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Mahesh

16/03/24 09:11 AM IST

HbA1C test

In News
  • One of the most commonly-used tests to diagnose pre-diabetes and diabetes (both type 1 and type 2) and to help manage diabetes, is the haemoglobin A1C (HbA1C) test.
Working of the test
  • Sugar enters your bloodstream from the food you eat.
  • The sugar, or glucose, attaches to the haemoglobin in your red blood cells.
  • Haemoglobin is a protein that transports oxygen to all the cells of your body.
  • Everybody has some sugar attached to their haemoglobin.
  • Those with pre-diabetes and diabetes, however, have more.
  • The HbA1C test measures the percentage of your red blood cells that have sugar-coated, or glycated, haemoglobin.
Discovery of HbA1C
  • HbA1c was first discovered in 1955, but elevated HbA1c levels in diabetes patients were not noted until 1968.
  • Another eight years passed before HbA1c was correlated with blood glucose values in hospitalised patients with diabetes and was proposed for monitoring glycemia.
  • The American Diabetes Association approved HbA1c as a diagnostic tool in 2009.
  • In 2011, after an expert consultation with the World Health Organisation (WHO), it said HbA1c could be used as a diagnostic test for diabetes “provided … stringent quality assurance tests are in place and assays are standardised to criteria aligned to the international reference values, and there are no conditions present which preclude its accurate measurement.”
Results of the test
  • The HbA1C levels are provided as either a percentage or in mmol/mol (which stands for millimoles per mole). A mole is a unit of measurement often used for chemical substances.
  • The higher the percentage, the higher your blood glucose levels are. An Hb1A1C below 5.7% is considered normal; between 5.7 and 6.4% may indicate you are pre-diabetic; and 6.5% or higher can indicate diabetes. In mmol/mol: below 42 corresponds to below 6.0%; 42-47 mmol/mol to 6.0 to 6.4%; and 48 mmol/mol to 6.5% or over.
  • The test’s results may change under certain conditions, including if a patient has kidney or liver failure, severe anaemia or a blood disorder such as thalassemia; if they have a less common type of haemoglobin found in some populations; or are under certain medications including steroids, opiates or dapsone (a drug used to treat leprosy). They may even change if a person is in early or late pregnancy.
  • Generally, for those whose results indicate pre-diabetes or diabetes, doctors specify a goal to achieve specific HbA1C levels.
  • But these vary from person to person and also depend on their age, health conditions, medications being taken, and other factors.
Limitations
  • It is important to note the HbA1C test does not replace other tests and may be carried out alongside others, such as the traditional blood sugar tests to test for diabetes and pre-diabetes.
  • It also does not replace regular blood-sugar testing at home, which a doctor may have recommended, as the blood sugar levels may spike and dip through the day or night, and the HbA1C test may not capture this.
  • This apart, while the HbA1C test remains one of the best to assess long-term control of diabetes in people known to have diabetes, it is not uniformly accepted as a diagnostic test by all global medical bodies because of its relatively low sensitivity arising from difficulties in assay standardisation.
  • In other words, a doctor may recommend a glucose test alongside an HbA1C test to obtain a clearer picture when diagnosing a person.
  • In some clinical situations, accurate measurements are harder to make. These include having conditions like thalassaemia, structural haemoglobin variants in the population, iron-deficiency anaemia (which is relatively high in India), and the use of certain drugs.
Source- The Hindu

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