September 25, 2013
Do You Know the HbA1c Test?
Many of my peers have written on this topic, but now is my attempt. I do receive emails asking me “what is the best HbA1c?” I answer that if you do not have diabetes, normal HbA1c should be between 4.2% and 5.6%, meaning the person is healthy and at minimum risk of diabetes. I have seen others say it should be between 4.2% and 4.8% for normal healthy individuals, and generally, these indicate no risk for diabetes. In all of this, I advise you to read this by David Mendosa. He did his research and speaks to the subject of normal being 4.7% to 5.7%.
These same people say that there is minimal risk for diabetes between 4.9% and 5.6%; however, they advise paying closer attention if this starts to creep up toward 5.7%. The range from 5.7% to 6.4% is ignored by most doctors and treated in a cavalier way. In reality, this range is for diagnosis of pre-diabetes, but don't rely on most doctors doing anything about it. If you have a history of diabetes in your family, are overweight, or having any of the symptoms of diabetes, make sure that your doctor is aware of this. Your risk for diabetes is higher than it should be.
Once your HbA1c crosses into the 6.5% or higher level, you have diabetes. Forget about arguing that you don't have diabetes. Your pancreas is having trouble producing enough insulin or your insulin resistance is preventing the insulin your pancreas is producing from being utilized. Now that I have said this, many doctors can't get away from the teachings of the American Diabetes Association (ADA), which declares diabetes starts at 7.0%. Even this is outdated, but in the recent past this was the crossing point for diabetes and many doctors cling to this.
I will advise people who have diabetes in their family history and their doctor will not test for diabetes to find an endocrinologist that will test them for diabetes and to do this a minimum of once per year. No I did not say fire your current doctor as with the changes happening under the Affordable Care Act (ACA), this may not be a good time to be without a doctor.
Patients with anemia, those taking vitamin C and E, patients with high blood cholesterol levels, and people with liver or kidney diseases need to be aware that they may have abnormal HbA1c tests. Be prepared to discuss this with your doctor and especially if you are taking supplements. Be careful and manage your diabetes as those who do not manage their diabetes have a much higher risk of developing the complications.
How often you should have the HbA1c test is another area for concern. I don't say this lightly as doctors vary considerably in how often they wish to test you. Some of this depends on how well you are managing your diabetes. If you are self-motivated and are always below 6.0% most doctors may wish to only test your HbA1c every six months. Some doctors will still insist on testing your quarterly. You should always strive to have HbA1c tests below 6.5% although some will say less than 7% - again this is the recommendation of the ADA.
I do appreciate what David Mendosa recommends in his blog. I will admit that being able to have the test strips for checking my blood glucose as frequently as I need has kept me from following his advice. Read the complete blog as he points out the importance of monthly HbA1c testing.