Health and Fitness Information CenterHow A1c Works
A1c formation is proportional to the amount of available glucose. The
attachment of the glucose and hemoglobin molecule is relatively
irreversible, and it remains attached on the surface of the Red Blood Cell
(RBC) for the life span of the RBC (G + Hb = glycated hemoglobin
).2
Why A1c is Clinically Important |
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The clinical significance of A1c is well documented in such landmark diabetes clinical studies as the Diabetes Control and Complications Trial (DCCT), where a direct relationship of lowering A1c and mean blood glucose levels was linked to the prevention of chronic complications such as kidney, eye and nerve damage.3 The DCCT demonstrated that individuals who maintained their A1c levels at or about the upper limit of normal reduced, delayed or prevented complications by as much as 76% for retinopathy (eye disease), 60% for neuropathy (nerve disease) and 35% for nephropathy (kidney disease) while reducing their risk for proteinuria by as much as 65%. A1c provides a viable solution to meet the new NCQA/DQIP/and HEDIS 3.0 testing measures |
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A recent quality care study in a large HMO documented that A1c levels were not documented in more than 56% of members.5 Current National Institutes of Health (NIH) estimates that less than 25% of individuals with diabetes have routine A1c tests performed. Medicare has recently established outcomes measurement requirements for beneficiaries with diabetes that include hemoglobin A1c testing for the purpose of evaluating improvement in their health care status.6 (The American Diabetes Association (ADA) recommends monitoring A1c at least four times per year).7
2,11. W. Tietz, Ph.D., W.B: Fundamentals of Clinical Chemistry; Edited by
Norbert. Saunders Company: ISBN 0-7216-8866-7; pages: 401-421. 3. The DCCT
Research Group: The effect of intensive treatment of diabetes on the
development and progression of long-term complications of insulin-dependent
diabetes mellitus. N Engl J Med. 329: 977-86, 1993. 4. Document on file
DTI: Jay Skyler, MD: University of Miami School of Medicine, Richard
Eastman, MD., NIH (NIDDK), selected paper: Stylized report (DCCT
follow-up): Spring, 1996. 5. Anne L. Peters, M.D., Antonio P. Legorreta,
M.D., MPH, R. Clifford Ossorio, M.D., Mayer B. Davidson, M.D.: Quality of
Outpatient Care Provided to Diabetic Patients: A health maintenance
organization experience: Diabetes Care, Vol 19, Number 6, June 1996. 6.
Enhancement of Diabetes Policy in the Balanced Budget Act of 1997; HR Bill
15 & 58, Sec. 4105, C3, The Bureau of National Affairs, Inc.,
Washington, D.C. 20037: Special Supplement, p 116 of 528, American Diabetes
Association 1997. 7. American Diabetes Association: Position Statement:
Standards of care for patients with diabetes mellitus. Diabetes Care 1996.
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Hemoglobin A1cMaintaining good Hemoglobin A1c levels will help reduce your risk of diabetes complications. While daily blood glucose testing tells you what your blood sugar level is, a Hemoglobin A1c Test tells you your average blood sugar level over the past 2–3 months.
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