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A1c and Fructosamine Testing
The A1c test (previously referred to as glycated hemoglobin, glycohemoglobin, glycosylated Hemoglobin GHb, A1c or HbA1) provides the most accurate account of overall glycemic control. Sugar not used for energy remains in the blood where it attaches to hemoglobin. The A1c test measures the amount of sugar that is attached to the hemoglobin in red blood cells (See Figure 3). Because red blood cells live about two to three months, this test can measures the average blood glucose level over the past several months. This test is most useful because it is not affected by short-term changes (eating, exercise, etc.). The test is usually performed every 3 to 6 months. Treatment goals for diagnosed diabetic are for an A1c < 7%.
Figure 3
The Fructosamine test refers to the linking of blood sugar on to protein molecules and indicates blood glucose levels over the previous 2-3 weeks. This test is more sensitive to short-term changes in blood. "Fructosamine levels have been shown to change more rapidly than glycohemoglobin." Recently, the Food and Drug Administration approved use of a Fructosamine and A1c fingerstick test, both now available without a prescription. (19,32-34,53)
Controlling blood glucose is the primary goal of diabetes treatment. The American Diabetes Association has suggested the following guideline (51) to measure diabetes control (See Table 4).
Table 4: American Diabetes Association Guidelines (51,48)
*TEST
 |
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GOAL
|
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| Blood sugar before meals |
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90-130 mg/dl |
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| Blood sugar 1-2 hours after a meal |
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Less than 180 mg/dL |
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| ~A1c |
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Less than 7% |
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| *test levels are not used for pregnancy |
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Glucose (SMBG)
