Glycated hemoglobin (HbA1c) serves as a crucial measure to determine how well diabetes is managed. The measurement serves as an indicator of blood sugar alterations over time while also showing strong correlations with diabetic complication risks. HbA1c serves as a vital measurement tool for assessing diabetes management levels. HbA1c develops as a result of glucose binding to hemoglobin to produce a unique compound known as glycated hemoglobin. Doctors utilize HbA1c levels to assess diabetic patients' glycemic control and estimate their likelihood of developing complications.
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Physiological Activity of Glycosylated Hemoglobin (HbA1c)
The compound glycated hemoglobin (HbA1c) forms when hemoglobin binds with glucose and serves as a primary tool for assessing diabetic patients' blood sugar control. HbA1c does not function as a physiologically active substance but its formation and level changes serve as indicators for metabolic state and glucose metabolism. Glycated hemoglobin represents the chemical bonding between glucose molecules and hemoglobin within red blood cells. HbA1c reflects average blood sugar levels from the past 2 to 3 months because red blood cells live for 120 days.
Fig 1. Glycated hemoglobin (HbA1c) formation (Sherwani, S., et al. 2016).
Long-term Monitoring of Blood Sugar Levels
By monitoring HbA1c levels, the patient's blood sugar control can be understood and the treatment plan can be adjusted according to the results.
Association with Diabetic Complications
Controlling HbA1c levels within a certain range can effectively reduce the risk of these complications.
Impact on Blood Rheology
Increases in HbA1c may affect the shape and function of red blood cells, thereby affecting blood fluidity and microcirculation, which may, to some extent, aggravate complications in diabetic patients.
Inflammation and Oxidative Stress
High HbA1c levels are associated with increased chronic inflammation and oxidative stress, which may lead to tissue damage and the development of diabetic complications.
HbA1c Testing Principle
HbA1c testing is an important part of diabetes management. Normally, HbA1c levels should be kept within a reasonable range (generally recommended to be <7%) to reduce the risk of diabetes-related complications. Since it reflects blood sugar levels over the past few months, it can better reflect the patient's long-term blood sugar management effect. HbA1c levels are closely related to the risk of diabetic complications (such as cardiovascular disease, nephropathy, retinopathy, etc.). Higher HbA1c levels are generally associated with a higher risk of complications. When blood sugar rises, glucose in the blood naturally binds to hemoglobin to form glycated hemoglobin. The higher the blood sugar, the more it binds, and the higher the HbA1c value.
HbA1c and Diabetes
By monitoring HbA1c levels, doctors can adjust treatment plans based on the patient's specific situation, such as changing diet, increasing exercise, or adjusting medication dosages if necessary. HbA1c can also be used for early screening of diabetes. If the HbA1c level is between 5.7% and 6.4%, this may indicate prediabetes, meaning the patient is at risk of developing type 2 diabetes.
| HbA1c level |
Meaning |
| < 5.7% |
Normal |
| 5.7% - 6.4% |
Prediabetes (Improper Glucose Tolerance) |
| ≥ 6.5% |
Can be diagnosed as diabetes |
HbA1c ≥ 6.5% can be used to diagnose diabetes. Compared with fasting blood sugar or oral glucose tolerance test (OGTT), HbA1c is more stable and is not affected by short-term diet and mood fluctuations.
Why is HbA1c the "Barometer" of Diabetes Management?
- Reflecting the effect of long-term blood sugar control: Unlike blood glucose meters that can only reflect blood sugar at the time, HbA1c records the average blood sugar level over the past few months.
- Predicting the risk of complications: The higher the HbA1c, the higher the risk of chronic complications such as retinopathy, nephropathy, and neuropathy.
- Guiding treatment plan adjustments: Doctors will judge whether the drug is effective and whether the diet or exercise plan needs to be adjusted based on the changes in HbA1c.
Control Target Recommendations
- For most patients with type 2 diabetes, the HbA1c control target is: < 7.0%
- For young patients with a short course of disease and no complications, the target can be more stringent (such as < 6.5%).
- For the elderly or those with severe complications, the target can be appropriately relaxed (such as < 8.0%).
Ways to Lower HbA1c
- Eat a healthy diet: control carbohydrates and increase dietary fiber intake.
- Exercise regularly: aerobic exercise + strength training.
- Take medication on time: take hypoglycemic drugs or insulin as prescribed by your doctor.
- Monitor blood sugar: keep abreast of blood sugar fluctuation trends.
Glycated hemoglobin serves as a crucial instrument to diagnose diabetes and manage its treatment. Doctors and patients can more accurately assess disease progression and control through HbA1c monitoring. Maintaining HbA1c levels leads to delayed diabetes progression and a substantial decrease in complication risks.
References
- Weykamp, C., et al. HbA1c: a review of analytical and clinical aspects. Annals of laboratory medicine. 2013, 33(6): 393.
- Sherwani, S., et al. Significance of HbA1c test in diagnosis and prognosis of diabetic patients. Biomarker insights. 2016, 11: BMI-S38440.
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