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Epidemiol Rev — Franklin VL, Waller A, Pagliari C, Greene SA A randomized controlled trial of Sweet Talk, a text-messaging system to support young people with diabetes.

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Health affairs Project Hope 33 2 — Wolever RQ, Dreusicke MH Integrative health coaching: a behavior skills approach that improves HbA1c and pharmacy claims-derived medication adherence. BMJ Open Diabetes Res Care 4 1 :e Fischer HH, Fischer IP, Pereira RI et al Text message support for weight loss in patients with prediabetes: a randomized clinical trial.

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The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Department of Public Health, University of Otago, Wellington, New Zealand. Department of Medicine, University of Otago, Wellington, New Zealand. Department Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.

You can also search for this author in PubMed Google Scholar. DS, MM and JaS led the study concept and design with input from VS, JK, RG and AD. MM managed the study.

VS developed the study database with support from MM and JaS. MM, VS, DT and KH acquired and managed the data with support from JeS and CD. MM, JaS and DS led the analysis and interpretation of data. VS, JeS, JK, AD and RG contributed to data analysis and interpretation.

MM and JaS wrote the first draft the manuscript with input from DS. MM, JaS, DS, VS, JeS, DT, KH, CD, JK, AD and RG provided critical revision of the manuscript draft.

All authors gave final approval of the version to be published. MM is the guarantor of this work and had full access to all the data in the study and final responsibility for the decision to submit for publication.

Correspondence to Melissa McLeod. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and permissions.

McLeod, M. et al. Impact of a comprehensive digital health programme on HbA 1c and weight after 12 months for people with diabetes and prediabetes: a randomised controlled trial. Diabetologia 63 , — Download citation. Received : 14 April Accepted : 20 July Published : 04 September Issue Date : December Anyone you share the following link with will be able to read this content:.

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Methods We conducted a randomised parallel-group two-arm single-blinded superiority trial in the primary care setting in two regions of New Zealand. Trial registration www. au ACTRN universal trial number U— Funding This study was funded by the Health Research Council of New Zealand, the Ministry of Health New Zealand and the Healthier Lives National Science Challenge.

Graphical abstract. BetaMe: impact of a comprehensive digital health programme on HbA1c and weight at 12 months for people with diabetes and pre-diabetes: study protocol for a randomised controlled trial Article Open access 05 March The carbohydrates we eat are broken down into glucose and a few other sugars , abs.

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Key facts HbA1c is a blood test that is used to help diagnose type 2 diabetes and monitor blood glucose control in people who have diabetes.

People with diabetes are advised to have this test every 3 to 6 months. No preparation is needed for this test. You should discuss your results with your doctor to see what the test results mean in your situation.

Back To Top. General search results. When A1C levels fall, there…. The A1C test shows average blood sugar levels over the past 2—3 months. It can help doctors diagnose diabetes and check how well treatment is working.

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Medical News Today. Health Conditions Health Products Discover Tools Connect. How can people manage their A1C levels? Medically reviewed by Angelica Balingit, MD — By Christine Richardson — Updated on November 8, Dangerous levels What does A1C measure? How the test works High A1C complications Setting A1C goals Tips to lower A1C Summary High A1C levels are a risk for diabetes and other complications.

What are dangerous levels? A1C value eAG value Potential diagnosis 5. A1C value eAG value Potential targets for : 5. What is A1C, and what does it measure?

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We included only those with sickle cell disease rather than the trait. Although megaloblastic anemia can also be caused by folate deficiency, we only included those caused by vitamin B12 deficiency.

Abnormal fasting blood glucose was defined as more than 5. Those patients were excluded. HbA1c is measured in our center using high-performance liquid chromatography utilizing the D system from Bio-Rad. The iron deficiency anemia group was the only group that met these numbers, along with the control group.

For the remaining three groups, we included all patients with the respective type of anemia that met the inclusion criteria beginning in , the year an electronic medical records system was established in our institution.

It was determined that the control group matched the highest group, which was the iron deficiency anemia group.

After completing the data collection process, an independent review of the correctness of the data was done by another author and then by the corresponding author. Missing data and outlier values were detected and treated prior to statistical analysis.

The descriptive categorical variables were presented in frequencies and percentages. The dependent factor of this study is the five groups which were IDA, SCA, β-thalassemia, megaloblastic anemia, and the control group. In addition, the descriptive numerical variables were depicted by mean and standard deviation.

Regarding the inferential statistics, chi-square, one-way ANOVA, and an unpaired T-test were utilized. A p -value of less than or equal to 0. A total of patients were included in this study.

One hundred and three Furthermore, the mean age was Of the patients diagnosed with one of the four causes of anemia, only 89 There was a clear female predominance in most groups of anemia. The group with the most female patients was β -thalassemia trait, in which 15 out of 17 Moreover, 51 out of 67 There was also a statically significant age difference between groups.

For example, the group with the highest mean age was the IDA group, with a mean age of In contrast, the group with the lowest mean age was the SCA group, which had a mean age of Baseline characteristics are shown in Table 1.

Mean hemoglobin levels before treatment were RBC count was markedly lower in the SCA and megaloblastic anemia groups. In addition, as expected, MCV and MCH values were much lower in the IDA and BT groups as illustrated in Table 1.

The highest mean of fasting glucose was 5. The mean ferritin level among the IDA group was Values of HbA1c before treatment of anemia were assessed for all anemic groups and compared to the control group. The mean HbA1c levels were significantly higher in SCA at 5.

On the other hand, the mean HbA1c levels in megaloblastic anemia at 5. In addition, the HbA1c values of the IDA group were compared before and after treatment to evaluate the effect of the hemoglobin level correction on the HbA1c value.

A significant decrease in HbA1c from 5. Difference between Hemoglobin levels and HbA1c levels in the different types of anemia compared to the control group.

IDA: iron deficiency anemia; SCA: sickle cell anemia; BT: Beta-thalassemia trait; MA: megaloblastic anemia; HbA1c: glycated hemoglobin. SCA was the only group that had a significant difference in HbA1c values between group 1, with 6.

The remaining groups had no significant difference in HbA1c levels at different hemoglobin levels, even though HbA1c levels were numerically higher at lower hemoglobin levels as shown in Table 4.

In the SCA cohort, the low Hb group had a significantly higher red cell distribution width RDW compared to the high Hb group The reference range for RDW in our center is The HbA1c test is used to measure the amount of glycosylated hemoglobin in the blood in the past 3 months.

It is used primarily to diagnose patients with diabetes mellitus and to monitor those diagnosed to assess their response to therapy. Levels between 5. Conditions such as different types of anemia can affect the levels of HbA1c in the blood.

In general, conditions associated with decreased erythropoiesis e. On the contrary, increased erythropoiesis resulting in rapid turnover of red blood cells can falsely lower HbA1c.

Many previous studies done in this field showed highly contradictory results. Therefore, this study aimed to measure the effects of four groups of anemia, IDA, SCA, β-thalassemia trait, and megaloblastic anemia, on HbA1c levels compared to a control group. It was found that there is a statistically significant increase in HbA1c levels in IDA and SCA patients when compared to the control group.

Regarding the IDA group, the mean HbA1c was significantly higher than the control group 5. In IDA, red cell production decreases, resulting in an increased age of circulating red blood cells. This will ultimately lead to higher HbA1c levels [ 1 ].

We also demonstrated that treating anemia in iron-deficient patients significantly lowered the HbA1c to 5. This finding was supported by multiple previous studies in the literature.

Brooks et al. found that iron-deficient nondiabetic patients had increased HbA1c values and returned to normal after iron replacement [ 17 ]. Moreover, Gram-Hansen et al. found that normal HbA1c concentrations in iron deficiency decreased to below-normal levels after iron therapy [ 16 ].

On the other hand, Heyningen and Dalton showed no differences in HbA1c concentrations in nondiabetic patients with IDA before and after iron replacement. Their study, however, contained only 14 patients, which might be an underrepresentation [ 18 ]. El-Agouza et al.

explained the HbA1c production mechanism, stating that HbA1c levels reflect a balanced relationship between HbA1c and serum glucose concentrations.

The HbA1c level is expressed as a percentage of total HbA. As a result, serum glucose is allowed to remain at a steady state, despite the decrease in hemoglobin concentration, which may result in an increase in the glycated fraction [ 19 ].

Although the lower hemoglobin group had a numerically higher HbA1c, this did not reach statistical significance. Ford et al. Theoretically speaking, sickle cells would have a much shorter life span compared to healthy red blood cells.

This shorter life span will result in falsely lower HbA1c when compared to healthy individuals [ 10 ]. It is hypothesized that the presence of hemoglobin S results in the shorter lifespan of red blood cells and less available time for hemoglobin glycation [ 12 ].

Another proposed mechanism by which sickle cell disease can affect HbA1c is assay interference caused by hemoglobin S on some of the HbA1c measurement techniques [ 12 ].

This has been corroborated in the literature. In a study done by Lacy et al. in adults with sickle cell trait, HbA1c levels were lower among people with sickle cell trait as compared to those without it [ 12 ].

Moreover, Atabani et al. showed similar results in patients with sickle cell anemia. They measured HbA1c for sickle cell anemia and sickle cell trait patients and compared the results with a control group.

Their study demonstrated that the mean HbA1c in SCA patients was 4. However, these results contradict our results. In our study, the mean HbA1c in SCA patients was significantly higher than in the control group 5.

There are a few caveats that can explain these results. First, only 13 out of the 33 patients with sickle cell anemia had normal ferritin.

However, even after analyzing only those with normal ferritin, the mean HbA1c was still statistically higher in the sickle cell patients compared to the control group 6. Second, we included only patients with sickle cell disease, unlike some of the other studies mentioned, which included sickle cell trait patients.

Third, we had a patient in the sickle cell anemia group who had an A1C of This very high A1C could have skewed the mean HbA1c. We did a secondary analysis after excluding this patient from the sickle cell disease group and the mean HbA1c was still statically higher than in the control group.

Fourth, abnormal hemoglobin, such as hemoglobin S and F, can sometimes cause an erroneous HbA1c reading. In our lab, we use high-performance liquid chromatography to measure HbA1c utilizing the D system from Bio-Rad.

Although this method has not been reported in the literature as being affected by abnormal hemoglobin, we think that it is still a plausible explanation for the falsely higher HbA1c in our sickle cell group [ 22 ].

Another possible explanation is the interesting finding that RDW, a measure of difference in size and volume of red blood cells, was significantly higher in the lower Hb group of patients with SCA. Bao et al. Finally, the number of patients with sickle cell anemia in our study is relatively small compared to those in the other studies mentioned.

There is a paucity of studies regarding the effect of β-thalassemia trait on HbA1c in non-diabetics. It is hypothesized that β-thalassemia trait can falsely lower HbA1c through multiple mechanisms. First, ineffective erythropoiesis and peripheral hemolysis can shorten the lifespan of erythrocytes, resulting in lower HbA1c.

Additionally, elevated hemoglobin F levels can affect some of the laboratory methods used to measure HbA1c [ 14 ]. Our results showed no effect on HbA1c in patients with β-thalassemia trait compared to the control group.

Also, there was no relation between the severity of anemia and HbA1c levels. A study by Tsilingiris et al. found that the mean HbA1c percentage in those with heterozygous thalassemia was similar to those without β-thalassemia trait.

However, they demonstrated that there is an inverse relation between hemoglobin concentration and HbA1c. They concluded that this correlation is of negligible clinical significance, and they advocated for continuing to utilize HbA1c in diagnosing diabetes mellitus in those with β-thalassemia trait [ 14 ].

Megaloblastic anemia is also associated with ineffective erythropoiesis and peripheral hemolysis. This is caused by apoptosis of hematopoietic cell precursors, which results from DNA synthesis abnormalities.

Both vitamin B12 and folate deficiency can cause defective DNA synthesis, but we included only patients with vitamin B12 deficiency [ 24 ].

In the group with megaloblastic anemia, the mean HbA1c was 5. Similar to what was reported by Gram-Hansen et al.

This supported the hypothesis that megaloblastic anemia is a type of anemia characterized by decreased RBC synthesis and no excess formation of young blood cells; thus, there will be little effect on HbA1c [ 25 ].

Pilla et al. also studied patients with megaloblastic anemia before and after correcting their anemia. The baseline HbA1c was significantly higher in those with megaloblastic anemia compared to the control group, and correcting the anemia did decrease the HbA1c level significantly to the range of the control group [ 26 ].

It is worth mentioning that in their study, the hemoglobin level was significantly lower than in ours 6. The high prevalence of IDA and megaloblastic anemia among female patients corresponds to other studies.

Sinha et al. showed female predominance among patients diagnosed with IDA [ 4 ]. This may be explained by heavy menstrual bleeding, lactation, and pregnancy [ 27 ]. Our results showed that Similarly, Green et al.

stated that there is a high prevalence of this condition in female patients compared to male patients by 3. Possible explanations include higher rates of autoimmune diseases among females, and that during pregnancy, there are multiple mechanisms that increase vitamin B12 absorption for the fetus [ 15 ].

The very-high female predominance in β-thalassemia and sickle cell anemia was surprising. Unfortunately, we could not find any local studies to support this finding and it seems that there is no gender preference in these diseases.

Our study has many limitations. First, the retrospective nature of the study renders it subject to different types of bias. Also, the sample size of the sickle cell group and β-thalassemia group was relatively small, making interpretation of findings in these two groups difficult.

Some patients came to our center already undergoing some treatment for their anemia IDA and megaloblastic so their initial hemoglobin levels might have been lower, which can affect the results.

Also, since this was a retrospective chart review study, there was a large variation in the treatment of anemia in terms of dosing and route of administration.

This might have affected some of the results; however, using the post-treatment hemoglobin level was our objective way of assessing response to therapy.

Moreover, the degree of iron deficiency and vitamin B12 deficiency was not severe. It would be interesting to see if severe deficiency can alter the HbA1c levels even more.

Although we excluded patients with elevated fasting and post-prandial blood glucose, isolated HbA1c might still be a sign of impaired glucose tolerance and it would not be possible to differentiate this from the effect of anemia or abnormal hemoglobin.

Finally, we only included patients who are not diabetics, and our results cannot be generalized to those known to have diabetes. In conclusion, IDA and sickle cell disease can falsely increase HbA1c and correcting the anemia in IDA patients can decrease the HbA1c level back to baseline. Our study found that the level of hemoglobin was inversely related to the HbA1c level in patients with sickle cell anemia, while high RDW correlated with high HbA1c levels.

Clinicians should use caution when depending on HbA1c to diagnose diabetes in those with IDA and sickle cell disease. We recommend correcting the anemia in patients with IDA before using HbA1c for diagnostic purposes.

Further studies on a larger scale are needed to evaluate the effect of sickle cell disease and RDW on HbA1c. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. Please contact the corresponding author, Suhaib Radi, to request any data or supporting files.

Christy AL, Manjrekar PA, Babu RP, Hegde A, Rukmini MS. Influence of iron deficiency anemia on hemoglobin A1c levels in diabetic individuals with controlled plasma glucose levels. Iran Biomed J. CAS Google Scholar. Gunton JE, McElduff A. Hemoglobinopathies and HbA 1c measurement.

Diabetes Care. Article CAS Google Scholar. Eyth E, Naik R. Hemoglobin A1C. Treasure Island: StatPearls; Google Scholar.

Sinha N, Mishra TK, Singh T, Gupta N. Effect of iron deficiency anemia on hemoglobin A1c levels. Ann Lab Med. Klonoff DC. Hemoglobinopathies and hemoglobin A1c in diabetes mellitus. J Diabetes Sci Technol. Bindayel IA. Influence of iron deficiency anemia on glycated hemoglobin levels in non-diabetic Saudi women.

J Int Med Res. Camaschella C. Iron-deficiency anemia. N Engl J Med. Article Google Scholar. Sluiter WJ, van Essen LH, Reitsma WD, Doorenbos H. Glycosylated haemoglobin and iron deficiency. Solomon A, Hussein M, Negash M, Ahmed A, Bekele F, Kahase D.

Effect of iron deficiency anemia on HbA1c in diabetic patients at Tikur Anbessa specialized teaching hospital, Addis Ababa Ethiopia.

BMC Hematol. Lonergan GJ, Cline DB, Abbondanzo SL. Sickle cell anemia. Jastaniah W. Epidemiology of sickle cell disease in Saudi Arabia.

Ann Saudi Med. Lacy ME, Wellenius GA, Sumner AE, Correa A, Carnethon MR, Liem RI, et al. Association of sickle cell trait with hemoglobin A1c in African Americans. Bajwa H, Basit H. Tsilingiris D, Makrilakis K, Voskaridou E, Pagkrati S, Dalamaga M, Liatis S.

Effect of heterozygous beta thalassemia on HbA1c levels in individuals without diabetes mellitus: a cross sectional study. Clin Chim Acta. Green R, Allen LH, Bjorke-Monsen AL, Brito A, Gueant JL, Miller JW, et al. Vitamin B 12 deficiency. Nat Rev Dis Primers. Gram-Hansen P, Eriksen J, Mourits-Andersen T, Olesen L.

Glycosylated haemoglobin HbA1c in iron- and vitamin B12 deficiency. J Intern Med. Brooks AP, Metcalfe J, Day JL, Edwards MS. A person with prediabetes has a good chance of reversing their high blood sugar levels and preventing diabetes from developing.

Read about more tips and strategies for managing prediabetes here. A1C level recommendations vary between individuals. People with more advanced diabetes will have higher A1C targets than healthy adults without diabetes. Factors such as life expectancy, treatment response, and medical history also have an impact.

A1C levels are a measure of blood glucose over 3 months. A doctor can use this measurement to monitor and diagnose diabetes. Strategies to manage blood sugar and A1C can include a varied eating plan, regular exercise, and following a diabetes treatment plan.

Having a snack before bed can help some people manage their blood sugar levels overnight, offsetting the dawn phenomenon and the Somogyi effect. The amount of sugar a person should consume varies, depending on their sex and age. In this article, we look at the recommended intake, as well as how….

Find out here about the differences and…. Hyperglycemia, or high blood sugar, can affect people with type 1 and type 2 diabetes. Learn about the symptoms, who is at risk, and when to consult a…. Researchers said baricitinib, a drug used to treat rheumatoid arthritis, showed promise in a clinical trial in helping slow the progression of type 1….

My podcast changed me Can 'biological race' explain disparities in health? Why Parkinson's research is zooming in on the gut Tools General Health Drugs A-Z Health Hubs Health Tools Find a Doctor BMI Calculators and Charts Blood Pressure Chart: Ranges and Guide Breast Cancer: Self-Examination Guide Sleep Calculator Quizzes RA Myths vs Facts Type 2 Diabetes: Managing Blood Sugar Ankylosing Spondylitis Pain: Fact or Fiction Connect About Medical News Today Who We Are Our Editorial Process Content Integrity Conscious Language Newsletters Sign Up Follow Us.

Medical News Today. Health Conditions Health Products Discover Tools Connect. How can you lower your A1C levels? Medically reviewed by Kim Rose-Francis RDN, CDCES, LD , Nutrition — By Jennifer Huizen — Updated on November 22, What is an A1C test?

Why reduce levels? Lifestyle tips Dietary tips Nutrition Understanding A1C levels Summary Tips for lowering A1C levels include dietary choices and exercise, as well as monitoring blood glucose regularly and following the treatment plan agreed with a doctor. Lifestyle tips. Dietary tips.

Understanding A1C levels. A1C value eAG value ADA diagnosis 5. A1C value eAG value ADA recommended goal for: 5. Diabetes Type 1 Type 2. How we reviewed this article: Sources. Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations.

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Hyperglycemia, or high blood sugar, can affect people with type 1 and type 2 diabetes. Learn about the symptoms, who is at risk, and when to consult a…. Researchers said baricitinib, a drug used to treat rheumatoid arthritis, showed promise in a clinical trial in helping slow the progression of type 1….

My podcast changed me Can 'biological race' explain disparities in health? Why Parkinson's research is zooming in on the gut Tools General Health Drugs A-Z Health Hubs Health Tools Find a Doctor BMI Calculators and Charts Blood Pressure Chart: Ranges and Guide Breast Cancer: Self-Examination Guide Sleep Calculator Quizzes RA Myths vs Facts Type 2 Diabetes: Managing Blood Sugar Ankylosing Spondylitis Pain: Fact or Fiction Connect About Medical News Today Who We Are Our Editorial Process Content Integrity Conscious Language Newsletters Sign Up Follow Us.

Medical News Today. Health Conditions Health Products Discover Tools Connect. How can you lower your A1C levels? Medically reviewed by Kim Rose-Francis RDN, CDCES, LD , Nutrition — By Jennifer Huizen — Updated on November 22, What is an A1C test? Why reduce levels? Lifestyle tips Dietary tips Nutrition Understanding A1C levels Summary Tips for lowering A1C levels include dietary choices and exercise, as well as monitoring blood glucose regularly and following the treatment plan agreed with a doctor.

Lifestyle tips. Dietary tips. Understanding A1C levels. A1C value eAG value ADA diagnosis 5. A1C value eAG value ADA recommended goal for: 5. Diabetes Type 1 Type 2. How we reviewed this article: Sources. Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations.

We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles.

You can learn more about how we ensure our content is accurate and current by reading our editorial policy. Share this article. Latest news Ovarian tissue freezing may help delay, and even prevent menopause.

RSV vaccine errors in babies, pregnant people: Should you be worried? Scientists discover biological mechanism of hearing loss caused by loud noise — and find a way to prevent it.

How gastric bypass surgery can help with type 2 diabetes remission. Atlantic diet may help prevent metabolic syndrome. Related Coverage. With HbA1c testing, can a diagnosis of diabetes mellitus be considered?

In January , the World Health Organisation WHO recommended that glycated Hemoglobin A1C HbA1c , a test that gives an overall picture of what average blood sugar levels have been over a period of weeks, could be used as an alternative to standard glucose measures to help indicate the presence of diabetes mellitus.

Since its introduction, not only has HbA1C testing has been found useful in determining the level of diabetic control but also, because of efficiency, has become an accepted method for confirming a diagnosis of diabetes mellitus.

Today, HbA1C levels of 6. What are the risks associated with prediabetic HbA1c levels below 6. HbA1C levels below 6. HbA1C levels in nondiabetic participants in the Atherosclerosis Risk in Community Study ARIC indicated a future risk for developing not only diabetes, but also coronary atherosclerotic heart disease CAD , ischemic stroke CVA and mortality from all causes.

HbA1C also appears to be an indicator of risk for development of macrovascular disease both CAD and ischemic stroke in nondiabetics. Are there also risks associated with HbA1C levels below 5 percent?

Although minimal, relative risk for mortality from all causes begins to rise at HbA1C levels above 5. Interestingly, those with HbA1C levels below 5 percent also appear to have a higher risk of mortality from all causes relative to those in the HbA1C 5. This results in a J-shaped mortality curve.

We know that HbA1C levels generally reflect a person's blood glucose levels over the previous eight to twelve weeks due to the attachment of hemoglobin to glucose. Therefore, since red blood cell survival time affects determination of HbA1C levels, alterations in the life of red blood cells may distort HbA1C values.

Many common situations can result in falsely depressed HbA1C levels including: rapid red blood cell turnover due to hemolysis; production of many new red blood cells through anemia treatment with iron, vitamin B 12, folic acid or erythropoietin; recent blood transfusion; and splenomegaly.

With such processes associated with rapid red blood cell turnover, splenomegaly, or the necessity for blood transfusion may well be indicative of underlying conditions associated with increased mortality. However, the J-shaped mortality curve remains after significant hematologic problems are excluded, suggesting that further evaluation of health problems associated with the low-normal glycemic state need to be investigated.

The glucose remains attached to the hemoglobin for the life of the red blood cell, or about 2 to 3 months. A blood test can measure the amount of glycosylated hemoglobin in the blood. The glycosylated hemoglobin test shows what a person's average blood glucose level was for the 2 to 3 months before the test.

This can help determine how well a person's diabetes is being controlled over time.