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Appendix A Diabetes Monitor
A1c and similar diabetes tests
Since the 1970's, diabetes researchers have developed several new laboratory tests that help in the evaluation of your blood sugar level. These tests are named A1c and fructosamine (fruk-TOES-ah-meen), and glycosylated protein (gly-COS-el-lay-ted PRO-teen). These tests are not substitutes for checking your blood sugar level at home. Your home blood sugar monitoring measures your blood sugar level at the very moment that the sample is obtained. These new tests give different information about your health, and add a new dimension to our ability to evaluate diabetes.
A1c: The A1c test was developed in the late 1970's. Other names that have been used to describe the same test are glycosylated hemoglobin, and hemoglobin A1c. This test gives information about your average blood sugar level during the past two or three months. The normal values for this test vary depending upon the lab, and you must look at the "normal range" or "reference range" that the lab uses to make sense of your result.1 If your A1c value is higher than the normal range, then we know that your average blood sugar has been elevated during the past two months. More importantly, if your recent A1c is lower than your previous value, then we know that you are now doing better than before!
Fructosamine: The fructosamine test has been developed more recently. Fructosamine is a term referring to the linking of blood sugar onto protein molecules in the bloodstream. Fructosamine levels have been shown to change more rapidly than glycohemoglobin. Your fructosamine value depends upon your average blood sugar level during the past three weeks. Therefore, it might be able to detect changes in diabetic control earlier than the glycohemoglobin.
The fructosamine test could be viewed as complementary to the glycohemoglobin, since the two tests are different reflections of diabetes control: glycohemoglobin looks back approximately eight weeks, and the fructosamine test looks back about three weeks.
Other tests: Other tests similar to the fructosamine test have been proposed; the glycosylated protein test is an example of another test that was suggested. Unfortunately, these newer tests are less reliable than originally hoped, and seems unlikely that either the fructosamine test or the glycosylated protein test will ever become as widely used for monitoring diabetes as the glycohemoglobin level.
What to do: Therefore, to evaluate your diabetes control, you should arrange to get a A1c level measured approximately every three months. By using this test, together with your home blood sugar monitoring, you and your health care team will have a much better idea about how your diabetes is doing.
- There are efforts underway to standardize the "normal range" for the glycohemoglobin test.
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