Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association

Jane L. Chiang; M. Sue Kirkman; Lori M.B. Laffel; Anne L. Peters

Disclosures

Diabetes Care. 2014;37(7):2034-2054. 

In This Article

A1C Testing

A1C reflects average glycemia over 2–3 months[57] and strongly predicts diabetes complications.[43,61] Thus, A1C testing should be performed routinely in all patients with diabetes at initial assessment and as part of continuing care. A1C is a convenient method to track diabetes control; however, there are disadvantages. Glycation rates, and thus A1C levels, may vary with patients' race/ethnicity. However, this is controversial. Additionally, anemias, hemoglobinopathies, and situations of abnormal red cell turnover affect A1C.[42]

A1C measurements approximately every 3 months determine whether a patient's glycemic targets have been reached and maintained. For any individual patient, the frequency of A1C testing should be dependent on the clinical situation, the treatment regimen used, and the clinician's judgment. Unstable or highly intensively managed patients (e.g., pregnant type 1 diabetic women) may require more frequent testing than every 3 months.[62] In patients with hemoglobinopathies that interfere with the A1C assay or with hemolytic anemia or other conditions that shorten the red blood cell life span, the A1C may not accurately reflect glycemic control or correlate well with SMBG testing results. In such conditions, fructosamine may be considered as a substitute measure of long-term (average over 2 weeks) glycemic control.

Recommendations.

  • Perform the A1C test quarterly in most patients with type 1 diabetes and more frequently as clinically indicated (i.e., pregnancy). (A)

  • Point-of-care A1C testing, using a DCCT standardized assay, may provide an opportunity for more timely treatment changes. (E)

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