Monitoring Your A1C Levels—What Goal to Shoot For?
For many years, A1C has been a key indicator of long-term blood glucose control, and most people have been encouraged to keep their A1C at 7 percent or less. Today, one A1C goal doesn't fit everyone's needs. What A1C level should you shoot for?
Measuring Your A1C
An A1C test gives you and your provider insight into all of your blood glucose ups and downs over the past two or three months. It's like the 24/7 video of your blood sugar levels. Observing your A1C results and your blood glucose (also known as blood sugar) results together over time are two of the key tools you and your health care provider can use to monitor your progress and revise your therapy as needed over the years.
Recent research is changing the way health professionals look at A1C levels. Instead of setting tight controls across the board, a healthy A1C level is now a moving target that depends on the patient. In the past, an A1C of 7 percent was considered a healthy goal for everyone. Yehuda Handelsman, M.D., medical director of the Metabolic Institute of America in Tarzana, California, says experts now recommend taking a patient-centered approach to managing A1C levels, which means evaluating goals based on individual diabetes management needs and personal and lifestyle preferences.
Current ADA Goals
The 2015 American Diabetes Association (ADA) Standards of Medical Care in Diabetes advise the following A1C levels:
• 6.5 percent or less: This is a more stringent goal. Health care providers might suggest this for people who can achieve this goal without experiencing a lot of hypoglycemia episodes or other negative effects of having lower blood glucose levels. This may be people who have not had diabetes for many years (short duration); people with type 2 diabetes using lifestyle changes and/or a glucose-lowering medication that doesn't cause hypoglycemia; younger adults with many years to live healthfully; and people with no significant heart and blood vessel disease.
• 7 percent: This is a reasonable A1C goal for many adults with diabetes who are not pregnant. At this level, studies have shown that people experience fewer long-term complications such as retinopathy and nerve damage if that target can be achieved and sustained over the years.
• 7.5 percent: This is the goal recommended for all children with diabetes (0 to 18 years old). It's important with children and their parents to balance the long-term health benefits of glucose control with the risks of hypoglycemia, especially in children younger than 6 years old who may be unable to recognize or articulate symptoms. (It is noted that a lower A1C goal of
• 8 percent or less: This is considered a less stringent goal. It may be appropriate for people with a history of severe hypoglycemia; those who have had diabetes for many years and have difficulty achieving tighter control; and people who are not expected to live many more years due to one or more diabetes-related complications or other medical problems.
How Often to Get A1C Checked
The frequency of your A1C tests depends on your diabetes goals, how well you're doing with your management, and your provider's guidance. If you've been recently diagnosed; made some changes in your diabetes management, like started a new glucose-lowering medication; or had a medical problem or surgery, you may need to have a your A1C checked quarterly. However, if your glucose levels and A1C are pretty stable, you may do well having your A1C checked just twice a year. Talk to your health care provider about how frequently you should have the test and your individual goal.
Interpreting A1C Research
Studies have shown that intensive glucose control in certain people—those who have had type 2 diabetes for several years and also had risk factors for or experienced a heart event—may increase the risk of death without significantly lowering the risk of cardiovascular disease.
In fact, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial had to be stopped prematurely in 2008 because the researchers found that people with type 2 diabetes who were aiming for intensive control—an A1C below 6.0 percent—were dying of all causes at a higher rate than those receiving standard therapy, an A1C target of 7.0-7.9 percent. The findings prompted experts to reconsider providing one target A1C goal for all adults living with diabetes.
Diagnosing Prediabetes with A1C
Since the ADA published the 2010 Standards of Medical Care, the A1C measure has been used to diagnose diabetes as well as to manage it. An A1C of 6.5 percent or higher can be used to diagnose diabetes. An A1C of 5.7 percent or lower means a person has normal blood sugar levels and doesn't have diabetes. If A1C is between 5.7 and 6.4 percent, this is now categorized as prediabetes—elevated blood sugar levels that aren't high enough to be diagnosed as diabetes. Having prediabetes greatly increases the risk of developing type 2 diabetes.
"We recommend that people with risk factors for type 2 diabetes be screened with the A1C test," says Yehuda Handelsman, M.D., medical director of the Metabolic Institute of America.
Over time, additional A1C results can reveal if someone with prediabetes is progressing toward diabetes or has already developed the disease. According to the 2015 Standards of Medical Care in Diabetes, the ADA recommends that people with the following situations be checked for diabetes or prediabetes (A1C is one test that can be used for diagnosis).
To Diagnose Prediabetes and Type 2 Diabetes
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Diabetes (type 2)*
A1C (done in a lab, not a home test)
*Lower glucose levels are used to diagnose gestational diabetes(during pregnancy).
Finding out you have an elevated A1C is a cue to take action. An A1C in the prediabetes range means you should strive to make changes in your lifestyle.
This article was reviewed by Hope Warshaw, R.D., CDE
Diabetic Living Magazine