*What is HbA1c?* HbA1c is also referred to as haemoglobin A
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Dr. Atul Chowdhury
*What is HbA1c?*

HbA1c is also referred to as haemoglobin A1c or simply A1c.
HbA1c is a modified form of haemoglobin. a molecule in our red blood cells which carries oxygen around the body; most of the haemoglobin is of a type called HbA.

HbA1c is formed during glycosylation, a process when glucose(sugar) molecules attach to HbA molecules. HbA1c where HbA = haemoglobin and 1c = glycosylated. Glycosylated haemoglobin stays in the body for about 3 months. As old red blood cells die, new ones replace them.

Measurement of glycated haemoglobin (HbA1c), represents an overall picture of what our average blood sugar levels have been over a 3 month period.

Higher the HbA1c, the greater the risk of developing diabetes-related complications in diabetics.

*How is HbA1c tested?*

Unlike Blood Glucose Level (BGL) tests that you can also monitor with a glucose meter, HbA1c tests need a professional set up and done in a pathology lab – ideally 2 to 4 times a year. Blood is taken from a vein in the arm and blood is sent to a laboratory to measure the HbA1c levels.

However, some have begun to provide HbA1c ‘point of care testing’ (POCT) where a person’s HbA1c is tested on the spot using a special machine through a finger prick of blood to perform the test and provides the result within minutes.

*HbA1c Measure*

HbA1c results are given in %, the test counts the number of red blood cells that are glycosylated (attached to sugar) – for example, if 6 out of every 100 red blood cells are attached to sugar, i.e HbA1c of 6%.

*HbA1c targets*

For most adults with diabetes, regardless of whether it’s type 1 or type 2, the general HbA1c target is <7.0%
HbA1c levels of 8.0% or above may indicate that tighter control of blood glucose levels is required.
As a reference point, in adults who don’t have diabetes, the HbA1c levels are usually between 4.0 to 6.0%.

*HbA1c in diagnosis*

HbA1c can indicate people with prediabetes or diabetes as follows:

Below 6.0%
6.0% to 6.4%
6.5% or over

*What are the benefits of lowering HbA1c?*

Two large-scale studies - the UK Prospective Diabetes Study (UKPDS) and the Diabetes Control and Complications Trial (DCCT) - demonstrated that improving HbA1c by 1% for people with type 1 diabetes or type 2 diabetes cuts the risk of microvascular complications by 25%.

Microvascular complications include:
Retinopathy (eye disease leading to blindness)
Neuropathy (Nerve Disorder)
Diabetic nephropathy (kidney disease)

Research has also shown that people with type 2 diabetes who reduce their HbA1c level by 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

*How does HbA1c differ from a blood glucose level?*

Both tests are useful for managing diabetes

HbA1c provides a longer-term trend, similar to an average, of how high your blood sugar levels have been over a period of time.

Measuring Blood Glucose level gives us real-time feedback on the present conditions, i.e any instances of hypoglycaemia or hyperglycaemia. This then allows appropriate (and immediate) changes to treatment (e.g. insulin), food intake and activity levels.

HbA1c is a measure of how well controlled your blood sugar has been over a period of about 3 months. It essentially gives a good idea how high or low, on average, your blood glucose levels have been.

*to lower HbA1c*

Set yourself a Goal - A goal will help you to set out challenges you face and how to answer them about target blood sugar range, weight loss, exercise, managing stress, and your diet. Talk to your doctor or a health expert to chalk out a plan, It will also help you set a goal, and steps you can take to achieve that goal.

Diabetes Management Plan - Diabetes treatment is different from one person to other. Discuss with your doctor to create a plan to manage your diabetes and always discuss first with them before making any changes. Keep everyone who knows about your condition on the same page as you are to help manage diabetes better. Your plan should also include emergency contacts, medical instructions, a medication list, target blood glucose levels, and blood sugar testing instructions.

Be Active - Try to get at least 30 minutes of exercise five days a week. This doesn’t have to be formal exercise, any activity you enjoy doing like playing a sport or cycling.

Track your diet – use an online platform or a journal to note what all you eat and be aware of your food and make changes accordingly. Keep your portions small. Completely stop sugary drinks and juices and avoid processed foods. Talk to a health expert for a balanced diet plan.

Be Disciplined - Fasting, skipping meals, or eating too much at one go can cause your blood sugar levels to fall and rise very frequently. Self- monitoring of blood sugar is necessary, even if A1C is monitored regularly. Always track your blood sugar to make necessary changes in your diet and activity. Being discipline would help you determine to alert you about foods that cause blood sugar spikes.
Dr. Atul Chowdhury
Rapid Action Force
Central Reserve Police Force
General Medicine
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