Expert-reviewed by Ashwini S.Kanade, Registered Dietician and Certified Diabetes Educator with 17 years of experience
HbA1c stands for Haemoglobin A1c, and it is a laboratory blood test that is conducted at intervals of minimum 3 months upon the recommendation of your doctor. Apart from your fasting and post-meal blood sugar levels. And it is considered more reliable because it shows the blood sugar control over time, whereas your other tests may be affected by what you eat before doing the tests.
How does the HbA1c test work?
You must’ve heard about haemoglobin in association with your iron levels and anaemia So, how is it connected to diabetes?
When blood sugar levels increase in your blood, the glucose attaches itself to the haemoglobin to form something called glycated haemoglobin. The HbA1c test, which is also known as the glycated haemoglobin test, measures the amount of this glucose-bound haemoglobin. A sample of blood extracted from your veins, as opposed to a finger prick, is used for the test.
How is it different from a regular blood sugar test?
HbA1c testing is conducted to detect the average blood glucose levels over the previous 3 months by checking the amount of glycated haemoglobin present in the blood. SMBG tells you the blood glucose levels at the time of the test.
In addition, HbA1c testing can be done at any time of the day without any prior diet restrictions, as opposed to regular tests like fasting blood sugar (FBS) and oral glucose tolerance test (OGTT), which require pre-test dietary restrictions.
Read more about how often you should be checking your blood sugar levels if you have diabetes.
Why is it needed?
The HbA1c test result is a good indicator of how one’s blood sugar has ranged over the past 3 months. It also gives your doctor an insight into your condition and whether your therapy needs to be modified to achieve good glucose control.
HbA1c test is used for screening and diagnosing type 2 diabetes. It is also routinely used to monitor glucose levels over time and helps your doctor in determining a suitable diabetes therapy for you.
This test can also confirm if you’ve achieved diabetes remission, which means a partial/complete absence of signs/symptoms and of the need for medication/insulin.
Here's everything you need to know about insulin therapy for Type 2 diabetes.
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How often should you get it done?
Your doctor will tell you when you need to get the HbA1c testing done. However, the recommendations for HbA1c testing are as follows:
- If your blood sugar is in the normal range - at least two times a year.
- If your blood sugar is above the normal range – four times a year.
- If your blood sugar range fluctuates inconsistently or you are under intensive therapy - more frequent testing (more than four times a year).
What do the test results mean? 
The test result is usually expressed in terms of a percentage. A person who does not have diabetes usually has their HbA1c result in the 4.0% to 5.6% range.
|5.7 to 6.4%||At risk for diabetes (pre-diabetes)|
|≥6.5% (on two separate testing)||Diabetes|
What is the HbA1c target range for people with diabetes?
Your doctor will tell you what your target HbA1c levels should be. Usually, a level of <7% is targeted. However, ensure you do not end up with dangerously low sugar levels (hypoglycaemia) while trying to reach that target.
A more stringent target of <6.5% may be suggested if:
- your diabetes onset is relatively recent
- you are being treated with lifestyle changes or metformin only
- you do not have significant cardiovascular (heart and blood) complications
A less stringent target of not more than 8% may be suggested if you have:
- a history of severe hypoglycaemia
- diabetes-related complications
- other co-occurring conditions
- long-standing diabetes with difficulty in attaining normal sugar levels
What does a high test result mean?
When you have diabetes, the test result can help predict your risk of developing diabetes-related complications. The higher the HbA1c, the greater is the risk.
For example, an HbA1C of >7% indicates that you are at a higher risk of developing diabetes-related complications such as diabetic retinopathy (eye disease) or diabetic nephropathy (kidney disease). Read the eight early signs of diabetes-related complications that you might be ignoring.
But studies have shown that even a 1% drop in your HbA1c levels could reduce your risk for 
- stroke by 12%
- ischaemic heart disease by 16%
- amputation & peripheral vascular disease by 43%
- eye disease by 21-24%
- all microvascular disease by 37%
- and death by 21%
If your HbA1c level is high, how can you lower it?
Consult your doctor who will guide you about the different ways of lowering your HbA1C suited to you.
In general, the doctor will advise you to monitor your sugar levels more often, commit to a healthier lifestyle, modify your diet, exercise regularly and reduce your weight. Your medications may also be changed. Here are a few home remedies that have been scientifically proven to help control blood sugar levels.
The relentless responsibility of self-care can be overwhelming and may lead to distress and depression. You may be severely self-critical when you fail to manage your condition well. This will do no good to you. So, be kind to yourself. According to a randomised controlled trial, learning to be kinder to oneself can significantly reduce HbA1C levels by an average of nearly 1%. Evoking goodwill towards yourselves in conditions of illness not only reduces depression and distress but also your HbA1c values.
- American Diabetes Association (ADA) 2017 Guidelines http://care.diabetesjournals.org/content/diacare/suppl/2016/12/15/40.Supplement_1.DC1/DC_40_S1_final.pdf
- National Diabetes Education Initiative http://www.ndei.org/ADA-2013-Guidelines-Criteria-Diabetes-Diagnosis.aspx.html
- National Diabetes Education Initiative http://www.ndei.org/ADA-diabetes-management-guidelines-glycemic-targets-A1C-PG.aspx.html
- Nordwall M, Arnqvist HJ, Bojestig M, Ludvigsson J. Good glycemic control remains crucial in prevention of late diabetic complications--the Linköping Diabetes Complications Study. Pediatr Diabetes. 2009 May;10(3):168-76. doi: 10.1111/j.1399-5448.2008.00472.x. Epub 2008 Oct 22. PubMed PMID: 19175900.
- Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et. al, BMJ, 2000, 321(7258):405-12.
- Friis AM, Johnson MH, Cutfield RG, Consedine NS. Kindness Matters: A Randomized Controlled Trial of a Mindful Self-Compassion Intervention Improves Depression, Distress, and HbA1c Among Patients With Diabetes. Diabetes Care. 2016 Nov;39(11):1963-1971. Epub 2016 Jun 22. PubMed PMID: 27335319.