HbA1C
HbA1c, also known as glycated hemoglobin, is a blood test that
provides an average of blood sugar levels over the past 2-3
months.
INTRODUCTION
Hemoglobin A1c (HbA1c) is a widely used blood test that reflects
the average blood glucose (sugar) level over the past two to three
months. It plays a central role in the diagnosis and long-term
management of diabetes mellitus, both in clinical and hospital
settings.
When glucose circulates in the blood, a portion of it naturally
attaches to hemoglobin, a protein in red blood cells. The
percentage of hemoglobin that is glycated (combined with
glucose) is measured as HbA1c. Because red blood cells have a
lifespan of around 120 days, this test provides a reliable long-
term view of a person’s blood sugar control.
OBJECTIVE
Assess Long-Term Glycemic Control-
Measures average blood glucose levels over the past 2–3 months.
Helps determine how well a person’s diabetes is being managed.
Diagnose Diabetes and Prediabetes-
Used as a diagnostic tool to identify:
o Normal glucose metabolism.
o Prediabetes (early risk).
o Diabetes mellitus.
Guide Treatment Decisions-
Helps healthcare providers:
o Adjust or initiate antidiabetic medications.
o Evaluate the effectiveness of current therapies.
o Tailor individualized care plans.
Monitor Patient Compliance-
Detects medication non-adherence or lifestyle issues (e.g., diet,
physical activity).
Supports pharmacist-led interventions.
Prevent and Reduce Diabetes-Related
Complications-
Keeping HbA1c within target range reduces risks of:
o Neuropathy.
o Nephropathy.
o Retinopathy.
o Cardiovascular diseases.
HbA1c Normal Range:-
HbA1c Ranges-
HbA1c (%) Interpretation
Below 5.7% Normal (No diabetes)
5.7% – 6.4% Prediabetes (Increased risk)
6.5% or higher Diabetes (Diagnostic level)
HbA1c Targets for People with Diabetes-
Group Recommended HbA1c Target
Most non-pregnant adults < 7.0%
Older adults / comorbidities < 7.5% – 8.0% (individualized)
Pregnancy (gestational diabetes) < 6.0% – 6.5% (if safely achievable)
CASE STUDY
Patient Information-
Name: Mr. Ahmed Khan
Age: 56 years
Gender: Male
Medical History: Type 2 Diabetes Mellitus (T2DM) for 7 years,
Hypertension.
Current Medications:
o Metformin 1000 mg BID.
o Glimepiride 4 mg OD.
o Amlodipine 5 mg OD.
Clinical Presentation-
Visit Reason: Routine follow-up.
Symptoms: Occasional fatigue, increased thirst.
Lab Results:
o HbA1c: 9.1%.
o Fasting Blood Glucose: 178 mg/Dl.
o Blood Pressure: 138/84 mmHg.
o BMI: 29 kg/m².
Clinical Assessment-
HbA1c of 9.1% indicates poor glycemic control.
Non-compliance suspected based on missed doses and irregular diet.
Patient not engaging in regular physical activity.
No signs of acute complications, but at high risk for long-term
diabetic complications.
Pharmacist’s Intervention-
1. Medication Review & Optimization-
o Recommend switching from glimepiride to a DPP-4 inhibitor
(e.g., sitagliptin) or initiating basal insulin due to persistently
high HbA1c.
o Continue metformin.
2. Patient Counseling-
o Educated on medication adherence.
o Provided diet and lifestyle guidance.
o Explained importance of monitoring blood glucose and keeping
follow-up visits.
3. Monitoring Plan-
o Repeat HbA1c in 3 months.
o Blood glucose self-monitoring at home.
o Referral to diabetes educator and dietitian.
4. Documentation & Follow-Up-
o Documented the intervention in the electronic medical record
(EMR).
o Scheduled follow-up appointment in 3 months.
REFERENCE
American Diabetes Association (ADA) Standards of
Care-
American Diabetes Association. (2024). Standards of Care in Diabetes—
2024. Diabetes Care, 47(Supplement_1): S1–S212.
[Link]
Provides HbA1c diagnostic criteria and treatment targets.
World Health Organization (WHO)-
World Health Organization. (2011). Use of glycated haemoglobin (HbA1c) in
the diagnosis of diabetes mellitus: Abbreviated report of a WHO consultation.
[Link]
Recognizes HbA1c ≥ 6.5% as a diagnostic tool for diabetes.
National Institute for Health and Care Excellence
(NICE)-
NICE. (2023). Type 2 diabetes in adults: management (NG28).
[Link]
Recommends HbA1c monitoring intervals and target ranges.
International Expert Committee Report-
International Expert Committee. (2009). International Expert Committee
report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care,
32(7): 1327–1334.
DOI: 10.2337/dc09-9033
One of the first to propose HbA1c ≥6.5% as a diagnostic threshold.
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