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The DCCT was the pivotal trial that provided the link between A1C levels and the risk of diabetes-associated complications. The United Kingdom Prospective Diabetes Study (UKPDS) was a large-scale trial that investigated the effect of intensive blood glucose control versus conventional treatment in patients with type 2 diabetes, with a median follow-up of 10 years. Therefore, any improvement in A1C levels is likely to reduce the risk of diabetic complications.
The A1C test is a blood test that reflects the average blood-glucose level over the last two to three months.
In 1950s, hemoglobin A1c was identified as one of the largest fractions of the minor components of normal adult hemoglobin.
Hemoglobin is a protein in the red blood cell, which transports oxygen from your lungs to the whole body. HbA1c is a simple blood test measures the percentage of hemoglobin variant “A’ subtype ‘1c” that has been attached to the glucose in the blood.
However, blood-glucose levels in the preceding 30 days can make more effect in the A1C than the 90 to 120 days earlier. If you are having A1C percentage, it looks less meaning, until you convert it into equivalent blood-glucose level help provide more meaning.
HbA1c tests can easily do with a regular finger stick or a blood sample drawn from a vein in your arm like testing for blood glucose. Laboratories should be aware of their method limitations with respect to interference from the most prevalent Hb variants. Decrease or increase in erythrocyte (decrease in RBC) can make you A1C to lower or increase respectively.
Hb Variants - Hemoglobin S trait, which affects about 8% of African Americans, hemoglobin C trait, which affects approximately 3% of African Americans, and hemoglobin E trait, which affects 10% to more than 50% of Southeast Asians in California, are all reported to affect some HbA1c assay methods. Vitamin C & E ingestion interfered with some assay methods and falsely decreasing results.
A splenectomy is a surgical procedure that partially or completely removes the spleen, will falsely raise A1C. Bone marrow conditions - include leukemia, multiple myeloma (cancer of the plasma cells in bone marrow), and lymphoma (blood cancer). Nutritional deficiencies such as iron, copper, foliate vitamins B6 and B12 can falsely affect the result.
Once A1C interferences are recognized; choosing an alternative form of testing, such as glycated serum protein testing (fructosamine or glycated albumin) can help assess glycaemia better.
Many people have a question, what does it mean if I have a high A1C and normal blood sugars?


Danish pharmaceutical company Novo Nordisk has recently celebrated the completion of 90 years since the first diabetes patients were treated with the company’s insulin. Ever since, the company has been focused on developing new and better treatments for people with diabetes and is today the world’s largest diabetes care company. The company’s story began in 1921, shortly after a team of scientists in Canada discovered insulin.
With the merger of two Danish pioneering foundations (Novo and Nordisk) in 1989, it continues to be at the forefront of developing new insulin delivery systems and advocating for a holistic approach to preventing and managing diabetes. Sweet Life is a South African diabetic community for those who have diabetes, both Type 1 diabetes and Type 2 diabetes. Sign up for our newsletter!Get all the latest news and info from the South African diabetes community, delivered to your inbox - for free!
The content of this site is intended as information and is not a substitute for seeking advice from a medical professional. Trulicity (dulaglutide) is a once-weekly glucagon-like peptide-1 (GLP-1) agonist for the management of type II diabetes. Trulicity is licensed for the treatment of type II diabetes when diet and exercise provide inadequate glycaemic control.
The safety and efficacy of dulaglutide were evaluated in six randomised, controlled, phase III trials involving 5,171 patients with type II diabetes. Another study compared dulaglutide 1.5mg and 750 microgram with sitagliptin 100mg daily in metformin-treated patients with inadequate glycaemic control. Dulaglutide was compared with insulin glargine in patients receiving metformin and a sulfonylurea.
Patients were randomised to dulaglutide once weekly or insulin glargine once daily, both in combination with prandial insulin lispro three times daily, with or without metformin. Higher rates of symptomatic hypoglycaemia were observed when dulaglutide was given in combination with a sulfonylurea plus metformin or prandial insulin. GPs can get MIMS print & online and GPonline for free when they register online – take 2 minutes, and make sure you get your free MIMS access! The results of the Diabetes Control and Complications Trial (DCCT) shown below are considered definitive for patients with type 1 diabetes. This observational analysis of data from the UKPDS demonstrated a direct relationship between the risk of diabetic complications and glycemia over time. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2002. Followed by different discoveries and in 1976, Koenig and colleagues demonstrated that HbA1c concentration was an indicator of fasting blood-glucose concentrations.


Elevated hemoglobin F, which is associated with thalassemia syndromes, also affects some assay methods. Unfortunately, factors affecting the accuracy of HbA1c measurement may not be recognized clinically.
Many others, on the other hand, have a question, what does it means if I have normal A1C and high fasting glucose?
Happy 90th birthday to Novo Nordisk, one of South Africa’s favourite insulin manufacturers. Novo Nordisk provides therapeutic treatments for an estimated 23 million people with diabetes worldwide and produces approximately 50 per cent of all insulin in the world. It improves glycaemic control by lowering fasting, pre-meal and postprandial glucose concentrations. Dulaglutide 1.5mg was superior to insulin glargine in lowering HbA1c at week 52 and the benefit was maintained until trial end (78 weeks). Relative risk increased with A1C for retinopathy, nephropathy, and microalbuminuria, and the risk of retinopathy and nephropathy accelerated at the highest levels of A1C. Each 1% absolute reduction in mean A1C levels was associated with a 37% decrease in the risk of microvascular complications and a 21% reduction in the risk of any diabetes-related complication or death. The blood-glucose level decides the volume of glycosylation reaction and the level of glycated hemoglobins. Home tests are now available too; they are subject to inaccuracy, if not conducted exactly as stated in the instructions. As with any laboratory test, any result that does not fit the clinical picture should require investigation further with the clinician. Marie and August Krogh set up a foundation called Nordisk Insulinlaboratorium, and made this the company’s majority shareholder in order to secure its independence. In this study, improved glycemic control following intensive diabetes therapy delayed the onset and slowed the progression of diabetic retinopathy, nephropathy and neuropathy in patients with type 1 diabetes. The foundation was also used as a channel to provide grants for research and humanitarian purposes. A similar foundation was established in 1951 by Novo’s founders, Harald Petersen and Thorvald Pedersen, and the foundation-based business model has been maintained since the subsequent merger of the two companies.



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