HbA1c is glycated haemoglobin which is a protein within red blood cells linked with glucose. It gives an overall picture of what average blood sugar levels have been over a period of months. This is important to know that higher the HbA1c, the greater the risk of developing Diabetes-related complications.
When the body processes sugar, glucose in blood naturally attaches to haemoglobin. The amount of glucose that combines with this protein is directly proportional to the amount of sugar that is in your system at that time. Because red blood cells survive for 8 to 12 weeks, measuring HbA1c can be used to reflect average blood glucose levels over that duration. So if your blood sugar levels have been high in recent weeks, your HbA1c will also be greater.
HbA1c Targets
A reasonable HbA1c goal for many nonpregnant adults <7%. More strict HbA1c goal of <6.5% for following patients
- Without significant hypoglycemia
- Without another adverse effect of treatment
- The short duration of diabetes
- Type 2 diabetes treated with lifestyle modifications or metformin only
- Long life expectancy
Less strict HbA1c goal of<8% for following patients
➢ History of severe hypoglycemia
➢ Advanced diabetic complications
➢ Extensive comorbidities
➢ Extensive diabetes in whom the goal is difficult to achieve despite treatment
Improving HbA1c by 1% for type 1 or type 2 diabetes decreases the risk of microvascular complications (retinopathy, neuropathy, nephropathy) by 25% (UKPDS Study & DCCT Study). Cardiovascular risk in type 2 diabetes is 16% less with lower HbA1c (UKPDS study)
Other research also shown people with type 2 diabetes, reduction in HbA1c of 1% are:
19% less likely to suffer cataracts
16% less likely to suffer heart failure
43%less likely to suffer amputation or death due to peripheral vascular disease
Recommendations:
Perform the HbA1c test at least two times a year in patients who are meeting treatment goals.
Perform HbA1c test quarterly in patients whose therapy has changed or who are not meeting glycemic goals.
Make a plan which includes:
1. Get at least 30 minutes of exercise daily for five days a week
2. Eat a balanced diet with proper portion sizes
3. Follow your treatment plan
4. Check your blood sugar as directed
Dr. Birjis Shaikh, Consultant Internal Medicine, Narayana Multispeciality Hospital, Ahmedabad