A1C testing

An A1C test, also known as a Hemoglobin A1C (HbA1C) test is an essential tool to measure your risk of diabetes— and if you have diabetes, an A1C test can help you monitor your condition and adjust your diabetes management plan accordingly, notes the National Library of Medicine (NLM).

What is an A1C test?

An A1C test can help you see how your lifestyle or medications (or both) are impacting your blood sugar levels. This information helps you make choices that affect your future health outcomes—such as dietary changes or adjusting your diabetic medications. Keeping your average blood sugar low can help you avoid future health events like a heart attack, stroke, or kidney disease, notes the NLM.

What’s measured by an A1C test?

Certain proteins known as hemoglobin are a part of your red blood cells. Hemoglobin works hard, ferrying oxygen and carbon dioxide molecules around your body. In the process of their daily work, these hemoglobin proteins become decorated with sticky glucose molecules as they travel throughout your bloodstream. An A1C test works by measuring the amount of these “glycolated” or “glucose-containing” hemoglobin proteins that are on your red blood cells.

Because medical specialists are familiar with the typical lifespan of a red blood cell, an A1C test can be an effective way of estimating your average blood glucose level over the past three months. If your blood glucose levels have been high, the percentage of hemoglobin proteins that have a sugar molecule stuck to them will be higher than normal.

What is a normal A1C level?

According to the NLM in a person without diabetes, your A1C should be less than 5.7%. In a person with prediabetes, an A1C test will be between 5.7% and 6.4%. In a person with diabetes, A1C test results will be above 6.5%.

Who should get an A1C test?

If you’re interested in an annual health screening that assesses your blood pressure, height, weight, and other parameters, an A1C test is another helpful tool to see how you are measuring up. If your A1C is slightly elevated into the prediabetic range, it is helpful information that can prompt you to make lifestyle changes and reduce your average blood glucose level and risk of diabetes.

If you have ever had a diagnosis of diabetes or prediabetes, you should get periodically tested with an A1C test. For people with prediabetes, an A1C test is usually checked every 1 to 2 years. For people with diabetes, an A1C test is usually checked at least every six months.

When should I get a disease test?

According to the Centers for Disease Control and Prevention (CDC), other reasons for getting an A1C test include:

• Being over age 45 (if your test is normal, they recommend repeating it every three years)
• Being under age 45 and having a medical condition that makes you more likely to develop diabetes
• Having symptoms of diabetes, such as excessive thirst, urinating frequently, feeling very hungry, unintentional weight loss, feeling tired, having frequent infections, or having slowly healing sores

How to get an A1C test

To request an A1C test you will need to have a conversation with a healthcare provider. This could be your regular doctor or a healthcare provider affiliated with a same-day clinic such as urgent care or a walk-in clinic. You can find and book an appointment with healthcare providers who can order an A1C test through Solv.

Depending on your specific medical situation, your healthcare provider may recommend an A1C test. This test may be particularly helpful if you’re curious about your blood sugar level but have just eaten a large meal or sugary treat (both of which could skew the results of a regular blood glucose test). Your healthcare provider can order an A1C test, and you may have the test performed at the clinic or an outside lab.

You can also order an at-home A1C test online without a doctor’s order, however, these tests may be costly and may not be covered under your insurance.

Can I get a disease test at home?

There are at-home A1C tests available for order online. However, the accuracy of these at-home tests may vary significantly from tests performed in a laboratory setting, notes the CDC. If you are experiencing symptoms of diabetes, or if you are diabetic, you should see a healthcare provider and get a medical-grade A1C test.

Cost of an A1C test

The cost of an A1C test in the US varies depending on the location and the laboratory. According to HealthCare.gov, the average cost of an A1C test without insurance is between $40 and $50. However, the cost can be higher or lower depending on where the test is taken and other factors such as whether the test is done at a hospital laboratory or a private laboratory.

How is the A1C test performed?

The A1C test is performed by drawing blood from a vein in the arm, in a procedure known as a venipuncture—the blood sample is then sent to a laboratory for analysis, according to the American Diabetes Association. The test does not require any special preparation and can be done at any time of the day.

What to expect during an A1C test

The A1C test is a simple blood test. Your healthcare provider or laboratory technician will use a small needle to draw blood from a vein, typically in your arm or hand. This should cause minimal pain.

What to do before your A1C test

You do not need to do anything specific to prepare for an A1C test. The A1C test does not require fasting, as it is not affected by short-term changes in blood glucose levels, notes the CDC.

What to expect during your A1C test

During a venipuncture procedure, a small sample of blood is collected. A healthcare provider or laboratory technician will collect a blood sample from a vein in your arm or hand using a needle and syringe—or a small needle attached to a tube. The procedure should be quick and relatively painless. You may experience mild discomfort, such as a small pinch or prick when the needle is inserted.

How to understand my A1C test results

Your A1C test result will be returned as a percentage, which indicates how much hemoglobin in your blood is coated with glucose (sugar). The lifespan of a red blood cell is three months, so the test will only be a valid measurement of your average blood glucose level over the past three months. The following thresholds, according to the NLM, can help you interpret your A1C test:

• Normal A1C range: Less than 5.7%
• Prediabetic A1C range: Between 5.7 and 6.4%
• Diabetic A1C range: 6.5% or greater

The healthcare provider who ordered your A1C test can help answer any questions that you may have about interpreting the test.

An A1C test can help make an initial diagnosis of prediabetes or Type 2 diabetes, but according to the NLM, an A1C test is not typically used to make an initial diagnosis of Type 1 diabetes or gestational diabetes.

How long does it take to get A1C test results?

Your test results may be available that same day but can take up to a few days, depending on the laboratory. Your healthcare provider can give you information about when to expect your results and how to find your results.

What to do if an A1C test is elevated

If you have an A1C test result that is 5.7% or greater, it is very important to have a follow-up conversation with your healthcare provider, notes the National Library of Medicine. Your healthcare provider can help you understand more about your blood glucose levels, and how they can affect your health over the long term. They can also guide you on what lifestyle changes you can make to get your levels back into a healthy range.

You can also discuss other factors that may be affecting your A1C test outside of prediabetes or diabetes.

What is an A1C test looking for?

The A1C test is used to measure the average blood glucose levels over the past two to three months. It is a valuable diagnostic tool for assessing your risk of developing diabetes and for managing diabetes.

According to the American Diabetes Association (ADA), the A1C test measures the percentage of hemoglobin that is coated with glucose (sugar). Hemoglobin is a protein found in red blood cells that carries oxygen throughout the body. When glucose levels in the blood are high, some of the glucose attaches to hemoglobin molecules, forming a glycated hemoglobin molecule.

The A1C test is looking for the percentage of glycated hemoglobin in the blood. This percentage indicates how well your blood glucose levels have been controlled over the past two to three months.

What does an elevated A1C test mean?

According to the ADA, an elevated A1C test means that the percentage of glycated hemoglobin in the blood is higher than normal. This indicates that blood glucose levels have been consistently high over the past two to three months.

Relatedly, an elevated A1C test is a red flag for diabetes, as it indicates that blood glucose levels have been consistently high over a period of several months. It is important to follow up with a healthcare provider to confirm the diagnosis and to start treatment as soon as possible.

Does a high A1C mean I have diabetes?

A high A1C test result may indicate that a person has diabetes, but a diagnosis of diabetes cannot be made based on the A1C test alone.

According to the ADA, an A1C level of 6.5% or higher is considered diagnostic for diabetes. However, healthcare providers may also use other tests, such as fasting blood glucose or oral glucose tolerance tests, to confirm a diagnosis of diabetes.

What kind of diabetes do I have if my A1C test is elevated?

According to the ADA, there are several forms of diabetes, including type I diabetes, type II diabetes, and gestational diabetes. An elevated A1C may indicate either type I or type II diabetes, but is most likely to be related to type II.

• Type 1 diabetes is an autoimmune disease that occurs when the immune system attacks and destroys the insulin-producing cells in the pancreas, resulting in little or no insulin production. The exact cause of type 1 diabetes is unknown, but genetic and environmental factors are believed to play a role.
• Type 2 diabetes is a metabolic disorder that occurs when the body becomes resistant to insulin or doesn't produce enough insulin to maintain normal blood glucose levels. Risk factors for type 2 diabetes include obesity, physical inactivity, family history, and age.

How often should I get my A1C checked?

The frequency of A1C testing depends on various factors, including the type of diabetes, treatment plan, and individual circumstances. Here are some general guidelines for how often A1C should be checked, according to the ADAn and CDC.

• For individuals with type 1 diabetes, the ADA recommends A1C testing at least twice a year if blood glucose levels are stable and under good control. If blood glucose levels are not well controlled, A1C testing may be done quarterly.
• For individuals with type 2 diabetes who are meeting treatment goals, the ADA recommends A1C testing at least twice a year. If treatment goals are not being met, A1C testing may be done quarterly.
• For individuals with newly diagnosed diabetes, the ADA recommends A1C testing at the time of diagnosis and then every three months until blood glucose levels are stable, after which testing can be done less frequently.
• For pregnant women with diabetes, the ADA recommends A1C testing at the initial prenatal visit, as well as at least one additional time during each trimester.

Can your A1C test result change?

Yes, A1C test results can change over time, as blood glucose levels can vary depending on factors such as diet, exercise, and medication, according to the ADA and CDC.

Someone with diabetes who has been managing their blood glucose levels well may see improvements in their A1C test results over time.

How can I lower my A1C?

Lowering A1C requires healthy lifestyle habits, and sometimes medication treatment. Here are some strategies that may help lower A1C, according to the ADA and CDC:

• Adopt a healthy diet: Eating a balanced diet that is low in sugar, saturated fats, and processed foods can help lower blood glucose levels. The ADAn recommends a diet that emphasizes whole grains, fruits, vegetables, lean proteins, and healthy fats.
• Increase physical activity: Regular exercise can improve blood glucose control and help lower A1C. The ADAn recommends at least 150 minutes of moderate-intensity aerobic exercise per week, spread over at least three days per week, with no more than two consecutive days without exercise.
• Take medication as prescribed: If medication has been prescribed, it's important to take it as directed by the healthcare provider to help lower blood glucose levels and improve A1C.
• Regularly monitor blood glucose levels: Checking blood glucose levels regularly can help individuals with diabetes and their healthcare providers monitor blood glucose control and make any necessary adjustments to the treatment plan.
• Manage stress: Stress can raise blood glucose levels, so managing stress through techniques such as meditation, deep breathing, or yoga may help lower A1C.

Is it possible to have a falsely elevated A1C?

According to the ADA and CDC, it is possible to have a falsely elevated A1C result, which can occur due to several factors, including:

• Hemoglobin variants: Certain hemoglobin variants, such as hemoglobin S, C, or E, can interfere with the accuracy of A1C results.
• Anemia: Anemia, a condition in which there are not enough red blood cells to carry oxygen throughout the body, can lead to falsely elevated A1C results.
• Blood transfusions: Blood transfusions can affect A1C results, as the donor blood may have different hemoglobin variants than the recipient.
• Certain medical conditions: Certain medical conditions, such as kidney disease and liver disease, can affect A1C results.
• Medications: Certain medications, such as high doses of vitamin C or aspirin, can interfere with A1C results.
• Laboratory errors: Errors in the laboratory testing process can also lead to falsely elevated A1C results.

It's important to note that falsely elevated A1C results are rare and that the test is generally considered a reliable indicator of blood glucose control. If there is a concern about the accuracy of an A1C result, additional testing or a repeat test may be recommended.

Are there risks of getting an A1C test?

A1C testing is a common and relatively safe procedure, notes the ADA. The venipuncture procedure that is done to collect a blood sample does have a small risk of bruising or infection.

How accurate is the A1C test?

The A1C test is generally considered a reliable indicator of blood glucose control over the past two to three months, notes the ADA. However, it is worth noting that the A1C test is not a perfect measure of blood glucose control. This is why your healthcare provider may order additional testing to confirm a diagnosis.

What are the benefits of having an A1C test?

According to the ADA and CDC, there are several benefits to having an A1C test, including:

• Evaluating whether you have diabetes - An elevated A1C result can indicate the presence of diabetes and the need for further testing or treatment.
• Monitoring blood glucose control - A1C testing can be used to monitor blood glucose control over time, which can help individuals with diabetes and their healthcare providers evaluate the effectiveness of the treatment plan and make any necessary adjustments.
• Evaluating risks - A1C testing can identify individuals who are at high risk of developing diabetes, even before symptoms appear. This can lead to early intervention and lifestyle changes that may help prevent or delay the onset of diabetes.
• Assessing cardiovascular risk - Elevated A1C levels are associated with an increased risk of cardiovascular disease. A1C testing can help identify individuals who may be at risk for cardiovascular events.
• Motivating behavior change - Seeing the results of an A1C test may motivate individuals with diabetes to make lifestyle changes, such as adopting a healthier diet, increasing physical activity, and taking medication as prescribed, to improve blood glucose control and overall health.

Can I eat before an A1C test?

Yes, you can eat before an A1C test.

What factors can affect an A1C test result?

According to the ADA, there are some factors that can affect your A1C results, including:

• Hemoglobin variants: Certain hemoglobin variants, such as hemoglobin S, C, or E, can interfere with the accuracy of A1C results.
• Anemia: Anemia, a condition in which there are not enough red blood cells to carry oxygen throughout the body, can lead to falsely elevated A1C results.
• Blood transfusions: Blood transfusions can affect A1C results, as the donor blood may have different hemoglobin variants than the recipient.
• Certain medical conditions: Certain medical conditions, such as kidney disease and liver disease, can affect A1C results.
• Medications: Certain medications, such as high doses of vitamin C or aspirin, can interfere with A1C results.