What is The Normal HbA1c by Age?
Donna Cross is a Type 2 Diabetes Advocate and Blogger, Content Writer, and a Certified Reiki Practitioner specializing in diabetes burnout. Diagnosed with Type 2 Diabetes in 2018 with an HbA1c of 12.3, Donna took matters into her own hands to change her circumstances. In 11 months, Donna successfully reversed her condition with significant lifestyle change, removing all medications and, in total, has lost 192 pounds naturally. Now, her HbA1c remains at a consistent 5.0.
Dr. Alice Greene received her medical degree from University of Pennsylvania and completed residency in Internal Medicine at New York University. Dr. Greene is board-certified in Internal Medicine and completed a Primary Care Psychiatry Fellowship at the University of California at Irvine. She received her B.A. in English from Columbia University.
Dr. Greene has dedicated over twenty years of her career as an Assistant Professor at Stony Brook Medicine. During her tenure, she played a pivotal role in pioneering the field of Lifestyle Medicine, bringing about a transformative shift in the conventional medical approach to disease management. Her work focused on addressing the fundamental underlying causes of illness, paving the way for a more holistic and proactive approach to healthcare.
What is The Normal HbA1c By Age?
The HbA1c test is a “powerhouse” of a diagnostic test, according to the American Diabetes Association. With more than 100 million U.S. adults living with diabetes and prediabetes, this test is just what the doctor ordered. With just a single finger prick, the HbA1c test can screen for prediabetes, diagnose diabetes, and manage your diabetes treatment plan over time. It turns out, however, that factors such as age, race, and other medical conditions, such as your pregnancy status, can all impact your HbA1c. It’s important to understand how to calculate your HbA1c when at home to understand where your numbers are at.
What Exactly is The HbA1c Test?
The HbA1c test measures how much blood glucose (sugar) is attached to your hemoglobin. HbA1c stands for “glycated hemoglobin”, the medical term describing how your red blood cells, containing a protein called hemoglobin, become loaded up with excess sugar. As sugar circulates in your bloodstream, especially after a meal, it sticks to the hemoglobin in your red blood cells. Sugar is sticky, and stays attached to your hemoglobin for up to 3 months, which is the average lifespan of your red blood cells.
The more excess sugar accumulates in your bloodstream, the more red blood cells are covered with sugar molecules. These excess sugar molecules will stay attached if they are not allowed into the blood cells to be used as energy properly, which is called “insulin resistance”. This is the key culprit in type 2 diabetes.
The HbA1c test measures the percentage of the hemoglobin in your red blood cells covered in sugar over the three-month timeframe. The higher the percentage of glycated red blood cells, the higher your HbA1c test result.
What Are Generally Normal HbA1c Ranges?
If you get into sports stats, then, the easiest way to explain the HbA1c test is comparing it to a baseball player’s season average — it tells you about a player’s overall success, not how the player performed during one particular game. Similarly, your HbA1c does not show your blood sugar levels for just one day. It shows your percentage of glycated cells over the course of three months.
For adults, healthcare providers use the following general HbA1c target ranges:
- A normal (non-diabetes) HbA1c level is below 5.7%
- Prediabetes is diagnosed between 5.7 and 6.4%
- Type 2 diabetes is diagnosed above 6.5%
- The goal for most adults with diabetes is an HbA1c that is less than 7%
In children under the age of 18, the normal range for HbA1c levels is 4.5% to 5.7%. Most experts recommend a target HbA1c of less than 7.5% in children with type 1 diabetes and a target HbA1c of less than 7% in children with type 2 diabetes.
In women before pregnancy, the recommended HbA1c is less than 6.5%. During pregnancy, HbA1c is considered normal for values less than 5.4% in the first and second trimester and considered normal for values less than 5.7% in the third trimester.
HbA1c levels also vary by age. Going back to the baseball analogy, a younger, stronger baseball player may have a better season average than an 80-year-old grandfather with poor eyesight and less mobility.
Why Do Normal HbA1c Ranges Vary by Age?
Diabetes researchers and physicians are still not in agreement over why age can make it more difficult for people to achieve and maintain lower HbA1c’s for better overall diabetic control. More than likely, there are multiple factors complicating this issue, such as race, and each person living with diabetes is different, therefore having different target levels for their unique needs. Basically, there is no one-size-fits all target level for HbA1c’s. One thing that is for certain is that as you get older, your HbA1c naturally increases, regardless of whether or not you have diabetes, as this chart below shows:
Age-Related HbA1C Increase With Non-Diabetes:
For 20-39 year olds:
HbA1c: 6%
Mmol: 42.1
Mg/L: 126
For 40-59 year olds:
HbA1c: 6.1%
Mmol: 43.2
Mg/L: 140
Over the age of 60:
HbA1c: 6.5%
Mmol: 47.5
Mg/L: 160
Updated HbA1c Ranges For Adults 65 years And Older
There is a debate amongst healthcare providers and diabetes researchers regarding how best to manage the elderly living with diabetes. Adults over the age of 65 can have many complex health conditions and represent a diverse patient population to which a single HbA1c target guideline may not apply.
The American Diabetes Association, the American Geriatrics Society, and the International Diabetes Federation all adjusted their target HbA1c ranges for adults aged 65 and older and then further broke down target ranges by the senior’s overall health. Therefore, HbA1c target ranges for this group increased up to 8.5% or even 9% for seniors over the age of 65.
Interestingly, neither the American Association of Clinical Endocrinologists (AACE) nor the European Association for the Study of Diabetes has made age-specific adjustments for HbA1c based on age or health status.
American Diabetes Association (ADA) Guidelines For Adults Age 65 Or Older:
Healthy <7.5% HbA1c
Intermediate <8.0 % HbA1c
Poor <8.5% HbA1c
American Geriatrics Society Guidelines For Adults Age 65 Or Older:
HbA1c by Health Status:
Overall – 7.5-8.0%
Healthy/Few Comorbidities – 7.0-7.5%
Poor – 8.0-9.0 %
International Diabetes Federation Guidelines For Adults Age 70 Or Older:
Functionally Independent – 7.0-7.5% HbA1c
Functionally Dependent – 7.0-8.0% HbA1c
Frail/Dementia – 8.5% HbA1c And Up
End Of Life – Avoid Symptomatic Hyperglycemia
Why Did These HbA1c Changes Occur?
There are several reasons behind the change advocated by the American Diabetes Association, American Geriatrics Society, and the International Diabetes Foundation. First, maintaining an HbA1c of 8% or 9% is much easier than achieving less than 7%. Maintaining less than 7% requires strict glycemic control, which includes following a healthy diet and exercise regimen, regular blood glucose monitoring, and taking very strong medications. These medications, especially taken in high doses, can increase the risk of low blood-sugar episodes, or hypoglycemia, in elderly or otherwise unhealthy patients. Hypoglycemia in the elderly, if severe, can lead to a change in mental health status (depression, anxiety), seizures, loss of consciousness, heart problems, fractures from falls, and death in extreme cases. Also, the elderly have higher rates of cognitive impairment (Alzheimer’s, Dementia), making it harder to follow strict diabetic treatment plans with regular blood sugar monitoring and frequently readjusting medication dosages. Also, as a rule, older adults with diabetes have a greater risk of hypoglycemia than younger adults, therefore, tight glycemic control may come at a higher cost for the elderly.
All clinical guidelines and research institutions do agree, however, that the management of diabetes, especially in the elderly, needs to be personalized. For this reason, frequently monitoring your HbA1c, regular glucose monitoring, taking medications as prescribed, following a nutritious meal plan and increasing daily movement is really the best way to keep your diabetes under control for your own unique health needs.
At What Age Should You Check Your HbA1c?
The CDC recommends getting a baseline HbA1c test if you’re an adult over age 45 or are under 45, are overweight, and have one or more of the following risk factors for prediabetes or type 2 diabetes:
- Have prediabetes
- Overweight/Obese
- 45 years or older
- Sibling or parent with type 2 diabetes
- Sedentary lifestyle or active less than three times per week
- History of Gestational Diabetes, or gave birth to a baby weighing over 9 pounds
- Have Non-Alcoholic Fatty Liver Disease
- Are African-American, Hispanic/Latino, American Indian, Alaskan Native, Pacific Islander or Asian-American
Is Your HbA1c Normal For Your Age?
Part of your health and wellness journey may be learning more about your risk of diabetes. Maybe you have family members living with diabetes and are worried about your own risk. Perhaps you want to measure the impact of changes you made in your lifestyle. Knowing that higher HbA1c levels are linked to diabetes complications such as stroke and coronary heart disease, an HbA1c test, and learning where you fall on the HbA1c chart, is vital information to help you be better informed on the status of your well-being.
At your next healthcare appointment, make it a point to ask your doctor to set you up with an HbA1c test! The knowledge you need to make healthier lifestyle choices for a healthier future.
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