Glycated hemoglobin

Definition:
Glycated hemoglobin (glycosylated hemoglobin, hemoglobin A1c, HbA1c, A1C, or Hb1c; sometimes also HbA1c) is a form of hemoglobin which is measured primarily to identify the average plasma glucose concentration over prolonged periods of time. It is formed in a non-enzymatic glycation pathway by hemoglobin's exposure to plasma glucose. Normal levels of glucose produce a normal amount of glycated hemoglobin. As the average amount of plasma glucose increases, the fraction of glycated hemoglobin increases in a predictable way. This serves as a marker for average blood glucose levels over the previous months prior to the measurement. In diabetes mellitus, higher amounts of glycated hemoglobin, indicating poorer control of blood glucose levels, have been associated with cardiovascular disease, nephropathy, and retinopathy. Monitoring the HbA1c in type-1 diabetic patients may improve treatment.

The Test is Performed to:

1-It is used to measure your blood sugar control over several months. It can give a good estimate of how well you have managed your diabetes. 2-The test may be used to screen for diabetes.

Principle:
In the normal 120-day lifespan of the red blood cell, glucose molecules react with hemoglobin, forming glycated hemoglobin. In individuals with poorly controlled diabetes, the quantities of these glycated hemoglobins are much higher than in healthy people. Once a hemoglobin molecule is glycated, it remains that way. A buildup of glycated hemoglobin within the red cell, therefore, reflects the average level of glucose to which the cell has been exposed during its life-cycle. Measuring glycated hemoglobin assesses the effectiveness of therapy by monitoring long-term serum glucose regulation. The HbA1c level is proportional to average blood glucose concentration over the previous four weeks to three months. Some researchers state that the major proportion of its value is related to a rather shorter period of two to four weeks.

Illustrated diagrammatically

Haemoglobin in the blood (red, rectangle) combines with glucose in the blood (green, circle) to form glycosylated haemoglobin. This reaction occurs over a 10 week period.

Controlled diabetes, not much glucose, not much glycosylated haemoglobin

Uncontrolled diabetes, more glucose, much more glycosylated haemoglobin

Measuring A1C:
There are a number of techniques used to measure A1C. Laboratories use: high-performance liquid chromatography (HPLC): The HbA1c result is calculated as a ratio to total haemoglobin by using a chromatogram. immunoassay

The approximate mapping between HbA1c values given in DCCT percentage (%) and eAG (estimated average glucose) measurements is given by the following equation:[16] eAG(mg/dl) = 28.7 A1C 46.7 eAG(mmol/l) = 1.59 A1C 2.59 Data in parentheses are 95% confidence intervals HbA1c eAG (estimated average glucose) (%) (mmol/mol) (mmol/L) (mg/dL) 5 31 5.4 (4.26.7) 97 (76120) 6 42 7.0 (5.58.5) 126 (100152) 7 53 8.6 (6.810.3) 154 (123185) 8 64 10.2 (8.112.1) 183 (147217) 9 75 11.8 (9.413.9) 212 (170249) 10 86 13.4 (10.715.7) 240 (193282) 11 97 14.9 (12.017.5) 269 (217314) 12 108 16.5 (13.319.3) 298 (240347)

Normal Results
An HbA1c of 6% or less is normal. If your it is above 6.5%, you may be diagnosed with diabetes. If you have diabetes, try to keep your level at or below 7%. But you and your health care provider must decide what a normal level is for you.

Abnormal Results Mean

Abnormal results mean that your blood glucose levels have been above normal over weeks to months. If your level is above 7%, your diabetes control may not be as good as it should be. High values mean you are at greater risk of problems from having diabetes. If you can bring your level down, you lower your chances of long-term complications. Ask your doctor how often you should have your level tested. Usually, doctors recommend testing every 3 or 6 months.

Two examples
Below are two examples of people who have their HbA1c measured. One is poorly controlled, one well controlled.

A graph of glucose changes over 9 weeks. The glucose (green line) changes between 7-12. This results in an HbA1c level of 10% at the end of the 9 weeks (red line). Poorly controlled.

Here the glucose changes between 5-9. This results in an HbA1c level of 7% at the end of the 9 weeks. Well controlled.