Health Disparities Series: Diabetes: What’s the big deal about A1C?

What is this A1C test?

The A1C test is a blood test that provides information about a person’s average levels of blood glucose, also called blood sugar, over a three-month period. The A1C test is sometimes called the hemoglobin A1c, HbA1c, or glycohemoglobin test.

This is the primary test used for diabetes management and diabetes research. The test result is reported as a percentage. The higher the percentage, the higher a person’s blood glucose levels have been and the greater the risk for diabetic complications such as retinopathy (eye disease), nephropathy (kidney disease) and neuropathy (nerve disease). A normal A1C level is below 5.7 percent. The goal is to have an A1C level less than seven percent.

The disparities of diabetes

Diabetes Mellitus (DM) is defined as the absolute absence of insulin (type 1) or the decrease production of insulin (type 2). Also type II individuals have a problem utilizing the insulin that is produced. Insulin is needed to carry glucose into the body’s cells for energy. Most people have type 2 DM.

According to the Journal of Public Health, African Americans are 50 percent to 100 percent more likely to have DM than their white counterparts. African Americans have a rate two to four times than non-Hispanics whites of having renal disease, blindness, amputations and amputation-related deaths.

End stage renal disease (ESRD) is 2.6 times higher among African Americans. Rates of blindness are only half as high for whites as they are for the rest of the population. No consistent evidence shows disparities between minorities and their white counterparts for diabetic-related neuropathy (especially in feet and legs). However, African Americans and American-Indians have a high rate of lower extremity amputation than whites.

A normal glucose level is 70mg/dl-110mg/dl. DM is diagnosed by an A1C level > 7, a fasting blood glucose >125mg/dl or a random level > 200mg/dl. DM can only be diagnosed by a healthcare provider. There are a lot of medications used for the management of DM and each medication regimen is structured to the individual’s specific needs.

Some patients may have higher sugars in the morning; some may have very high sugar levels after eating and others at bedtimes. Medication care plans are adjusted according to the levels recorded by the blood glucose monitoring devices.

Type 2 DM are typically controlled by “by mouth” medications, whereas type 1 DM is only controlled with insulin therapy. Unfortunately, some type 2 patients with high initial A1C levels of 10 or greater may require insulin injections also. The higher the A1C level the more risk of complications. Studies show for each one percent drop in A1C it reduces the risk of kidney, eye and nerve complications by 33 percent.

Diabetes is a complicated disease and along with family support and medication therapy, diet and exercise plans are also extremely important. Community Health Centers of Pinellas, Inc. offers free cooking classes for diabetics and free exercise classes for all people at the Johnnie Ruth Clarke Community Health Center location. Please take advantage of these services offered to better your health.

Dr. Charlie W. Colquitt

Dr. Charlie W. Colquitt

Dr. Charlie W. Colquitt is the Associate Professor of Pharmacy Practice at Florida A & M University, College of Pharmacy and provides services for Community Health Centers of Pinellas, Inc.

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