Available literature demonstrates that hemoglobin A1c (HbA1c) level has received recommendations as a diagnostic test for diabetes due to its capacity to indicate how well controlled blood sugars have been over time (Liang et al., 2012). As suggested by these authors, HbA1c is essentially a marker of long-term glycemic exposure particularly in patients with microvascular diabetic complications such as retinopathy.
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It is very useful in the diagnosis and treatment of several forms of diabetic complications as it reflects an average blood glucose level over 2-3 month period of time (Liang et al., 2012).
It is a well known fact that improved glycaemic control forms a critical component in delaying the onset of diabetic complications, hence medical practitioners should use HbA1c to monitor the blood sugars as “…the Hb molecules have a stable adduct of glucose to the N-terminal valine chain [Hb chain (blood) – N-(1-deoxyfructos – 1-yl) Hb chain]” (John & English, 2012 p.1243).
In more simpler terms, it is well known that blood glucose tends to bind itself to the surface of Red Blood Cells (RBCs), and that the average life-span of a Red Blood cell is around 90-120 days or three-four months. The concept of HbA1c measures the numbers of RBCs with glucose attached to them to provide a basic understanding of how well controlled blood glucose levels are over the past three months.
This therefore implies that higher levels of glucose in the blood will be exhibited by the number of RBCs in the sampled blood with an appendage of glucose (Liang, 2012). Owing to its capacity for telling a longer period of blood sugar control, the examination of haemoglobin A1c is currently widely employed as a diagnostic testing tool for the assessment of the blood sugar (glycemic) control among patients presenting with diabetic complications (Wiwanitkit, 2012).
It has been mentioned that the average lifespan of the red blood cell is 90-120 days or three-four months, implying that persons with various diabetes complications such as diabetic retinopathy need to undertake the test after every three months to coincide with the average lifespan of the RBCs (Liang et al., 2012). However, available literature demonstrates that the test is very costly and it may be available in the developing countries for a limited number of people with diabetic and cardiovascular complications (Wiwanitkit, 2012).
Lastly, it is imperative to have a basic understanding of how the blood sugar goes up and down and how this is demonstrated in the HbA1c test. Blood glucose is bound to rise when the patient takes carbohydrate-containing foods, eats meals or snacks close to each other, experiences shifts in hormone levels, or lives a very inactive life.
In equal measure, the blood glucose level is likely to go down if the patient becomes physically active, takes appropriate diabetes medicines, and engages in concerted efforts to check his or her level of calorie uptake (Rose & Kitchell, 2008).
Taking alcohol on an empty stomach and exercising beyond what is medically acceptable for diabetic patients may lead to disastrous results in terms of lowering the blood glucose levels to the extreme. However, as mentioned earlier, the level of blood sugars will be exhibited by the number of RBCs in the sampled blood with an appendage of glucose when the HbA1c is performed on the patient (Liang et al., 2012).
Higher levels of glucose appendages in the RBCs will most probably demonstrate high and unsustainable levels of blood sugars that have the capacity to occasion or worsen diabetic complications.
John, G., & English, E. (2012). IFCC standardized HBA1c: Should the world be as one? Clinical Chemistry & Laboratory Medicine, 50(7), 1243-1248.
Liang, J., Zhou, N., Teng, F., Zou, C., Xue, Y., Yang, M., Song, H., & Qi, L. (2012). Hemoglobic A1c levels and aortic arterial stiffness: The cardiometabolic risk in Chinese (CRC) study. PLoS ONE, 7(8), 1-6.
Rose, E., & Kitchell, D. (2008). Does daily monitoring of blood glucose predict hemoglobin A1c levels. Journal of Family Practice, 52(6), 485-490.
Wiwanitkit, V. (2012). Correlation between hemoglobin A1c level and fasting blood glucose level: A summary on the reports in the setting of high prevalence of hemoglobin disorder. Scientific Journal of the Faculty of Medicine in Nus, 29(2), 89-92. Retrieved from https://publisher.medfak.ni.ac.rs/index.php/en/