For people who have diabetes, blood sugar control is key to managing the disease. Glucose is a form of dietary sugar that is transferred from the blood to the cells via insulin, a hormone produced by the pancreas. People with diabetes do not have enough insulin to adequately transport the glucose out of the bloodstream. Over time, too much blood glucose negatively affects a wide array of body systems.
“In the ‘olden days,’ patients used to record their blood sugars, bringing these results with them to discuss with their primary care physician. Unfortunately, these recorded results were not always accurate, and the physician didn’t always know what to believe,” says nurse Lore Gross, a certified diabetes educator at SSM St. Mary’s Health Center.
However, another type of blood glucose test—used in combination with home glucose monitoring—offers a more complete picture of a patient’s glucose control. Hemoglobin A1C is a laboratory blood test that provides an average blood glucose level for the previous two to three months. The test measures the amount of glucose attached to hemoglobin, a protein molecule located on the outer portion of red blood cells. “Now the physician has a way to validate the overall averages of those day-to-day blood sugar tests,” Gross says. “A1C testing is recommended once a year for people without a history of diabetes and for people at high risk for developing diabetes. Testing once a year is also needed for people with well-controlled diabetes. For people with uncontrolled diabetes, the American Diabetes Association recommends checking an A1C every three or six months.”
A1C testing is not new, but with the advent of electronic health records systems, which prompt physicians to remind patients of scheduled screenings and tests, awareness is increasing, notes Dr. Kathleen Brunts, an internal medicine physician with Esse Health. “Now that we’ve had electronic health records for several years, we’ve developed a process where, if people are overdue for the lab test, we’ll give them a call or send them a reminder. That way, it won’t slip through the cracks.”
The National Diabetes Education Program (NDEP) calls for an A1C of 7 percent or less as an ongoing treatment goal. However, Dr. Charles Kilo, founder of the Kilo Diabetes & Vascular Research Foundation, recommends patients maintain an A1C of 6 percent or less. “Achieving this goal of 6 percent will prevent or delay all diabetic complications,” he says.
Gross emphasizes that patients need to continue daily at-home glucose monitoring, but “A1C testing provides an advantage to both the patient and the physician. The results are almost immediate, which gives the health care provider a real-time advantage to set goals with the patient,” she says.
Kilo agrees that both types of testing are crucial. “Self-monitoring of blood glucose, along with the hemoglobin A1C testing, has made it possible for us to aggressively manage diabetes,” he says. “With these tools, diabetes education and proper medications, we can achieve blood sugar control to the damaging effects of diabetes.”