Amanda Wilde (Host): You may have heard of an A1C. That's a test that measures blood glucose levels. An A1C can be used to diagnose diabetes or prediabetes and is used for diabetes management. We're talking about A1C and blood sugar control with endocrinologist Dr. Makarem Abulimon. This is Memorial Health Radio with Memorial Health System Ohio. I'm Amanda Wilde. Welcome, Dr. Abulimon. Glad to have you here.

Makarem Abulimon, MD: Hi, thank you so much for having me!

Host: Well, I have heard of the test, but why is it important to know your A1C? Is this something everyone should test for?

Makarem Abulimon, MD: Yes, basically, A1C is used, first of all, to diagnose pre diabetes and diabetes conditions and eventually we use it in the clinic to monitor how well your diabetes is controlled or if your pre diabetes did progress over time to diabetes.

Host: So, it's good to have that baseline. How often should a patient have theirs checked?

Makarem Abulimon, MD: Well, it depends. Basically, if we were looking at the screening tool, we usually start at the age of 35 and then maybe do it every three years if the patient did not have any issues with their A1C. Eventually, if the patient A1C is at the level of prediabetes, we technically recommend the ideal situation of diet and lifestyle modification and educate them that potentially, with time, they might progress to diabetes.

Now, in guidelines, we have to check A1C on a yearly basis for pre diabetic patients to make sure that they did not progress to diabetes, and eventually, if patient is in the diabetic range, we have to monitor their A1C every three months to make sure that the current treatment plan is working for them.

Host: Mmhmm. So, how often will vary based on what your readings are? You've mentioned diabetes. This is the main function of the A1C. Are there other concerns if someone has an elevated A1C?

Makarem Abulimon, MD: Most of the time, it's not. But again, in practice, people can have elevated glucose levels if they were super ill, under stress. But that usually resolves within the days that they have that illness, so it should not flip into an A1C being above the target. So, like, if the patient was ill and their glucose was elevated for a short period of time, the A1C will read the past three months, of glucose worth of data.

So A1C elevation is an accurate way to diagnose pre diabetes and diabetes, but it's not the most accurate way, but it's the easiest way. It's fairly common. Patients do not need to fast for it, and that's why we choose it.

Host: So, it's the initial tool you might use to monitor?

Makarem Abulimon, MD: To diagnose, yes, and we basically, to diagnose patients with diabetes, we need two different readings that put the patient's glucose or the patient's levels within the prediabetes or the diabetes range. So we cannot rely on one reading of one test, but then eventually, yes, A1C will be more than enough for us to look at the progress of their disease.

Host: Now, when checking blood sugar, are there things that the patient should be watching?

Makarem Abulimon, MD: Yes, because A1C, as I mentioned, it does reflect the glucose control over the past three months. But when patients are taking insulin, or medications that could potentially cause hypoglycemia, which is a low glucose reading, and no one wants that, regardless diabetic versus none, or pre diabetic, we need patients to help us figure out if this good A1C was a legit reading because all day and all night the readings were fine or they do have fluctuations to the point that they have some low glucose readings and some patients do not even notice this and that will even out the high readings. And when we see them in the clinic, we'll see a good A1c, but that was just a random average of a very high and a very low readings.

So patients should definitely be checking on their glucose at home to help us make that decision.

Host: As far as checking for A1C regularly, what are the long term benefits of maintaining that appropriate A1C and blood sugar level?

Makarem Abulimon, MD: Yeah, so when we have an A1C, target, that indicates a lower risk of the complications that could happen in patients who are diabetic. Diabetic patients are prone to have cardiovascular problems, eye problems, kidney problems, vascular problems in their legs, ending in numbness and amputations, and having a good A1C, and our target is below 7 for most of the patients, will decrease that risk for them.

Host: You were saying that most of us should start getting tested around age 35. Do you think enough of us are getting this test?

Makarem Abulimon, MD: Not really, in a sense that if the patient probably was not concerned about being diabetic with a family history of diabetes, most of the time that's an overlooked test. Even like I just mentioned randomly the 35 age, there's other criterias that we have to look at before we decide if the patient really qualifies for the check. And a lot of our patients meet that criteria and it's an overlooked test.

Host: So hopefully our conversation will enlighten more people about the importance of the A1C test. Thank you, Dr. Abulimon, for this really important information.

Makarem Abulimon, MD: No problem. Thank you for having me again.

Host: And that wraps up this episode of Memorial Health Radio with Memorial Health System. Head on over to our website at mhsystem.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all other Memorial Health System podcasts.

Thanks for listening to Memorial Health Radio with Memorial Health System Ohio.