The American Diabetes Association (ADA) recommends to begin A1c testing at age 45 for overweight or obese people; if the result is normal, the testing should be repeated at a minimum of 3-year intervals, with consideration of more frequent testing depending on initial results and risk status, or when classical signs or symptoms of increased blood glucose levels are observed.
The A1C test measures the glucose (blood sugar) in your blood by assessing the amount of what’s called glycated hemoglobin. “Hemoglobin is a protein within red blood cells. As glucose enters the bloodstream, it binds to hemoglobin, or glycates. The more glucose that enters the bloodstream, the higher the amount of glycated hemoglobin,” Dr. Dodell says.
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Hemoglobin A1c (“HbA1c” or just “A1c”) is the standard for measuring blood sugar management in people with diabetes. A1c reflects average blood sugars over 2 to 3 months, and through studies like DCCT and UKPDS, higher A1c levels have been shown to be associated with the risk of certain diabetes complications (eye, kidney, and nerve disease). For every 1% decrease in A1c, there is significant pretection against those complications.

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People with diabetes receive mixed messages about weight loss from magazines, newspapers, friends, family, and, yes, even health professionals. Few subjects have accumulated as much misleading and potentially dangerous folklore as the subject of obesity. A common message is that losing weight is just a matter of willpower, and if you have been losing weight and reach a plateau, it's because you've lost your willpower and are no longer following your diet. Furthermore, for people with type 2 diabetes, the message often is that weight loss is the answer to improving glucose control: “If you just lose 20 lb, you won't need insulin.” What does research tell us about these issues, and what should our messages as health professionals be to people with diabetes?
To explain what hemoglobin A1c is, think in simple terms. Sugar sticks to things, and when it has been stuck to something for a long time, it's harder to the get sugar (glucose) off. In the body, sugar sticks too, particularly to proteins. The red blood cells that circulate in the body live for about three months before they die. When sugar (glucose) sticks to these red blood cells by binding to hemoglobin A1c, it gives the doctor an idea of how much glucose has been around in the blood for the preceding three months. Hemoglobin A1c is a minor component of hemoglobin to which glucose binds. Hemoglobin A1c levels depend on blood glucose concentrations. The higher the sugar concentration in the blood, the higher the detectable hemoglobin A1c levels. At any point in time, hemoglobin A1c levels represent the average blood sugar concentrations in the person with diabetes for approximately the preceding 3 months. Other ways hemoglobin A1c may be termed include HbA1c, A1c and Hb1c.
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Odds are your glucose levels will be significantly higher during this test than the ranges in other tests, so don’t freak out. It’s supposed to be that way. Just remember that the RPG screening is just that—a screening. It isn’t perfect. It is useful for getting a sense of your overall glucose levels—and possibly ruling out diabetes. It’s not great for pinpointing your ranges with surgical precision.
The ACP guideline are the most unscientific and irresponsible publication. The studies they used did not used the newer agents we have now. Glp1ra, SGLT2i and DPP4i. Not all medication in diabetes management are created equal when taking in consideration CV data. A person who is 65< can easily surpass 10yrs with good medical care. Ignoring the abundant amount of evidence that demonstrates higher glucose levels causes damage to the patient. Hypoglycemia is a risk when using hypoglycemic agents. With other agents, they can achieve a better glucose control with no hypoglycemia risk.
If your blood sugar drops too low, you can have a low blood sugar reaction, called hypoglycemia. A low blood sugar reaction can come on fast. It is caused by taking too much insulin, missing a meal, delaying a meal, exercising too much, or drinking too much alcohol. Sometimes, medicines you take for other health problems can cause blood sugar to drop.
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