The ABCs of the A1C

Recognizing your diabetes risk by the numbers

Understanding your diabetes risk and managing the condition is all about knowing the numbers – your blood sugar numbers.

The A1C blood test measures your average blood glucose, or sugar numbers, over the past couple of months. The number gives an average snapshot of your sugar levels over a period in time rather than the results of a single day, and is a good measure of whether you have diabetes or are predisposed to it, according to the American Diabetes Association.

Normal levels of blood sugars in an A1C test register as less than 5.7 percent. A reading of 5.7 to 6.4 percent indicates prediabetes and 6.5 percent or higher signals diabetes, the association says.

Still, many Americans don’t know their numbers, even among those diagnosed with diabetes. In a survey conducted by the American Association of Diabetes Educators, 24 percent of people with diabetes knew their A1C levels.  

The advantage of the A1C compared to other methods of testing is that it requires no fasting and only a small amount of blood for the test.

“The hemoglobin A1C test provides the longer view,” said Dr. Thomas Dotson, an internal medicine provider at Novant Health UVA Health System Virginia Internal Medicine and Primary Care. “It’s reliable and more convenient than other blood sugar tests.”

Because the test doesn’t require fasting and blood can be drawn at any time of the day, experts believe it will be helpful in diagnosing people before they have full-blown diabetes. The National Institutes of Health (NIH) recommends testing since diabetes in its early stages has no symptoms.

More than 100 million U.S. adults are now living with diabetes or prediabetes, according to a 2017 report by the Centers for Disease Control and Prevention (CDC). Some 30.3 million Americans – 9.4 percent of the U.S. population – have diabetes. Another 84.1 million have prediabetes, a condition that often leads to type 2 diabetes.

“The percentage of people could even be greater because symptoms may not appear early on,” said Dotson. “People can have blood sugar levels out of range for a long time and not realize it, during which time bad things are happening to their bodies.”

Diabetes is the seventh leading cause of death in the United States and has serious health consequences, including heart disease, blindness, kidney failure and lower limb amputation. Fifteen to 30 percent of people with prediabetes will likely develop type 2 diabetes within five years, unless they make lifestyle changes to get their weight and blood sugar under control.

“Some people with prediabetes who successfully make and maintain lifestyle changes can reverse the course of their condition. In other cases, it will delay the onset of diabetes,” Dotson said.

Lifestyle changes can also help people already diagnosed with diabetes. “Weight management, losing weight and physical activity are also extremely important for people managing type 2 diabetes,” Dotson said. “The American Diabetes Association recommends 150 minutes of moderate exercise a week.”

Dotson added that patients have to be careful not just about their weight, but what they eat and carefully monitor carbohydrate intake.

For people already diagnosed with diabetes, the A1C is an effective test for monitoring blood sugar levels, according to the NIH. The American Diabetes Association recommends that patients with diabetes who are meeting treatment goals have the test twice a year. Health care providers may repeat the test more frequently until blood glucose levels reach recommended levels.

“It’s useful for following people with diabetes because it gives a better picture of glucose control over time, even at times of day when you aren’t checking your blood sugar,” Dotson said.

About a third of the people living with diabetes are not at their ideal A1C levels, according to the American Diabetes Association. To raise awareness, the association is teaming up with pharmaceutical manufacturer Merck and singer Tim McGraw on a program called “America’s Diabetes Challenge: Get to Your Goals.”

The effort seeks to encourage people with type 2 diabetes to meet their A1C goals with the help of their doctors by taking a pledge.

When meeting with your doctor to set the goal for your pledge, the association recommends asking the following questions:

  •      What is my A1C and what should my goal be?
  •      What are the signs and symptoms of high and low blood glucose?
  •      Do I need to make any changes to my diabetes management plan?
  •      What are the benefits and possible side effects of the medicine I’m taking?
  •      What are the possible causes of high and low blood glucose?

Dotson noted patients should be their own advocates and request to be screened. Before seeing your doctor, learn about the risk factors such as a body mass index (BMI) over 31, being older than 35, gestational diabetes, and family history, and inform your doctor about any predisposing condition that may affect you.

“Ask to have an A1C test,” the doctor advised. “Many times screening tests become delayed because of whatever acute issue is at hand while at the doctor’s office.”

By Susan Tulino

 

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