What is hemoglobin A1C and why is it so necessary?

According to the American Diabetes Association (ADA), 34.2 million Americans (over 10% of the population) had diabetes in 2018, and roughly 1.5 million Americans are diagnosed with diabetes annually (ADA, 2020). For patients with diabetes, controlling glucose levels is crucial to stopping long-term complications. Nurses must have understanding of different ways to measure blood glucose levels because we play an integral role in educating our patients about diabetes and the right way to monitor it. In this blog we are going to give attention to hemoglobin A1C, what it’s and why it’s important.
AND
Prick-stick blood glucose and continuous glucose monitoring are common methods that provide immediate results, enabling clinicians and patients with diabetes to make decisions regarding glucose control and insulin dose selection before meals and throughout the day (Selvin, 2020). This is a snapshot of a patient’s glucose level at a selected time limit. Glycated hemoglobin (A1C) is a clinical blood test that estimates average blood glucose levels over a two-to-three-month period. Although this test has been around for several a long time, in 2010 it was finally recognized by the ADA as a tool for diagnosing diabetes and prediabetes (Dugger and Clark, 2011) and has change into essentially the most widely used test for monitoring chronic glycemic control (Selvin, 2020). ). The American Association of Clinical Endocrinologists and the American College of Endocrinology recommend that HbA1c be used along side other criteria equivalent to fasting plasma glucose (FPG) and/or oral glucose tolerance test (OGTT) when diagnosing diabetes (Hill and Appel, 2010).

What exactly does A1C measure?

When we eat, glucose enters the bloodstream and because it accumulates, it binds to hemoglobin in red blood cells to form glycated (or glycosylated) hemoglobin. Red blood cells live for about three months, so the A1C value can reflect the common plasma glucose level during the last 90 days. It is a reliable, rapid test that doesn’t require the patient to fast and may help distinguish stress-induced hyperglycemia from the chronic or persistent hyperglycemia that happens in diabetes (Dugger and Clark, 2011). For people without diabetes, the traditional range for A1C levels is 4% to five%. An HbA1C level between 5.7% and 6.4% is taken into account prediabetes, which indicates that the patient is at high risk of developing diabetes in the long run. A level greater than 6.5% is taken into account diabetes. For diabetic patients, the standard goal is to maintain A1C levels below 7%, as consistently higher than 8% can result in long-term complications.
AND

AND

Conditions affecting HbA1C values ​​(Selvin, 2020)

Any condition that affects the life cycle of red blood cells will impact your A1C results. If red blood cell turnover is low, there could also be a disproportionate variety of older red blood cells, causing a falsely high A1C value. Anemia resulting from vitamin B12 or folate deficiency could cause low red blood cell turnover. However, with rapid cell turnover, more young red blood cells are produced that are usually not certain to glucose, leading to a falsely low HbA1C value. Conditions that could cause rapid cell turnover include chronic hemolysis (i.e., thalassemia); patients treated for iron, vitamin B12 or folic acid deficiency; and patients treated with erythropoietin.
AND
A1C levels alone will not be helpful in patients who’ve recent blood loss, hemolytic anemia, hemoglobinopathy (i.e., sickle cell trait), severe liver and kidney disease, or frequent episodes of hypoglycemia (Dugger and Clark, 2011). A1C is just not really helpful for the diagnosis of type 1 diabetes or gestational diabetes. Additionally, it must be noted that there are several genetic variants of hemoglobin that will be present in African American, Latino, and Asian American populations. A1C testing could have limitations in these patient groups, but most up-to-date laboratory tests are not any longer affected by common hemoglobin variants (Selvin, 2020).
AND
A invaluable tool in primary care, A1C may help establish treatment and dietary regimens for glycemic control in patients with diabetes and assess the effectiveness of those treatments. A1C can also be really helpful in hospitalized patients if results from the last 2–3 months are usually not available (Dugger and Clark, 2011) because early identification will help improve patient outcomes.

American Diabetes Association (2018). Diabetes statistics. https://www.diabetes.org/resources/statistics/statistics-about-diabetes

AND
Dugger, L., & Clark, A. P. (2011). Can hemoglobin A1c testing in a hospital setting assist in the early diagnosis of diabetes? (4), 171–175. https://doi.org/10.1097/NUR.0b013e318222a693

AND
Hill, A. N., and Appel, S. J. (2010). Diagnosing diabetes by A1C: implications and considerations for measurements and surrogate markers. (10), 16–24. https://doi.org/10.1097/01.NPR.0000388206.16357.02

AND
Selvin, E. (2020, December 4). Measurements of glycemic control in diabetes. . https://www.uptodate.com/contents/measurements-of-glycemic-control-in-diabetes-mellitus

AND