normal, you should repeat the test every 3 years.

If your results show you have prediabetes, you will usually need to be tested every 1 to 2 years. Ask your provider how often to get tested and what you can do to reduce your risk of developing diabetes. If your results show you have diabetes, you should get an A1C test at least twice a year to monitor your condition and treatment.

You are under 45 and are more likely to develop diabetes because you: Have prediabetes. Are overweight or have obesity. Have a parent or sibling with type 2 diabetes.

Have high blood pressure or high cholesterol levels. Have heart disease or have had a stroke. Are physically active less than 3 times a week. Have had gestational diabetes diabetes during pregnancy or given birth to a baby over 9 pounds. Are African American, Hispanic or Latino, American Indian, or an Alaska Native person.

Some Pacific Islander and Asian American people also have a higher risk of developing diabetes. Have polycystic ovarian syndrome PCOS. You may also need an A1C test if you have symptoms of diabetes, such as: Feeling very thirsty Urinating peeing a lot Losing weight without trying Feeling very hungry Blurred vision Numb or tingling hands or feet Fatigue Dry skin Sores that heal slowly Having more infections than usual.

What happens during an A1C test? Will I need to do anything to prepare for the test? You don't need any special preparations for an A1C test. Are there any risks to the test? What do the results mean? To diagnose diabetes or prediabetes, the percentages commonly used are: Normal: A1C below 5.

Is there anything else I need to know about an HbA1C test? References American Diabetes Association [Internet]. Arlington VA : American Diabetes Association; c— Understanding A1C: A1C does it all; [ cited May 17]; [about 5 screens]. Common Terms; [cited May 17]; [about 57 screens].

Atlanta: U. Department of Health and Human Services; All About Your A1C; [reviewed Aug 10; cited May 17]; [about 4 screens]. html Centers for Disease Control and Prevention [Internet].

Department of Health and Human Services; Diabetes Risk Factors; [reviewed Apr 5;cited May 17]; [about 3 screens]. html Mayo Clinic [Internet]. Mayo Foundation for Medical Education and Research; c— A1c test; [cited May 17]; [about 7 screens]. Diabetes Mellitus DM ; [modified Sep; cited May 17]; [about 13 screens].

Bethesda MD : U. Department of Health and Human Services; Blood Tests; [updated Mar 24; cited May 17]; [about 8 screens].