HbAc measurement -
HbA1c reflects average glycaemia over the preceding 6—8 weeks. The test is subsidised by Medicare up to four times in a 12 month period.
in pregnancy when up to six tests in a 12 month period can be subsidised. The Service Incentive Program for diabetes care requires at least one HbA1c measurement per year. It is suggested that HbA1c is done every 6 months if meeting target, or every 3 months if targets are not being met or if therapy has changed.
Self blood glucose monitoring BGM and HbA1c complement each other: BGM informs the patient about blood glucose at any particular time eg. when the patient feels hypoglycaemic and informs the patient and doctor about the glycaemic pattern over the 24 hour cycle and guides the timing and level of lifestyle intervention and hypoglycaemic therapy.
HbA1c is tested using venous blood, taken at any time of day and without any preparation such as fasting. In the paediatric setting, a finger-prick capillary sample can be used. A Medicare rebate is available for the test. Patients can usually understand that the HbA1c reflects the long term overall control of blood glucose, whereas self BGM measures the blood glucose at one particular time on one particular day.
Patients can get to know what their target HbA1c level is and the reason for targets including the increased risk of diabetic complications with higher levels of HbA1c. HbA1c is formed by a nonenzymic chemical reaction between glucose and the amino group of the N-terminal valine of the haemoglobin beta chain.
Other forms of glycosylated haemoglobin are also formed by glycosylation on the alpha and beta chains Figure 1. The rate of glycosylation depends on the blood glucose level BGL and HbA1c accumulates in the red cell during its circulation in the body approximately days — newly formed red cells have no HbA1c and those about to be removed contain the most.
The HbA1c assay measures the average percentage of haemoglobin, ie. HbA1c over the entire red cell population and has been found to mainly reflect the preceding 6—8 weeks.
Glycosylation changes the electric charge and structure of the haemoglobin molecule and the three principles commonly used to separate HbA1c from the other members of the haemoglobin family are based on these changes Table 1.
There are many different assay systems, but all have been standardised to report the same numerical values as those in pivotal trials,3,4 which establish the rate of microvascular complication development and progression at different levels of HbA1c.
women with gestational diabetes and higher targets for those with least to gain and most to lose eg. frail patients with limited lifespan. Changes in the level of HbA1c reflect changes in average glycaemia and the effect of hypoglycaemic intervention.
Figure 1. Haemoglobin components in adults without diabetes Note: Haemoglobin contains four protein chains which interlock.
Adult haemoglobin HbA is the main form of haemoglobin but small amounts of fetal haemoglobin HbF and haemoglobin A2 also occur. The glycated haemoglobins include haemoglobin A1a, b and c. Interpretation of results is limited by factors that affect the relationship between HbA1c and average overall glycaemia Table 2.
Furthermore, HbA1c does not reflect the swings in blood glucose, which can be as clinically important as overall glycaemia.
Patients could have the same HbA1c but with frequent episodes of hypo- and hyperglycaemia or with stable glycaemia. As noted earlier, HbA1c testing and self BGM are complementary and provide information about different aspects of glycaemic control.
The level of HbA1c is also affected by some pathophysiological conditions and some laboratory factors 7 Table 2. Different forms of haemoglobin interact with the laboratory re-agents and have variable effects on the relationship between HbA1c and average blood glucose.
The different HbA1c assays may be affected by a wide range of factors including clinical conditions, medications and haemoglobinopathies. When HbA1c does not reliably assess average glycaemia Table 2 , alternate ways of assessing glycaemic control include self BGM and measuring other glycosylated proteins such as fructosamine.
Clinical review might indicate some remediable medical condition Table 2 and the laboratory may be able to use another assay method which will make the HbA1c reliable. If not, there are two alternatives to HbA1c testing to monitor overall glycaemia:. There are two developments in diagnosis and reporting that may be implemented in Australia in — 9.
There may also be a move toward more point-ofcare testing which is being used in some areas of Australia, particularly remote settings. Beverley was only testing the fasting blood glucose generally the lowest over the 24 hour period.
Tests at other times were much higher, explaining the HbA1c result. John had haemoglobinopathy, causing a spuriously low result in the laboratory's usual testing method. With a different assay system, the HbA1c was 8. Australian Family Physician.
So, if your test result was higher than normal, you may have another A1C test or a different type of diabetes test , usually either a fasting blood glucose test or an oral glucose tolerance test OGTT. If your A1C test was done to monitor your diabetes, talk with your provider about what your test results mean.
Learn more about laboratory tests, reference ranges, and understanding results. The A1C test is not used to diagnose gestational diabetes or type 1 diabetes.
Also, if you have a condition that affects your red blood cells, such as anemia or another type of blood disorder , an A1C test may not be accurate for diagnosing diabetes. Kidney failure and liver disease can also affect A1C results. In these cases, your provider may recommend different tests to diagnose diabetes and prediabetes.
The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health. Hemoglobin A1C HbA1c Test. What is a hemoglobin A1C HbA1C test? An A1C test can show your average glucose level for the past three months because: Glucose sticks to hemoglobin for as long as the red blood cells are alive.
Red blood cells live about three months. Other names: HbA1C, A1C, glycohemoglobin, glycated hemoglobin, glycosylated hemoglobin. What is it used for? An A1C test may be used to screen fo r or diagnose: Type 2 diabetes.
With type 2 diabetes your blood glucose gets too high because your body doesn't make enough insulin to move blood sugar from your bloodstream into your cells, or because your cells stop responding to insulin. Prediabetes means that your blood glucose levels are higher than normal, but not high enough to diagnosed as diabetes.
Lifestyle changes, such as healthy eating and exercise , may help delay or prevent prediabetes from becoming type 2 diabetes. Why do I need an HbA1C test? The Centers for Disease Control CDC recommends A1C testing for diabetes and prediabetes if: You are over age If your results are normal, you should repeat the test every 3 years.
If your results show you have prediabetes, you will usually need to be tested every 1 to 2 years. Ask your provider how often to get tested and what you can do to reduce your risk of developing diabetes. If your results show you have diabetes, you should get an A1C test at least twice a year to monitor your condition and treatment.
You are under 45 and are more likely to develop diabetes because you: Have prediabetes. Are overweight or have obesity. Have a parent or sibling with type 2 diabetes.
Have high blood pressure or high cholesterol levels. Have heart disease or have had a stroke. Are physically active less than 3 times a week.
Have had gestational diabetes diabetes during pregnancy or given birth to a baby over 9 pounds. Use the Question Builder for general tips on what to ask your GP or specialist.
A diagnosis of diabetes can be made if your HbA1c result is 6. Sometimes the test needs to be repeated to confirm the result. If your HbA1c level is lower than this, you might need other tests to check whether you have diabetes or not. If your HbA1c result is higher than your target range, your doctor may consider changing your treatment or monitoring your blood sugars more closely.
Video provided by Pathology Tests Explained. Visit the Pathology Tests Explained website for more information about HbA1c testing. You can also call the healthdirect helpline on known as NURSE-ON-CALL in Victoria.
A registered nurse is available 24 hours a day, 7 days a week. FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services. Learn more here about the development and quality assurance of healthdirect content.
The HbA1c glycated haemoglobin test is a useful, simple and inexpensive blood test that can be used to diagnose diabetes and also to monitor blood glucose control in people with known diabetes. Read more on myDr website. Read more on Know Pathology Know Healthcare website.
As glucose circulates in your blood, some of it spontaneously binds to haemoglobin the protein that carries oxygen in your red blood cells. This combinatio. Read more on Pathology Tests Explained website. The fructosamine test is a measurement of glycated protein which is formed by a nonenzymatic reaction of serum proteins with glucose.
However, glycated album. Behind the scenes — how pathology analyses your diabetes tests Mar 23, 0 Comment Post By:Annette Stenhouse There are over pathology laboratories nationwide but few people know what goes on inside them.
Hyperglycaemia means too much sugar glucose in the bloodstream. For someone with diabetes it means their diabetes is not well controlled.
When you see a doctor and they order some blood tests, a specimen of your blood will be taken and the sample will go off to a laboratory to be analysed along.
Read more on Diabetes Victoria website.
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