Pronounced H-B-A-one-C
Also known as Glycated haemoglobin, A1c, Three-month sugar test
HbA1c measures the proportion of haemoglobin that has sugar stuck to it, which reflects the average blood glucose over roughly the past three months. It needs no fasting and is used both to diagnose diabetes and to judge how well it is controlled.
Glucose in the blood attaches slowly and irreversibly to , and a red cell lives about 120 days. So the percentage of haemoglobin carrying sugar is a record of the average level over the life of those cells — weighted toward the most recent weeks, but immune to whether you skipped breakfast or ate a mithai yesterday. That is its great advantage over a single .
| Result | Per cent | mmol/mol |
|---|---|---|
| Normal | Below 5.7 | Below 39 |
| Prediabetes | 5.7–6.4 | 39–47 |
| 6.5 or above | 48 or above | |
| A common treatment target in diabetes | Around 7.0 or below | Around 53 or below |
HbA1c is unreliable wherever the life of the red cell is not normal, and this matters in Pakistan more than in the populations the test was validated in. Iron deficiency falsely raises it. Recent blood loss, haemolysis, thalassaemia and other haemoglobin variants, late pregnancy and advanced kidney disease can all falsely lower or distort it. Where any of those apply, glucose measurements are used instead.
Two practical notes. Because it moves slowly, there is no point repeating it more often than about every three months — a test at six weeks mostly measures the previous quarter. And a good HbA1c can hide wide swings between high and low readings that average out, which is why it is read alongside home glucose readings rather than in place of them.
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