Jewels Doskicz, RN, is a freelance writer, patient advocate, health coach, and long-distance cyclist. She and her daughter both live healthfully with type 1 diabetes.

Efforts are not always reflected in our numbers.

Hemoglobin A1c (HbA1c) results are most often seen as either “good” or “bad.” It is a single, judgmental number. And if the number is “bad,” it can squish our self-esteem and motivation.

The words used to interpret and describe diabetes measurements matter. One word may have the power to erase or negate in our mind all of the hard diabetes work we complete every day.

When we look beyond the results or “the number” to find greater meaning and understanding, it can help shape positive changes to improve our health.

Using nonjudgmental words for disease management—by explaining numbers as “high,” “low,” or “just right,” for example—is much more palatable for those of us living with diabetes.

As a nurse, I explain the HbA1c test regularly to people living with diabetes. Many have surprisingly never been taught what their HbA1c results represent—and what gaps are left in the story for clinicians to interpret.

Here’s what you should know about this test and its shortcomings.

How is my HbA1c number different than my meter's blood sugar results?

The hemoglobin A1c test measures the amount of sugar that adheres to the walls of a red blood cell, producing a number that represents an average over a period of time.

Red blood cells have a lifespan of three months, which is why this lab test is typically ordered every three months. By comparison, a blood sugar test with a meter tells us what our number is right now.

There is no predictive value or retrospective value associated with it like an HbA1c produces. But HbA1c values don’t tell us if the results represent an average of extreme high and low blood sugars over the past few months or if they represent blood sugars consistently remaining within a normal range. The A1c number is only an overall average. Continuous glucose monitors (CGMs) can fill in those blanks. If you wear one, it can graph how much time is spent in the high, normal, and low ranges.

The benefits of HbA1c

There have been tremendous strides in the health of those living with diabetes, especially over the past decade. There’s no doubt that HbA1c tests and other advances in diabetes technology are worth their weight in gold.

“We’re seeing a 60 percent reduction in heart attack, a 50 percent reduction in stroke, a 40 percent reduction in amputation, and a 28 percent reduction in diabetic kidney disease,” Robert Ratner, MD, FACP, FACE, chief scientific and medical officer for the American Diabetes Association, stated during the recent Food and Drug Administration workshop “Diabetes Outcome Measures Beyond Hemoglobin A1c.”

Beyond the Hemoglobin A1c test

The gold standard A1c test we’ve been using for three decades to measure how well we are taking care of our diabetes business is helpful, but it is like a slice of Swiss cheese.

When we look beyond the results or “the number” to find greater meaning and understanding, it can help shape positive changes to improve our health.

There are holes in the story that require investigative work. There is no easy formula for us to follow for success. We’re all unique, and our personal experience influences how we shoulder our chronic disease.

Diabetes numbers often sway how we feel and function, our happiness day to day, our safety, and much more. Meaningful measures are vital to our well-being. How can we and our healthcare providers get better at tracking and understanding our diabetes?

According to Endocrine Today, some experts call for an adaptive model of diabetes control that paints a clearer picture than HbA1c alone, “one that may include HbA1c, but also incorporates metrics including time in range, hypoglycemia, change in body weight, and patient-reported outcomes, such as health-related quality of life.”

What role does the HbA1c test play in your diabetes management? How do you make the best use of the information it provides? Share your thoughts by commenting below.