A person wears medical gloves as they hold a test tube labeled, "HbA1c - Test."
An improvement in standards has made the A1C test more reliable for diabetes testing. (For Spectrum Health Beat)

The A1C test has undergone significant improvements in recent years to become a more reliable method to diagnose diabetes.

The test, which provides a three-month average measurement of blood sugar levels, is now one of two main ways to determine if a person has diabetes.

The other is the fasting blood sugar test, which involves drawing blood after a person has refrained from eating for at least 12 hours.


For A1C tests, blood is drawn every three months.

Prior to just five years ago, A1C tests weren’t used to diagnose diabetes because there was too much variation in standards. Even today there remain some conflicting opinions about A1C readings—specifically, the point at which a person is considered to have Type 2 diabetes under control, said Valerie Kowalski, RD, CDE, a diabetes educator for the Spectrum Health Center for Diabetes and Endocrinology.

The American Diabetes Association has said that an A1C reading of 6.5 percent or higher is a sign of diabetes, while a pre-diabetes level is 5.7 to 6.4 percent.

When it comes to what is considered normal, health care professionals agree that blood sugar levels in the A1C test should be below 5.7 percent, Kowalski said.

Debate continues regarding the point at which medication should be prescribed. Some doctors recommend that a patient with an A1C level above 6.5 percent receive medications, while others say it should be prescribed at 7 percent or higher. Some doctors might even recommend medication for someone in the prediabetes range.

The distinction is important because someone diagnosed with diabetes may need medication to control the disease. Those in the pre-diabetes stage—depending upon their doctor—may be able to make improvements with weight loss, healthy eating and exercise.

The decision, Kowalski said, is up to the individual and primary care physician.

Identifying risk

There are many factors when it comes to diabetes risks.

A person’s family history can play a role, and those in certain ethnic groups may be at increased risk, such as African-Americans, Hispanics and Native Americans.

What is clear is that people with pre-diabetes or Type 2 diabetes often need to make substantial changes in diet and exercise if they want to avoid the complications associated with diabetes.

Some of the long-term ailments can include heart disease, nerve damage in the hands and feet, kidney disease, and eye disorders, including blindness, Kowalski said.

Lifestyle changes alone may not be enough to bring diabetes under control—other interventions such as medication may be needed.

For someone whose blood sugar level is still in the pre-diabetes range, maintaining a healthy weight, proper diet and regular exercise are the best way to reduce the risk of developing diabetes, Kowalski said.

“Don’t wait until you have been diagnosed with diabetes to make lifestyle changes,” she said.