HbA1c (average 3 months blood sugar)
Lipids (HDL, LDL, TR, CHOL)

HbA1c

Measurements of haemoglobin A1c (HbA1c) more accurately identify persons at risk for clinical outcomes than the commonly used measurement of fasting glucose. High HbA1c levels accurately predicts future diabetes. In addition HbA1c isa risk marker for stroke, heart disase and all-cause mortality.

John Hopkins University Bloomberg School of Public Health

The HbA1c test adds value as a marker of general health and can be used for monitoring individuals with and without diabetes. Not only high but also low HbA1c levels might be associated with allcause disease and underpins the applicability and value of HbA1c testing. Rebecca Paprott et al Diabetes Care Nov. 2014

 

HbA1c management is poor

  • Few patiens with diabetes actually know their HbA1c level
  • Over half of patients with diabetes who get their HbA1c tested have an HbA1c level higher than 7%
  • Patients who know their last level report better assessment of their bloodsugar control than those who did not

The diagnosis of diabetes is made if the HbA1c level is > 6.5%

  Present HbA1c New HbA1c mmol/mol Medium-glucose mmol/1
  5.0 31 5.4
  6.0 42 7.0
Measure for HbA1c type 2-diabetes less than 6.5 48 7.7
  7.0 53 8.5
Measure for HbA1c type 1-diabetes less than 7.5 58 9.3
  8.0 64 10.1
  9.0 75 11.7
Target groups:
  • Pre diabetes
  • Diagnosed, diabetes is under control
  • Diagnosed, diabetes is not under control

How does glucose compare to HbA1c

Below table list the close relationship between testing your glucose and testing your HbA1c level (your average glucose)

  Types of blood sugar test Advantages Disadvantages
HbA1c This blood test measure the percentage of blood sugar attached to haemoglobin

HbA1c levels between 5.7 and 6.4 per cent indicate that a patient has pre diabetes

HbA1c levels of 6.5 percent or higher on separate tests indicate that at patient has diabetes

Accuracy of test

HbA1c is better associated with chronic complications

Fasting is not required for HbA1c asessment and there are not acute pertubations

So far has been difficult to access reliable device outside hospital/medical settings
Glucose (random) Test a bloodsample taken at a random time

A random bloodsugar level of 200 (mg/dL) /11.1 (mmol/L) or higher suggests diabetes

Convenient

Part of basic metabolic panel screen

Insensitive measurement

Great patient variability

Glucose (fasting) Test a blood sample taken after an overnight fast

A fasting blood sugar level between 100 and 125 mg/dL (5.6 and 6.9 mmol/L) is considered pre diabetes

Low cost

Assay is widely available

Assay is automated

Indicates single point blood glucose level

Sample not stable after collection

Meals, activity, medications and stress affect your blood sugar

HbA1c to Average Blood Glucose Conversion Table
Recommended target for diabetes treatment is 7% (diagnosis at > 6.5%)
Recommended Glucose (fasting/before meals) 70 -130 mg/dL
Recommended Glucose (2 hours after meals) < 180 mg/dL

    Hba1c Glucose    
4 68 6 126 8 183
4.1 71 6.1 128 8.1 186
4.2 74 6.2 131 8.2 189
4.3 77 6.3 134 8.3 192
4.4 80 6.4 137 8.4 194
4.5 83 6.5 140 8.5 197
4.6 85 6.6 143 8.6 200
4.7 88 6.7 146 8.7 203
4.8 91 6.8 149 8.8 206
4.9 94 6.9 151 8.9 209
5.0 97 7.0 154 9 215
5.1 100 7.1 157 9.1 215
5.2 103 7.2 160 9.2 217
5.3 105 7.3 163 9.3 220
5.4 108 7.4 166 9.4 223
5.5 111 7.5 169 9.5 226
5.6 114 7.6 171 9.6 229
5.7 117 7.7 174 9.7 235
5.8 120 7.8 177 9.8 235
5.9 123 7.9 180 9.9 237

Diabetes treatment Type 2 and Type 1