Keeping track of your blood sugar levels is an important part of staying in control of type 2 diabetes. One of the main ways to do this is through an A1c test. But what exactly is the A1c test, and what numbers should you aim for? In this article, we’ll dive into these questions and more.

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What Does the A1c Test Measure?

A hemoglobin A1c test, often abbreviated as A1c or HbA1c, measures your average blood glucose (blood sugar) levels over the last two or three months. The glucose in your body sticks to hemoglobin in your bloodstream. If you have higher amounts of glucose in your blood, more of it will stick to the hemoglobin. Glucose can stick to your hemoglobin for about three months, which is the lifespan of a red blood cell.

To perform an A1c test, your doctor will take a blood sample. It may be tested in the office or sent to a lab. A1c test results are reported as a percentage. A higher percentage may mean that you’re at higher risk for diabetes-related complications.

Unlike daily blood glucose checks, which show your blood sugar at a specific moment, the A1c test gives a broader picture of how well your blood sugar has been controlled over time. Even if you get regular A1c tests, you will probably still need to check your blood sugar at home daily with a blood glucose monitor or device.

When A1c Testing Is Recommended

An A1c test is important for managing diabetes because it helps you and your healthcare provider understand how well your current treatment plan is working. If you’re meeting your treatment goals, you’ll most likely get an A1c test about twice a year, or every six months. However, if your A1c was higher than expected or you’ve recently changed medications, you may need to repeat testing every three months.

An A1c test can also be used to diagnose diabetes or find out if someone has prediabetes, which means they’re more likely to develop diabetes. If you’re 35 or older, you don’t exercise often, or you have obesity or a family history of diabetes, your healthcare provider may have you do an A1c test.

Ideal A1c Numbers

For most adults with diabetes, the American Diabetes Association recommends an A1c goal of less than 7 percent.

It’s important to know that ideal A1c targets can vary for each person. Factors like age, overall health, and other risk factors all play a role. For example, people with diabetes who are pregnant or planning to become pregnant should try to keep their A1c level as close to normal as possible. Children with diabetes may have a looser target range to keep them safe.

Risks of High A1c Levels

If you have high A1c levels, it means that your blood sugar has been too high over the past few months. This can lead to serious health problems and increase the risk of diabetes-related complications such as:

• Heart disease
• Nerve damage, also known as neuropathy
• Kidney disease or problems, like nephropathy
• Retinopathy, or vision loss due to diabetes
• Stroke

Keeping your A1c at a healthy level is essential for preventing these issues and staying healthy overall. However, some people may get results that aren’t accurate — similar to getting a false high reading on a blood sugar test.

Risks of Low A1c Levels

While it’s important to keep your A1c levels low, trying too hard to lower them can also be dangerous. If your blood sugar gets too low, it can cause hypoglycemia. Hypoglycemia can lead to symptoms like dizziness, confusion, or even fainting.

Having lower A1C levels and hypoglycemia is especially risky for older adults and those with other health conditions. Sometimes, doctors may set the A1c goal for these groups of people at less than 8 percent. Because of this, it’s important to find the right balance and avoid pushing your A1c levels too low.

Personalized A1c Goals

Because of the risks that come with both a high A1c and an overly aggressive control of A1c, it’s important to work with your healthcare provider to set personalized A1c goals. Keep in mind that these goals may change over time.

To find the best target for you, your doctor will look at factors like your age, overall health, and lifestyle. This helps make sure that your diabetes management plan is both safe and effective. Remember, A1c goals are different for everyone, and they don’t tell the whole story about how healthy you are.

While the general A1c goal for most adults with diabetes is below 7 percent, individual targets may vary. Managing diabetes is a journey, and your A1c levels are just one part of it.

Always talk to your doctor about your A1c goals and any concerns you have. Your healthcare provider can help you understand your test results and make changes to your treatment plan as needed. Regular checkups and open communication with your doctor are key to staying healthy and managing your diabetes safely.

A1c vs. GMI: Levels, Differences, and Testing Frequency

Both A1c and the glucose management indicator (GMI) are used to assess how well your blood sugar is managed over time, but they gather information in different ways. The A1c test is a lab test that measures your average blood glucose over the past two to three months based on the amount of sugar attached to your hemoglobin. Doctors recommend that most people with diabetes get their A1c checked at least twice a year, or more often if their treatment changes or their blood sugar is not well controlled. GMI, on the other hand, is calculated from the average glucose readings collected by a continuous glucose monitor (CGM) over the past 14 days or more. GMI estimates what your A1c could be if your current glucose patterns continue.

The main difference is that A1c reflects a longer-term average and is not affected by day-to-day changes, while GMI provides a more immediate, actionable view based on recent data from your CGM. This can be especially helpful for making adjustments between A1c lab tests. However, A1c can be influenced by conditions that affect red blood cells, such as anemia, whereas GMI is only affected by glucose readings. Using both A1c and GMI can help you and your doctor get a fuller picture of your blood sugar control and make informed decisions about your diabetes management.

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