6 However, little is known about other biological factors that result in low HbA1c values among individuals without diabetes. Certain health conditions that decrease erythrocyte life span (eg, iron-deficiency anemia) are known to alter HbA1c values and make them unreliable. Very low HbA1c values among persons without diabetes may reflect underlying biological processes.
9. HEMOGLOBIN A1C NORMAL RANGE HOW TO
HbA1c ≥6.5% has been shown to be reasonable for diagnosing diabetes, 5 but it is currently uncertain how to interpret low HbA1c values. Along with the broad use of this assay, low HbA1c values, including very low values <4.0%, may be frequently detected. 3 Recently, the American Diabetes Association updated its clinical practice recommendations to include HbA1c as a diagnostic test for diabetes, 4 which may lead to its widespread use. 1, 2 Additionally, a recent study identified HbA1c as a better predictor of cardiovascular events compared with fasting plasma glucose. This association was attenuated but remained statistically significant after further multivariable adjustment for lifestyle, cardiovascular factors, metabolic factors, red blood cell indices, iron storage indices, and liver function indices (HR, 2.90 95% CI, 1.25 to 6.76).Įlevated hemoglobin A1c (HbA1c) is associated with an increased risk of cardiovascular events among individuals without diabetes. An HbA1c <4.0% versus 5.0% to 5.4% was associated with an increased risk of all-cause mortality (HR, 3.73 95% CI, 1.45 to 9.63) after adjustment for age, race-ethnicity, and sex. Participants with a low HbA1c (<4.0%) had the highest levels of mean red blood cell volume, ferritin, and liver enzymes and the lowest levels of mean total cholesterol and diastolic blood pressure compared with their counterparts with HbA1c levels between 4.0% and 6.4%. There were 1825 deaths during the follow-up period.
Cox proportional hazards regression was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association between HbA1c levels and all-cause mortality for 14 099 participants without diabetes. National Health and Nutrition Examination Survey III (NHANES III) participants, 20 years and older, were followed up to 12 years (median follow-up, 8.8 years) for all-cause mortality.
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