What is A1C(hb1ac) test, its levels, its normal range, its cost and more

Medically Reviewed By
Dr. Ragiinii Sharma

Written By Prekshi Garg
on Oct 17, 2022

Last Edit Made By Prekshi Garg
on Mar 17, 2024

Increase in the levels of blood sugar of a huge number of people has emerged as one of the most important concerns in recent times, especially in the people diagnosed with diabetes. The most accurate and reliable method for the diagnosis and monitoring of your diabetes is the A1C (hb1ac) test. The A1C (hb1ac) lab test report shows the average level of sugar present in your blood over the past 3 months. The A1C (hb1ac) lab test results do not depend on the food that you have had before the test. Certain factors that have an effect on your test results include your age and whether or not you have had anaemia at some point.

In this article, let us discuss about the most reliable sugar blood test, that is, A1C (hb1ac) test including A1C meaning, the A1C (hb1ac) range, target value, who should get it done, when should you consult a doctor, and the ways in which you can help get a reduced A1C (hb1ac) levels.

What is the A1C (hb1ac) Test?

The A1C (hb1ac) test is an important diagnostic tool for diabetes that reports the average level of sugar present in your blood over the past 3 months. It is an important and accurate parameter because it gives the result of your blood sugar levels in the past 3 months. The test results of the A1C (hb1ac) test are not dependent on what you have eaten before the test, it majorly depends on other crucial factors like your age and whether or not you have anaemia.

What is the principle of the A1C (hb1ac) test?

The A1C (hb1ac) test is based on the association of sugar molecules with haemoglobin. Sugar on entering your bloodstream attaches to the haemoglobin (haemoglobin is a protein present in your red blood cells and is responsible for transporting oxygen and carbon-di-oxide in your body). There is some sugar attached to the haemoglobin molecule in every individual. However, people with diabetes or high blood sugar have increased levels of sugar attached to the haemoglobin. The A1C (hb1ac) test gives the percentage of red blood cells that contain sugar-coated haemoglobin.

Who should get the A1C (hb1ac) test done?

The A1C (hb1ac) test in general is conducted for either the diagnosis of diabetes or for the management of the condition. There are certain groups of people where regular A1C (hb1ac) tests are recommended because they are at a higher risk of developing diabetes. The people who should get the A1C (hb1ac) test done include:

You should definitely get the test done if you are above 45 years of age
If you are overweight and below 45 years of age
If you have risk factors associated with diabetes
If you have had gestational diabetes in the past
If you fall into the category of prediabetic people
Get the test done to know how well your body is responding to the medication plan.

Diabetes is a lifelong condition. You cannot treat diabetes completely but you can manage the condition by managing blood sugar levels effectively to have a good quality of life. For proper management of diabetes or for its diagnosis, the A1C (hb1ac) lab test is the test of choice. It is very important to get an early diagnosis of the disease so that it can be effectively managed. The undiagnosed or unmanageable diabetes can lead to severe life threatning complications. Therefore, make sure that you get a timely diagnosis of diabetes done to avoid future life threatening complications.

What is the normal A1C (hb1ac) level?

The A1C (hb1ac) test reports the level of sugar present in your blood in the form of percentages. The normal or optimum levels of blood sugar levels are different in normal, prediabetic, and diabetic people. Therefore, according to the American Diabetes Association (ADA) and the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), the A1C (hb1ac) normal range in non-diabetic, diabetic, and prediabetic people are summarised in the table below:

S.No.	Group	Blood Sugar Level
1.	Healthy (Non-diabetic)	Less than 5.7%
2.	Prediabetic	5.7% to 6.4%
3.	Diabetic	6.5% or more

A1C (hb1ac) calculation chart

The percentage values depicted in the A1C (hb1ac) test report are often confusing. Values of blood sugar levels in SI units are more easily acceptable and understandable. Therefore, for your ease, the A1C (hb1ac) levels in percentage are converted into mmol/L, mmol/mol, and mg/dL in the table below.

S.No.	Blood Sugar Level
In %	In mmol/ mol	In mmol/L	In mg/dL
1.	5	31	5.4 (4.2 - 6.7)	97 (76 - 120)
2.	6	42	7 (5.5 - 8.5)	126 (100 - 152)
3.	7	53	8.6 (6.8 - 10.3)	154 (123 - 185)
4.	8	64	10.2 (8.1 - 12.1)	183 (147 - 217)
5.	9	75	11.8 (9.4 - 13.9)	212 (170 - 249)
6.	10	86	13.4 (10.7 - 15.7)	240 (193 - 282)
7.	11	97	14.9 (12.0 - 17.5)	269 (217 - 314)
8.	12	108	16.5 (13.3 - 19.3)	298 (240 - 347)
9.	13	119	18.1 (15 - 21)	326 (260 - 380)
10.	14	130	19.7 (16 - 23)	355 (290 - 410)
11.	15	140	21.3 (17 - 25)	384 (310 - 440)
12.	16	151	22.9 (19 - 26)	413 (330 - 480)
13.	17	162	24.5 (20 - 28)	441 (460 - 510)
14.	18	173	26.1 (21 - 30)	470 (380 - 540)
15.	19	184	27.7 (23 - 32)	499 (410 - 570)

What can affect the A1C (hb1ac) test reports?

There are certain factors that can affect the test results of A1C (hb1ac) by either increasing or decreasing the levels. These factors include:

If you have severe anemia
If you are diagnosed with liver disease or kidney failure
If you have a different or less common type of hemoglobin
If you are diagnosed with any blood disorder like thalassemia or sickle cell anemia
If you have had severe blood loss or blood transfusion in the past
If you are on medicines like opioids or for HIV infection
If you have had an early or late pregnancy in your life

What should be your A1C (hb1ac) goal or target?

Your normal A1C (hb1ac) target depends on several factors. Therefore, there cannot be an ideal A1C (hb1ac) target common for all people. In general, the target A1C (hb1ac) value depends on the following factors:

Your overall health
Your age
Stage of your life, that is, whether you are pregnant or not
The years for which you have had diabetes
Any adverse effects from the treatment in the past like hypoglycemia or low blood sugar levels
The treatment plan which has been prescribed to you
Any complications that you have had in the past due to diabetes
Your personal preferences and treatment priorities

If you are young and have along life expectancy
If you have been recently diagnosed with diabetes
If you have managed your diabetes effectively through metformin alone or lifestyle changes
If you have an overall good health

A 7.0-8.5% A1C target levels are generally set for the following category of people:

If you are old and have a short life expectancy
If you have been diagnosed with diabetes for several years
If your diabetes is difficult to manage even after prescribing multiple medicines
If you have had adverse effects of diabetes treatment in the past like hypoglycemia
If you have experienced complications due to diabetes in the past
If you are diagnosed with underlying chronic health conditions

When should you consult a doctor?

Proper and regular doctor consultation is very important to manage diabetes effectively. Make sure that you consult your doctor positively under the following conditions:

If you have doubts or concerns related to your ongoing treatment plan
If you find it hard to keep your blood sugar levels within the targeted range
If you experience symptoms of low or high blood sugar levels
If you think or feel that you have complications related to diabetes

The symptoms of high blood sugar that you must look for and consult a doctor if you observe them in yourself are:

Unusual thirst
Fatigue
Blurred vision
Frequent urination.

On the other hand, the symptoms of low blood sugar levels that you may experience even after being a diabetic due to the side effect of certain medicines are:

Sweating
Shaking
Hunger
Dizziness
Confusion
Irritation
Anxiety
Nervousness

Make sure that you consult a doctor if you observe any of the symptoms which are stated above.

How can I reduce the A1C (hb1ac) value?

It is important to reduce the levels of A1C (hb1ac) to slow down the progression of diabetes and prevent fatal complications as well as cardiovascular diseases and nerve damage. Therefore, you must always aim to reduce your A1C (hb1ac) levels. This can be done through lifestyle and dietary modifications.

Lifestyle modifications

The lifestyle changes that you must include in your daily life to reduce A1C (hb1ac) levels are:

Indulge yourself in at least 150 minutes of physical exercise every week.
Keep yourself moving by performing your daily household chores
Monitor your blood glucose levels at regular intervals to meet your target range
Include medicines and lifestyle therapies in your treatment plan
Manage your weight efficiently
Track your progress so that you stay motivated throughout your journey

Dietary modifications

Diet plays a crucial role in managing your blood sugar levels. Therefore, you must take care of what you eat the whole day to reduce your blood sugar levels considerably. Generally, a diet that is low in salt, sugar, carbohydrate, and fat intake is recommended for people diagnosed with diabetes. Your diet must also be rich in vegetables and fruits. The dietary tips that can help you reduce your A1C (hb1ac) levels considerably are:

Eat something in every 3-5 hours regularly
Be careful about the portion sizes that you take, that is, eat small portions of snacks and meals.
Plan what you want to eat before hand only
Do not take all carbohydrate rich food at one go. Instead, spread carbohydrate rich food throughout your daily diet.
Keep a track on your medicines, food, and exercise
Choose whole food and less-processed food like fruits, whole grains, vegetables, nuts, and legumes
Ensure that you have a balanced diet throughout the day.

What is the cost of the A1C (hb1ac) test?

The A1C (hb1ac) test cost varies depending upon the pathology centre that you choose to get your test done. At Redcliffe labs, the cost of an A1C (hb1ac) test is Rs 299/- approximately all across the country.

Takeaway

You must always monitor and control your blood sugar levels especially if you are a diabetes patient. The A1C (hb1ac) test accurately measures the level of blood glucose in percentage. It represents the aggregate blood sugar levels present within a span of three months. Now that you know how important the A1C (hb1ac) test is, make sure that you get it done frequently and at regular intervals. Also, try maintaining your A1C (hb1ac) levels within the target range by including the lifestyle and dietary modifications discussed earlier in the article.

Frequently Asked Questions (FAQs)

Is the daily self-monitoring of blood sugar level enough?

No, daily self monitoring gives you the sugar levels for that day only and it is highly dependent upon the food that you take. The A1C (hb1ac) test is necessary as it calculates your blood sugar levels for the complete 3 months.

Is fasting required before the A1C (hb1ac) test?

No, you don't need to fast before your sample is collected for the A1C (hb1ac) test. The test results will not be affected by what you eat before the A1C (hb1ac) test.