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July 5, 2000

A1c (Glycohemoglobin, HgbA1c)

Question from Waterford, Michigan, USA:

I know how that HbA1c lab values very a lot from lab to lab and even within the same lab. This makes it somewhat difficult to compare how much better or worse my diabetes control is. Is there going to be anything mandated to remedy this situation some time in the future? And, how high is too high? My last A1c value was 11.4 with the normal range less than 7.0. That's almost 4.5 points over. To me it sounds unacceptable. What if it were 9.0? Is that more acceptable? I have been under the impression that as long as it doesn't go more than 2 percentage points over the normal non-diabetic range, then that would be quite acceptable. Of course being only 1 percent over would be much better. My endocrinologist didn't really tell me much about where it should be. She is probably assuming I know where it should be. When I had a 9.1%, I was told that it was acceptable because the normal for that lab was anything under 8%. I hope something is being done about all this chaos. Every time I have the A1c test done the normal range is reported as very different.


Unfortunately I don’t see much progress in the near future towards standardizing HgbA1c tests.

In the meantime, you should try to have your HgbA1c done in the same lab each time if possible so you can compare results (of course the labs sometimes switch methods). I think you should discuss with your own doctor your goals for HgbA1c. I usually say as close to non-diabetic as possible as long as the person isn’t having serious lows (which can “improve” the HgbA1C but cause other problems). Keep in mind, rarely there are conditions that can give falsely elevated or lowered hemoglobin A1C.

Personally, I think a good blood sugar record kept by the patient often gives more information than HgbA1c levels. HgbA1c levels are good to give you some indirect information about when you are not testing, but nothing beats frequent blood sugar testing to help you decide what to do to improve your control. Hopefully, the GlucoWatch, a wristwatch-like device that can measure blood sugar every 20 minutes, will be out soon. I think this information will be extremely helpful.