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Hemoglobin A1C
Aka: Hemoglobin A1C, Glycosylated Hemoglobin, HBA1C, HgbA1c
- Epidemiology
- Hemoglobin A1C may be important measure in non-diabetic
- Hemoglobin A1C associated mortality (contrast with <5)
- Relative Risk of Hemoglobin A1C 5.0 to 5.4
- All cause mortality: 1.41
- Cardiovascular mortality: 2.53
- Relative Risk of Hemoglobin A1C 5.4 to 6.9
- All cause mortality: 2.07
- Cardiovascular mortality: 2.46
- Relative Risk of Hemoglobin A1C 7.0 or higher
- All cause mortality: 2.64
- Cardiovascular mortality: 5.04
- References
- Khaw (2001) BMJ 322:15-8 [PubMed]
- Background
- Glycosylated Hemoglobin is not equivalent to A1C
- Hemoglobin A1C is 70% total Glycosylated Hemoglobin
- Causes: Falsely lower Hemoglobin A1C
- Acute blood loss
- Chronic Liver Disease
- Hemolytic Anemia
- HIV Antiretrovirals
- Pregnancy
- Vitamin E supplementation
- Vitamin C supplementation
- Causes: Falsely higher Hemoglobin A1C
- Aplastic Anemia
- Hyperbilirubinemia
- Hypertriglyceridemia
- Iron Deficiency Anemia
- Renal Failure
- Splenectomy
- Causes: Falsely modified Hemoglobin A1C (variably affected)
- Hemoglobinopathy
- Malnutrition
- Interpretation: Approximating Serum Glucose from A1C
- Hemoglobin A1C of 6% represents mean Glucose of 130
- Each 1% increase in A1C, Glucose increases 30
- Interpretation: Correlation to Mean Serum Glucose
- Hemoglobin A1C: 5.5% represents mean Glucose of 100
- Hemoglobin A1C: 7.0% represents mean Glucose of 150
- Hemoglobin A1C: 8.0% represents mean Glucose of 180
- Hemoglobin A1C: 9.0% represents mean Glucose of 220
- Hemoglobin A1C: 10.0% represents mean Glucose of 250
- Hemoglobin A1C: 11.5% represents mean Glucose of 300
- Hemoglobin A1C: 13.0% represents mean Glucose of 350
- Interpretation: Fasting vs post-prandial Hyperglycemia
- Hemoglobin A1C <7.3%:
- Postprandial Glucose: 30%
- Fasting Glucose: 70%
- Hemoglobin A1C 7.3-8.4%
- Postprandial Glucose: 50%
- Fasting Glucose: 50%
- Hemoglobin A1C 8.5-9.2%
- Postprandial Glucose: 55%
- Fasting Glucose: 45%
- Hemoglobin A1C 9.3-10.2%
- Postprandial Glucose: 60%
- Fasting Glucose: 40%
- Hemoglobin A1C >10.2%
- Postprandial Glucose: 70%
- Fasting Glucose: 30%
- References
- Monnler (2003) Diabetes Care 26:881-5 [PubMed]
- Interpretation: Diagnosis of Diabetes Mellitus
- Hemoglobin A1C <5.2%: No Diabetes Mellitus
- Test Sensitivity: 100%
- Hemoglobin A1C >6.5%: Diabetes Mellitus
- Test Specificity: 100%
- References
- Malkani (2011) Am J Med 124(5): 395-401 +PMID:21531226 [PubMed]
- Pippitt (2016) Am Fam Physician 93(2): 103-9 [PubMed]