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A1c Test

Overview

A glycohemoglobin test, or hemoglobin A1c, is a blood test that checks the amount of sugar (glucose) bound to the hemoglobin in the red blood cells. People who have diabetes or other conditions that increase their blood glucose levels have more glycohemoglobin (sugar bound to hemoglobin) than normal.

An A1c test can be used to diagnose prediabetes or diabetes. The A1c test checks the long-term control of blood glucose levels in people with diabetes. Most doctors think checking an A1c level is the best way to check how well a treatment plan is working. This test can be done with a blood draw from a vein. Sometimes an A1c test can be done with blood from a finger stick.

A home blood glucose test measures the level of blood glucose only at that moment. Blood glucose levels change during the day for many reasons, including medicine, diet, exercise, and the level of insulin in the blood.

It is useful for a person who has diabetes to have information about the long-term control of blood sugar levels. The A1c test result does not change with any recent changes in diet, exercise, or medicines.

Glucose binds to hemoglobin in red blood cells at a steady rate. Since red blood cells last 3 to 4 months, the A1c test shows how much glucose is in the plasma part of blood. This test shows how well your diabetes has been controlled in the last 2 to 3 months and whether your diabetes treatment plan needs to be changed. This test may not be accurate for everyone because many things can affect the life span of red blood cells, such as the second or third trimester of pregnancy, a recent blood loss or a blood transfusion, sickle cell disease, hemodialysis, or erythropoietin (ESA) medicine.

The A1c test can also help your doctor see how big your risk is of developing problems from diabetes, such as kidney failure, vision problems, and leg or foot numbness. Keeping your A1c level in your target range can lower your chance for problems.

Why It Is Done

The A1c test is one of the tests used to diagnose prediabetes and diabetes. If you have diabetes, this test is done to check how well your diabetes has been controlled over the past 2 to 3 months. Your doctor can use this information to adjust your treatment, if needed.

How To Prepare

You don't need to stop eating before you have an A1c test. This test can be done at any time during the day, even after a meal.

How It Is Done

A health professional uses a needle to take a blood sample, usually from an arm.

How It Feels

You may feel nothing at all from the needle, or you may feel a quick sting or pinch.

Risks

There is very little chance of having a problem from this test. A small bruise may form at the site.

Results

The A1c level is shown as a percentage. The result of your A1c test can also be used to estimate your average blood sugar level. This is called your estimated average glucose, or eAG.

Each lab has a different range for what's normal. Your lab report should show the range that your lab uses for each test. The normal range is just a guide. Your doctor will also look at your results based on your age, health, and other factors. A value that isn't in the normal range may still be normal for you.

Hemoglobin A1cfootnote 1

Normal

Less than 6.0%

Prediabetes (increased risk for diabetes)

6.0%–6.4%

Diabetes

6.5% and higher

A1c and estimated average glucose (eAG)footnote 2

A1c %

Estimated average plasma glucose (mmol/L)

6%

7.0

7%

8.6

8%

10.2

9%

11.8

10%

13.4

11%

14.9

12%

16.5

Diabetes Canada recommends that most non-pregnant adults who have diabetes and children who have type 2 diabetes have an A1c level of 7.0%. There is evidence to suggest that for children with type 2 diabetes, having an A1c of <6.0% within the first 6 months of diagnosis may reduce the risk of treatment failure. Diabetes Canada recommends that most children who have type 1 diabetes have an A1c level of 7.5% or less. Talk to your doctor about your diabetes treatment plan and your target A1c goal.

References

Citations

  1. Diabetes Canada Clinical Practice Guidelines Expert Committee, et al. (2018). Definition, classification and diagnosis of diabetes, prediabetes and metabolic syndrome. Canadian Journal of Diabetes, 42(Suppl 1): S10–S15. DOI: 10.1016/j.jcjd.2017.10.003. Accessed October 15, 2018.
  2. American Diabetes Association (2019). Standards of medical care in diabetes—2019. Diabetes Care, 42(Suppl 1): S1–S193. Accessed December 17, 2018.

Credits

Adaptation Date: 7/6/2021

Adapted By: Alberta Health Services

Adaptation Reviewed By: Alberta Health Services

Adapted with permission from copyrighted materials from Healthwise, Incorporated (Healthwise). This information does not replace the advice of a doctor. Healthwise disclaims any warranty and is not responsible or liable for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.