Digital HbA1c test results that can help monitor glycemic control

What Is Glycemic Control?

Written on December 22, 2023 by Amy Harris, MS, RN, CNM. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

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Regardless of whether or not you have been diagnosed with diabetes, glycemic control can be a key component to staying healthy for a lifetime. Having large amounts of sugar in your bloodstream (which your body converts to glucose) is unhealthy. Paying attention to your blood sugar levels to achieve glycemic control is one way to maintain your health. But should you be checking your blood sugar if you don’t have diabetes? Learn more about glycemic control and the latest wellness trend coming to glucose monitors near you.

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What Is Glycemic Control?

Glycemic control is trying to get your blood glucose levels as close to target levels as safely possible.[1] For healthy people without diabetes, the normal range fluctuates depending on what you eat and how physically active you are.

In general, however, if your blood sugar levels stay between 70 to 140 mg/dL, you are said to have good glycemic control. If you have diabetes, self-testing your blood sugar (blood glucose) to help stay within your target range can be an important tool in managing your diabetes and preventing complications.[2]

Diabetes And Glycemic Control

Diabetes is a chronic health condition that can occur when your body either fails to produce a hormone called insulin (type 1 diabetes) or doesn’t respond to insulin (type 2 diabetes). There is no cure for diabetes, only medications to treat it.

If you don't have diabetes, your body naturally regulates blood sugar levels with the hormone called insulin. Your pancreas produces insulin and directs your body to either store it or use it for energy after each meal you eat.

After a meal, your pancreas releases insulin in response to higher blood sugar levels. Insulin allows your body to absorb glucose from the blood to lower your blood sugar levels back to a healthy range. If your blood sugar levels get too low, the insulin level falls and triggers your body to release glucagon (another hormone). Glucagon signals your liver to turn stored glycogen back into glucose and release it into the blood. This helps bring blood sugar levels back to normal levels. When your body’s insulin and glucose regulation system is not working correctly, the result can be high blood sugar levels, called hyperglycemia.[3]

Suppose you don't have prediabetes or diabetes and your blood sugar fluctuates in the normal range ( 70 to 140 mg/dL). In that case, there's no need to measure blood sugar levels routinely, according to the U.S. Centers for Disease Control (CDC) and the American Diabetes Association (ADA).[4,5]

Testing Your Blood Sugar to Achieve Glycemic Control: Glucometers, Continuous Glucose Monitors, and HbA1c

People who are otherwise healthy and who have not been diagnosed with diabetes do not need to check their blood sugar regularly. Suppose you are an adult aged 35-70 who is overweight or obese based on your body mass index (BMI). In that case, the U.S. Preventative Task Force (USPTF) recommends regular screening for pre-diabetes and diabetes, even if you don’t have any symptoms.[6]

Regardless of whether or not you have diabetes, testing your blood sugar can help you [2]:

  • Monitor the effect of medications on blood sugar levels
  • Identify blood sugar levels that are high or low
  • Track your progress in reaching your overall treatment goals
  • Learn how diet and exercise affect blood sugar levels
  • Understand how illness or stress affects blood sugar levels

Healthcare providers use three main tests to assess whether you have diabetes and to assess your glycemic control. These are [4s]:

  1. Fasting blood glucose (your blood sugar level is checked after not eating anything for 8 hours before having your blood drawn)
  2. Two-hour post-prandial blood glucose level (your blood sugar level checked two hours after a meal)
  3. The HbA1c or A1C test (used to diagnose type 1 and 2 diabetes and tell you what your blood sugars have been averaging over the prior three months)

Everlywell conveniently offers you an affordable, at-home HbA1c test, with no appointment needed with a healthcare provider for testing. You'll receive physician-reviewed digital results and valuable insights on our secure platform within days.

Once your healthcare provider diagnoses you with pre-diabetes or type 2 diabetes (the more common type of diabetes), they will most likely recommend some kind of ongoing monitoring of your blood sugars and your glycemic control. You can measure your blood sugar with a glucometer or a continuous glucose monitor (CGM). The frequency that you need to test depends on your type of diabetes and your treatment plan.[2]

A glucometer is a small hand-held monitor with glucose strips and a small needle to draw blood from a finger. Some people with type 2 diabetes with good levels of control will only need to monitor several times a week when they are sick or when their schedule changes once they learn how to follow a diabetes-friendly diet.[2,5]

Continuous glucose monitors are becoming more available and more popular. Recently approved by the U.S. Food and Drug Administration, CGMs allow you to monitor your blood glucose levels 24/7 in real time. The newest type of CGM has an implanted sensor that can detect blood sugar levels for up to three months. You wear a transmitter on your body that sends blood sugar information wirelessly from the sensor to a smartphone app. This wearable technology is beneficial for people at risk of extreme highs and lows, like those people newly diagnosed with type 2 diabetes or people with type 1 diabetes.[4]

There is insufficient data to show that continuous glucose monitors improve health, athletic performance, or metabolic function in people without diabetes. So even though they may be FDA-approved and seem like the latest and greatest health gadget, CGMs are not proven to help improve your health or reduce your risk for diabetes.

The Connection Between the HbA1c Test And Glycemic Control

Besides glucometers and continuous glucose monitors, the HbA1c test is another test used to assess glycemic control. It measures how your blood sugar levels impact your red blood cells.

Everlywell HbA1c Test CTA graphic

Your red blood cells contain a protein called hemoglobin that helps them transport oxygen to wherever your body needs it. Every red blood cell has hemoglobin. The glucose in your bloodstream can stick to hemoglobin, forming glycosylated hemoglobin. The sugar molecules stay on the hemoglobin for the rest of the red blood cell’s lifespan, which is usually about three months (your body keeps making new red blood cells as old ones die off).[2,5]

HbA1c, or glycosylated hemoglobin, is the percentage of the hemoglobin in your red blood cells covered in sugar (glycosylated)—giving you a good idea of your average blood sugar level over the past three months. If your blood glucose levels have been elevated, and you have been chronically hyperglycemic, then many of your red blood cells will be covered with sugar molecules. In this scenario, you will have a higher HbA1C percentage, and you are at greater risk for experiencing some of the complications of diabetes (if you have diabetes).

Your healthcare provider will set target blood sugar ranges for glycemic control based on several factors, including [2,7]:

  • Type and severity of diabetes
  • Age
  • How long you've lived with diabetes
  • Your pregnancy status
  • The presence of diabetes complications
  • Your overall health and the presence of other medical conditions

Your healthcare provider can track your HbA1c numbers over time to see if your blood sugars are within a normal range. Healthcare providers use the following cutoffs for HbA1C results [5]:

  • HbA1C < 5.7% = normal
  • HbA1C 5.7%-6.4% = prediabetes
  • HbA1C > 6.5% = diabetes

How Does Glycemic Control Help You Avoid The Health Risks Of Hyperglycemia?

Over time, if your blood sugar levels are consistently too high, called chronic hyperglycemia, your body and organ systems begin to pay a high price. Diabetes’ effects on your body and organs happen slowly and can often progress without notice. Chronic hyperglycemia has been shown to be associated with [8]:

  • Heart disease (including stroke, atherosclerosis, and peripheral artery disease)
  • Kidney damage
  • Peripheral neuropathy (nerve pain)
  • Vision loss
  • Osteoporosis (bone thinning), type 1 diabetes
  • Alzheimer's disease and dementia

Research shows that keeping your blood glucose close to a pre-determined target range for blood sugars can help delay or prevent complications of diabetes.[8,9]

Is the Everlywell HbA1c Test Right For You?

Everlywell’s HbA1c Test can be a great choice if you are looking for a quick and easy way to check your glycemic control over the past three months. With just a tiny blood sample from a finger prick—collected from the convenience of your home—the test can help you learn how often your blood sugars have been in a healthy range.

While there still may be debate about whether continuous glucose monitors are a worthwhile investment of your precious healthcare dollars if you don’t have diabetes, HbA1c testing offers you an affordable and accessible window into your glycemic control without expensive technology.

The fact remains that diabetes (90% of which is type 2 diabetes) affects a growing number of Americans every day.[9] Checking your HbA1c, following a healthy diet, and engaging in regular physical activity are all ways to improve your glycemic control and keep your blood sugar levels within a healthy range.

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References

  1. Glycemic control. The Johns Hopkins Patient Guide to Diabetes. https://hopkinsdiabetesinfo.org/glossary/glycemic-control/. Accessed December 13, 2022.
  2. Blood sugar testing: Why, when and how. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/blood-sugar/art-20046628. Published February 1, 2022. Accessed December 13, 2023.
  3. Hyperglycemia (High Blood Glucose). American Diabetes Associaiton. https://diabetes.org/living-with-diabetes/treatment-care/hyperglycemia. Accessed December 12, 2023.
  4. Diabetes tests. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/getting-tested.html. Published February 28, 2023. Accessed December 13, 2023.
  5. Continuous glucose monitors. American Diabetes Association. https://diabetes.org/advocacy/cgm-continuous-glucose-monitors. Accessed December 14, 2023.
  6. US Preventive Services Task Force. Screening for Prediabetes and Type 2 Diabetes: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;326(8):736–743. doi:10.1001/jama.2021.12531
  7. Diabetes complications and risks. American Heart Association. https://www.heart.org/en/health-topics/diabetes/diabetes-complications-and-risks. Published May 4, 2021. Accessed December 13, 2023.
  8. Rooney MR, Tang O, Echouffo JB, Tcheugui PL and et al. American Diabetes Association framework for glycemic control in older adults: Implications for risk of hospitalization and mortality. Diabetes Care 1 July 2021; 44 (7): 1524–1531. https://doi.org/10.2337/dc20-3045.
  9. Bin Rakhis SA Sr, AlDuwayhis NM, Aleid N, AlBarrak AN, Aloraini AA. Glycemic control for type 2 diabetes mellitus patients: A systematic review. Cureus. 2022;14(6):e26180. Published 2022 Jun 21. doi:10.7759/cureus.26180.
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