open access

Vol 10, No 3 (2021)
Review paper
Published online: 2021-05-31
Get Citation

Clinical Use and Limitation of Hemoglobin A1c Examination

Ketut Suastika
DOI: 10.5603/DK.a2021.0045
·
Clinical Diabetology 2021;10(3):299-306.

open access

Vol 10, No 3 (2021)
Review articles (submitted)
Published online: 2021-05-31

Abstract

Haemoglobin A1c (HbA1c/A1C) is a part of haemoglobin
(Hb) that binds to glucose through non-enzymatic
reactions. In general, HbA1c is used as a parameter for
diagnosis, target therapy and monitoring or prediction
of long-term complications of diabetes mellitus
(DM) outcome. However, HbA1c can also be used to
predict the incidence of DM and vascular outcomes
in those without DM. HbA1c above 6.5% is used as
the limit for diagnosing DM, and in general, HbA1c
< 7.0% is used as the target limit of therapy in adult
DM patients. As a parameter for the diagnosis of DM
and long-term monitoring, HbA1c has limitations
and advantages over blood glucose testing, because
HbA1c is strongly influenced by several conditions
that affect the life span of erythrocytes where Hb will
remain throughout the life of the cell. Likewise, HbA1c
cannot assess the variability of blood glucose levels
short-termly and cannot determine the presence of
hypoglycaemia. With all its limitations, now HbA1c has
been established as a parameter to diagnose DM and
the most reliable parameter in predicting the incidence
of chronic complications from DM.

Abstract

Haemoglobin A1c (HbA1c/A1C) is a part of haemoglobin
(Hb) that binds to glucose through non-enzymatic
reactions. In general, HbA1c is used as a parameter for
diagnosis, target therapy and monitoring or prediction
of long-term complications of diabetes mellitus
(DM) outcome. However, HbA1c can also be used to
predict the incidence of DM and vascular outcomes
in those without DM. HbA1c above 6.5% is used as
the limit for diagnosing DM, and in general, HbA1c
< 7.0% is used as the target limit of therapy in adult
DM patients. As a parameter for the diagnosis of DM
and long-term monitoring, HbA1c has limitations
and advantages over blood glucose testing, because
HbA1c is strongly influenced by several conditions
that affect the life span of erythrocytes where Hb will
remain throughout the life of the cell. Likewise, HbA1c
cannot assess the variability of blood glucose levels
short-termly and cannot determine the presence of
hypoglycaemia. With all its limitations, now HbA1c has
been established as a parameter to diagnose DM and
the most reliable parameter in predicting the incidence
of chronic complications from DM.

Get Citation

Keywords

HbA1c, predictor, diagnostic, prognostic, diabetes

About this article
Title

Clinical Use and Limitation of Hemoglobin A1c Examination

Journal

Clinical Diabetology

Issue

Vol 10, No 3 (2021)

Article type

Review paper

Pages

299-306

Published online

2021-05-31

DOI

10.5603/DK.a2021.0045

Bibliographic record

Clinical Diabetology 2021;10(3):299-306.

Keywords

HbA1c
predictor
diagnostic
prognostic
diabetes

Authors

Ketut Suastika

References (33)
  1. Schechter AN. Hemoglobin research and the origins of molecular medicine. Blood. 2008; 112(10): 3927–3938.
  2. Gupta S, Jain U, Chauhan N. Laboratory Diagnosis of HbA1c: A Review. J Nanomed Res. 2017; 5(4).
  3. Clark SLD, Santin AE, Bryant PA, et al. The initial noncovalent binding of glucose to human hemoglobin in nonenzymatic glycation. Glycobiology. 2013; 23(11): 1250–1259.
  4. Hörber S, Achenbach P, Schleicher E, et al. Harmonization of immunoassays for biomarkers in diabetes mellitus. Biotechnol Adv. 2020; 39: 107359.
  5. Sherwani SI, Khan HA, Ekhzaimy A, et al. Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients. Biomark Insights. 2016; 11: 95–104.
  6. Weykamp C. HbA1c: a review of analytical and clinical aspects. Ann Lab Med. 2013; 33(6): 393–400.
  7. Little RR, Rohlfing C, Sacks DB. The National Glycohemoglobin Standardization Program: Over 20 Years of Improving Hemoglobin A Measurement. Clin Chem. 2019; 65(7): 839–848.
  8. Bonora E, Kiechl S, Mayr A, et al. High-normal HbA1c is a strong predictor of type 2 diabetes in the general population. Diabetes Care. 2011; 34(4): 1038–1040.
  9. Zhang X, Gregg EW, Williamson DF, et al. A1C level and future risk of diabetes: a systematic review. Diabetes Care. 2010; 33(7): 1665–1673.
  10. Jang JY, Moon S, Cho S, et al. Visit-to-visit HbA1c and glucose variability and the risks of macrovascular and microvascular events in the general population. Sci Rep. 2019; 9(1): 1374.
  11. Cavero-Redondo I, Peleteiro B, Álvarez-Bueno C, et al. Glycated haemoglobin A1c as a risk factor of cardiovascular outcomes and all-cause mortality in diabetic and non-diabetic populations: a systematic review and meta-analysis. BMJ Open. 2017; 7(7): e015949.
  12. Mitsios JP, Ekinci EI, Mitsios GP, et al. Relationship Between Glycated Hemoglobin and Stroke Risk: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2018; 7(11).
  13. Ghouse J, Skov MW, Kanters JK, et al. Visit-to-Visit Variability of Hemoglobin A in People Without Diabetes and Risk of Major Adverse Cardiovascular Events and All-Cause Mortality. Diabetes Care. 2019; 42(1): 134–141.
  14. Perkumpulan Endokrinologi Indonesia (Perkeni). Pedoman Pengelolaan dan Penegahan Diabetes Melitus. Tipe 2 Dewasa di Indonesia 2019. Penerbit PB Perkeni. Jakarta, 2019.
  15. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: . Diabetes Care. 2021; 44(Suppl 1): S15–S33.
  16. Davies P, Chellamuthu P, Patel V. How to Diagnose Diabetes? Practicalities and Comments on the WHO Provisional Recommendation in Favour of HbA1c. Brit J Diabetes Vasc Dis. 2010; 10(6): 261–264.
  17. American Diabetes Association (ADA). Glycemic Targets: Standards of Medical Care in Diabetes—2021. Diabetes Care. 2020; 44(Suppl 1): S73–S84.
  18. American Diabetes Association (ADA). Older Adults: Standards of Medical Care in Diabetes—2021. Diabetes Care. 2020; 44(Supplement 1): S168–S179.
  19. Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000; 321(7258): 405–412.
  20. Rawshani A, Rawshani A, Franzén S, et al. Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2018; 379(7): 633–644.
  21. Wang H, Shara NM, Lee ET, et al. Hemoglobin A1c, fasting glucose, and cardiovascular risk in a population with high prevalence of diabetes: the strong heart study. Diabetes Care. 2011; 34(9): 1952–1958.
  22. Menon V, Kumar A, Patel DR, et al. Impact of Baseline Glycemic Control on Residual Cardiovascular Risk in Patients With Diabetes Mellitus and High-Risk Vascular Disease Treated With Statin Therapy. J Am Heart Assoc. 2020; 9(1): e014328.
  23. Gu J, Pan JA, Fan YQ, et al. Prognostic impact of HbA1c variability on long-term outcomes in patients with heart failure and type 2 diabetes mellitus. Cardiovasc Diabetol. 2018; 17(1): 96.
  24. Chiu WC, Lai YR, Cheng BC, et al. HbA1C Variability Is Strongly Associated with Development of Macroalbuminuria in Normal or Microalbuminuria in Patients with Type 2 Diabetes Mellitus: A Six-Year Follow-Up Study. Biomed Res Int. 2020; 2020: 7462158.
  25. Critchley JA, Carey IM, Harris T, et al. Variability in Glycated Hemoglobin and Risk of Poor Outcomes Among People With Type 2 Diabetes in a Large Primary Care Cohort Study. Diabetes Care. 2019; 42(12): 2237–2246.
  26. Ceriello A, Ofstad AP, Zwiener I, et al. Empagliflozin reduced long-term HbA1c variability and cardiovascular death: insights from the EMPA-REG OUTCOME trial. Cardiovasc Diabetol. 2020; 19(1): 176.
  27. Pinto MV, Rosa LC, Pinto LF, et al. HbA1c variability and long-term glycemic control are linked to peripheral neuropathy in patients with type 1 diabetes. Diabetol Metab Syndr. 2020; 12: 85.
  28. Lui DTW, Lee CH, Chan YH, et al. HbA1c variability, in addition to mean HbA1c, predicts incident hip fractures in Chinese people with type 2 diabetes. Osteoporos Int. 2020; 31(10): 1955–1964.
  29. Zhao MJY, Prentice JC, Mohr DC, et al. Association between hemoglobin A1c variability and hypoglycemia-related hospitalizations in veterans with diabetes mellitus. BMJ Open Diabetes Res Care. 2021; 9(1).
  30. Fayyaz B, Rehman HJ, Minn H. Interpretation of hemoglobin A1C in primary care setting. J Community Hosp Intern Med Perspect. 2019; 9(1): 18–21.
  31. Sacks DB. A1C versus glucose testing: a comparison. Diabetes Care. 2011; 34(2): 518–523.
  32. Chehregosha H, Khamseh ME, Malek M, et al. A View Beyond HbA1c: Role of Continuous Glucose Monitoring. Diabetes Ther. 2019; 10(3): 853–863.
  33. Unnikrishnan R, Anjana RM, Mohan V. Drugs affecting HbA1c levels. Indian J Endocr Metab. 2012; 16(4): 528.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

 

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl