Hemoglobin A1c, or HbA1c, is the compound formed in the blood when a hemoglobin molecule in a red blood cell binds with a glucose molecule. The more glucose that enters the bloodstream, the higher the amount of HbA1c.

Measuring the percentage of HbA1c in the blood provides information about the average blood glucose levels over the prior few months. This test can be used by a health care professional, along with other tests and a physical exam, to help diagnose type 2 diabetes and prediabetes and for diabetes management.

How to read your results

You can access your HbA1c results by clicking on the “hbA1c” tab at the top of your “my Test Results” page.

The result page will look as follows, with your current value indicated in the graph on the left, and all results plotted by time in the chart on the right.

NOTE: The image below is for demonstration only and does not reflect your personal results.

Below this you will find a table of your latest and past HbA1c results. The latest result will be at the top.

What HbA1c level do you want to aim for?

For individuals without diabetes, an HbA1c result of less than 5.7% is indicative of a low risk, while the range of 5.7% – 6.0% is indicative of an increased risk of developing diabetes. An HbA1c result of greater than 6.5% is usually related to a diagnosis of diabetes.

Any HbA1c results that are above 7.0% or below 4.5% are considered critical values as they are very high or low compared to the normal reference range and could indicate a health issue. These results are automatically re-tested by the laboratory to confirm that the result was still in the critical range. It is recommended that these critical value results are discussed with a healthcare provider soon after receiving them.

Levels above 7.0% are associated with an increased risk of complications among diabetics, including eye, kidney, and heart disease, nerve damage, and stroke.

IMPORTANT NOTE: Some things can cause falsely low HbA1c levels, such as certain medications, high triglycerides, and liver disease. Deficiency of iron or vitamin B12 may cause falsely high HbA1c levels. See below for more details.

What could cause an inaccurate HbA1c result?

Several factors can affect the accuracy of the A1c test result:

• blood disorders such as sickle cell disease, thalassemia, and hemolytic anemia (in which the lifespan of red blood cells is shorter) can lead to falsely low HbA1c
• iron deficiency anemia (and other conditions in which the lifespan of the red blood cells is increased) can lead to a falsely high HbA1c
• individuals from an African, Mediterranean, or Southeast Asian decent may have certain uncommon forms of hemoglobin which can lead to falsely low or high HbA1c levels
• certain kidney and liver diseases may also affect the accuracy of the test, as can recent blood loss or transfusion

Learn more here.

What can you do if your HbA1c result is too high?

If the HbA1c level comes back too high, it indicates that the blood sugar overall needs to be lowered. Diet, lifestyle, and supplements can all be helpful for lowering blood sugar and, therefore, HbA1c.

Diet
Decreasing consumption of sugar and starchy carbohydrates (foods that have a high glycemic index and are more likely to cause a spike in blood sugar) and increasing intake of whole grains and fiber (and other foods that have a low glycemic index which are less likely to raise blood sugar) can help to control blood sugar levels, as can eliminating trans-fats and ultra-processed foods.

For a list of foods and their glycemic index value, visit https://glycemic-index.net/glycemic-index-chart/ or download a glycemic index app to learn how different foods affect your blood sugar.

Physical Activity
Exercise can also help manage blood sugar levels and decrease insulin resistance, as can lowering levels of inflammation in the body. Weight training, cardio, and exercises to improve balance and flexibility can also positively assist in blood sugar health, weight management, and improve mood.

Supplementation
Supplements such as those high in antioxidants, vitamin D, and omega-3 fatty acids have shown to help the body manage blood sugar levels. Supplementing with omega-3s DHA and EPA to keep the AA:EPA ratio below 3 and C-reactive protein (hsCRP) levels low, and supplementing to ensure that the vitamin D serum level (as 25(OH)D) is at least 40 ng/ml (100 nmol/L), will also help to maintain healthy blood sugar levels and decrease inflammation. Additional supplements to consider include those high in polyphenols, such as those made from Maqui berry extract, green tea, and other dark berries.

Track Blood Sugar Regularly
Using a Continuous Glucose Monitoring Device (CGM) can help you track how your blood sugar is affected by foods, exercise, and stress, as is understanding how to correct for each of these factors. Bolusing and correcting for carbs if on insulin is key to lowering HbA1c levels. If not on insulin, notice how exercise and certain foods affect blood glucose over time (pizza is a great example of a food that can have a prolonged effect) so that adjustments in diet and activity can also be made.

Lifestyle
Stress and hormones can play a role in blood sugar health, as can getting good sleep and getting and keeping your body weight in a healthy range.

Ask for help and seek medical advice along the way as needed.

How long should you wait to re-test your levels?

The American Diabetes Association recommends that diabetics measure their HbA1c level every 3-6 months. This same recommendation could also be suitable for individuals whose levels are out of range. Individuals without any concern for blood sugar health may choose to measure their levels once per year or less often.

Is there a relationship between vitamin D status and HbA1c level?

A 2019 study among adolescents diagnosed with Type 1 Diabetes (T1D) found an inverse, linear correlation between the HbA1c values and vitamin D levels (as vitamin D levels increased, HbA1c levels decreased) for those with T1D. While this finding was statistically significant within the T1D group, there was no correlation in the healthy, non-T1D control group.

Learn more about the study here.

What are the HbA1c levels of other participants?

Among the 233 participants who had tested their Hemoglobin A1c levels at the time of analysis, the average level was 5.2%. As you can see from the chart below, 75% of these participants have levels in the normal range, 19% have levels in the range indicating prediabetes, and 6% have levels in the range indicating diabetes.

Additionally, among those who completed two or more tests, 73% of those with levels 5.7% or higher (prediabetes or diabetes) lowered their hemoglobin A1c levels after their first test.

Questions?

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