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What is HbA1c and why do you need it?

Sustainable Health

If you’re diabetic, you likely bought a glucometer on your way home from the doctor’s practice when you learned about having the condition, and use it every so often, perhaps making disapproving sounds when your blood glucose levels are high and and showing the reading to anyone who’ll see when the readings are within normal ranges. All of us do that.

Your blood glucose reading applies to the moment you pricked your finger and took the measurement. If you were really bad the previous day, eating sugary, floury foods and snacks from packets and soft drinks and all of that, depending on your condition, your sugar would have been above average at the least and really high at worst. The next morning, after an uneventful night of rest and fasting, you wake up and after spending a day behaving yourself as far as food is concerned, you check your blood sugar levels and are thrilled when the number is within the normal range or only slightly high.

Here’s the problem. Whatever damage your high blood sugar levels had to do the previous day, has already been done. Today’s very nice reading doesn’t undo that. Next, if you didn’t measure your blood sugar levels the previous day, you won’t even know they were bad. We only know our current blood glucose levels with a glucometer.

HbA1c

The basic logic is that glucose binds to the haemoglobin in our red blood cells and this test measures the percentage of sugar-coated (glycated) haemoglobin. The greater the percentage the worse the individual’s sugar control. Since the life of a red blood cell is roughly 3 months, that’s also the scope of this test.

The good news is, with an HbA1c test, we can tell how we’ve been controlling our blood sugar levels over the past three odd months, as opposed to a blood glucose test that only informs us of a point in time reading, which apart from becoming familiar with our body’s unique response to different foods, is otherwise useless in my opinion for the larger purpose of maintaining controlled blood sugar over a duration of time.

This test is available with virtually every diagnostic lab in India and is inexpensive too.

HbA1c mg/dlmmol
5%975.4
6%1267
7%1548.5
8%18310.2
9%21211.8
10%24013.3
11%26914.9
12%29816.5
13%32618.1
14%35519.7

Self Testing

As per research specifically on the subject, self testing doesn’t serve much practical purpose. A study involving 450 patients was conducted, in which they were randomly divided into 3 groups.

  1. No self monitoring of blood glucose
  2. Once daily self monitoring of blood glucose
  3. As in group 2, with enhanced feedback from patients

The outcome was contrary to what one may expect. The general thought is that greater measurement and observation of a condition is likely to cause the occurrence of positive outcomes.

There were none. Quoting the study, “there were no significant differences in glycemic control across all groups, nor were there significant differences found in health related quality of life.

Conclusion

What should you do? In my opinion, we should check blood glucose levels from time to time, but not depend upon the readings as an accurate measure of our sugar control. The American Diabetic Association recommends an HbA1c test twice a year. I suggest you double it and hit the labs once every 3 months while keeping one eye on your glucometer reading. That way you’ll be informed of the big picture as well as the situation immediately at hand and will be equipped to make lifestyle changes before things go out of hand.

References

  1. https://medlineplus.gov/labtests/hemoglobina1chba1ctest.html
  2. https://www.mayoclinic.org/tests-procedures/a1c-test/about/pac-20384643
  3. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2630691
  4. https://www.health.harvard.edu/newsletter_article/ask-the-doctor-whats-the-difference-between-blood-sugar-and-hemoglobin-a1c
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