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Hemoglobin A1c

Hemoglobin A1c is a topic covered in the Davis's Lab & Diagnostic Tests.

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Synonym/Acronym:
A1c, glycated hemoglobin (Hgb), glycohemoglobin.

Rationale
To identify individuals with diabetes and to monitor treatment in individuals with diabetes by evaluating their long-term glycemic management.

Patient Preparation
There are no food, fluid, activity, or medication restrictions unless by medical direction.

Normal Findings
Method: Chromatography

Values vary widely by method. The recommended treatment goal assumes the use of a standardized test, as referenced to the National Glycohemoglobin Standardization Program—Diabetes Control and Complications Trial, and the absence of clinical conditions such as hemoglobinopathies, anemias, and kidney and liver diseases known to affect the accuracy of the test results.

Recommended Goals for Monitoring Glycemic Management Using Hgb A1cA1c%
Children and adolescents (applicable to all ages in the pediatric category; however, goals should be individualized especially for type 1 diabetes, and special consideration should be given to age-related lack of awareness for hypoglycemia when setting goals)Less than 7.5%
Pregnant females without hypoglycemia (goals are stricter for pregnant females, especially in the second and third trimesters, related to hemodilution and increased red blood cell (RBC) turnover which has the effect of independently decreasing A1c)6%–6.5%
Nonpregnant adults with or without diabetes who do not experience significant hypoglycemia (see table note)Less than 7%
Diabetes (stricter goals are reasonably recommended for certain individuals with diabetes, e.g., those who are otherwise healthy, are newly diagnosed, are type 2 diabetics being treated with lifestyle adjustments and limited oral antidiabetes medications such as metformin to lower glucose levels, have not yet developed complications related to diabetes, do not experience significant hypoglycemia)6.5% or less
Diabetes (less strict goals are reasonably recommended for certain individuals with diabetes, e.g., those who have been diagnosed with diabetes for a lengthy period of time and have been unsuccessful achieving lower A1c goals; have complications related to diabetes; have one or more comorbidities; have a short life expectancy; are being treated with multiple antidiabetes medications, including insulin, to lower glucose levels; have a documented history of hypoglycemia)Less than 8%
Age, ethnicity, and hemoglobinopathies are variables that independently affect blood glucose levels, thereby also affecting A1c levels and the approach to glycemic management. A1c goals for persons with diabetes are set and monitored by the health-care provider (HCP) in collaboration with the patient. Goals are based on a variety of factors that include the number of years diagnosed with diabetes, identification of complications related to diabetes, identification of comorbidities, evidence of hypoglycemia, life expectancy based on risk factors, recommended therapies, ability to access resources required to support the treatment plan, level of available and dependable support (e.g., for pediatric patients, patients with language barriers, or patients with intellectual, emotional, or physical impairments).Abridged from American Diabetes Association. Standards of Medical Care in Diabetes. (2018). Diabetes Care, 41(Suppl. 1):S1–S159.

Critical Findings and Potential Interventions
N/A

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Citation

Bladh, Mickey Lynn., and Anne M. Van Leeuwen. "Hemoglobin A1c." Davis's Lab & Diagnostic Tests, 7th ed., F.A. Davis Company, 2017. Nursing Central, nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425491/all/Hemoglobin_A1c.
Bladh ML, Van Leeuwen AM. Hemoglobin A1c. Davis's Lab & Diagnostic Tests. 7th ed. F.A. Davis Company; 2017. https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425491/all/Hemoglobin_A1c. Accessed June 20, 2019.
Bladh, M. L., & Van Leeuwen, A. M. (2017). Hemoglobin A1c. In Davis's Lab & Diagnostic Tests. Available from https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425491/all/Hemoglobin_A1c
Bladh ML, Van Leeuwen AM. Hemoglobin A1c [Internet]. In: Davis's Lab & Diagnostic Tests. F.A. Davis Company; 2017. [cited 2019 June 20]. Available from: https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425491/all/Hemoglobin_A1c.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hemoglobin A1c ID - 425491 A1 - Bladh,Mickey Lynn, AU - Van Leeuwen,Anne M, BT - Davis's Laboratory & Diagnostic Tests UR - https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Lab-and-Diagnostic-Tests/425491/all/Hemoglobin_A1c PB - F.A. Davis Company ET - 7 DB - Nursing Central DP - Unbound Medicine ER -