Many diabetics know this dilemma: The next appointment for blood glucose measurement is on and the radical diet is to compensate for the small food cracker, so that the values return to normal. A big mistake, because crucial for a good blood sugar adjustment is the long-term blood sugar value, the so-called HbA1c value. From many large studies it could be proven that an improvement in the HbA1c value is associated with a reduced number of diabetes-related complications.
Vascular damage from diabetes
But few diabetics know the exact meaning of this value. Many people with diabetes do not even know about their condition. This raises a major problem: Until the diagnosis of diabetes usually pass many years, in which the blood sugar is often too high and thus already the first fine vessels and nerves are damaged.
These damages progress creepingly and are barely noticed by the diabetics due to the reduced sensation of pain. Not infrequently, these "small", palpable changes in the dreaded diabetes-related sequelae end. But this does not have to be! Because studies prove that a good blood sugar control can reduce the risk of diabetes-related sequelae.
HbA1c - the important hieroglyph in diabetes therapy
The HbA1c value reflects the proportion of "sugared" red blood pigment (hemoglobin) in total hemoglobin. This stable "sugar hemoglobin", known in technical terms as "glycosylated hemoglobin" or "HbA1c", is produced by anyone, not just diabetics, and depends on the average blood sugar concentration. Put simply, the higher the blood sugar level over a certain period of time, the higher the HbA1c value.
With the HbA1c value, the physician can determine the average blood glucose level of the last 8 to 10 weeks, regardless of whether the values have risen or fallen sharply in the meantime. Because of this, the HbA1c value is often referred to as the long-term blood sugar value. As early as 1999, the World Health Organization (WHO) recommended HbA1c, in addition to blood glucose monitoring and the glucose tolerance test, as an important parameter for assessing the quality of diabetic control. The HbA1c value is therefore often referred to as the "gold standard" in diabetes therapy.
HbA1c - Healthier under 7
Whether the blood sugar is well adjusted, can be read off on the basis of the HbA1c value. The better the blood sugar is set, the lower the HbA1c value. In healthy people, the HbA1c is between 4.5 and 6.5 percent, in patients with well-adjusted diabetes between 6.5 and 7.0 percent, and in the ill-adjusted diabetic over 7.5 percent.
In general, the lower the HbA1c value, the lower the risk of complications. For example, the results of the UKPD study, one of the largest studies in the treatment of type 2 diabetes, showed that a 1% reduction in HbA1c was associated with:
- 21% reduction in the risk of diabetes-related complications
- 25% reduction in diabetes-related deaths
- 17% reduction in total mortality
- 18% reduction in the risk of having a heart attack
- 15% risk reduction for strokes
- 35% reduction in the risk of sequelae on the eyes and kidneys
The current guidelines of the specialist societies recommend a HbA1c value of <6.5 percent for the prevention of diabetes-related sequelae as well as a therapy adjustment from a HbA1c value above 7. However, it is a fact that almost every other type 2 diabetic has an HbA1c value of over 7.5 percent and thus has a poor set.
Consequences of a poorly adjusted diabetes
Persistently high blood glucose levels, which are reflected in high HbA1c levels, cause damage to the large and small blood vessels and to the nerves. Due to narrowed or even closed vessels (arteriosclerosis), the tissue is no longer sufficiently supplied with nutrients. The most common sequelae include diabetic foot, nerve damage, cardiovascular damage, eye damage and kidney damage.
According to the CODE-2 study, the following diabetic new cases occur annually in Germany: 58, 000 foot ulcers, 44, 000 strokes, 27, 000 heart attacks, 6, 000 kidney failure dialysis cases and 6, 000 blind spots. Against this background, doctors and patients should be given even more information about the HbA1c value and sensitized for its importance in diabetes therapy.
The discovery history of HbA1c
The introduction of the determination of the HbA1c value as a standard method was a decisive step forward in the control of effective diabetes therapy. The different variants of hemoglobin (HbA1, HbA2 and HbF) could be determined in 1955, followed in 1958 by the separation and identification of subtypes of HbA1 (HbA1a, HbA1b and HbA1c). The fact that HbA1c has bound glucose firmly to hemoglobin could not be proven until the seventies. But already in 1968 the Tehran pediatrician Dr. Samuel Rahbar that an increased concentration of HbA1c is associated with diabetes.
The quantitative detection of HbA1c gained in importance as it could be demonstrated that reduced blood glucose levels resulted in a reduction of the HbA1c value. The development of new methods of determination and analytical methods has been enormously advanced in the following years and especially since the beginning of the eighties. Today, the HbA1c value can be determined within minutes using modern laboratory methods. This makes it easy to ensure close monitoring of the metabolism of the diabetes patient.