Pharmacists and HbA1c Testing

According to a nationwide survey by the American Association of Diabetes Educators (AADE), only 25 percent of people with diabetes know their HbA1c level, and less than 20 percent have their HbA1c tested regularly. FDA approved, over-the-counter (OTC) Hemoglobin A1c (HbA1c) tests should have prominent shelf space in your pharmacy's diabetes care department. While glucose monitoring is vital for day-to-day diabetes management, long-term blood glucose control requires an additional measurement: average blood glucose levels. HbA1c testing measures the average blood sugar over three-month period. It helps patients maintain better control of their blood sugar and helps them control their diabetes.

The American Diabetes Association (ADA) recommends HbA1c testing for all people with diabetes at least twice a year, and four times annually for those requiring insulin injections. More than everyday glucose values, the HbA1c test tells a more complete story of diabetes control. As glucose travels through the body, it attaches itself to hemoglobin, which is a protein inside red blood cells. When glucose connects itself to hemoglobin molecules, the process is called glycosylation or glycation.

When blood glucose levels are high (even after a meter says normal), some glucose will stay attached to red blood cells. So, the more often the body has high glucose levels, the more glucose will attach to the hemoglobin. The red blood cells only live for about three months, and are then replaced by new red blood cells. Thus, when HbA1c levels are measured every three months, you get a quarterly average of glucose levels.

Once glucose and red blood cells are attached, they are known as glycated hemoglobin. This is the same action that cures meat to make beef jerky. Beef jerky is tough, not easily penetrated by bacteria and does not decay. These may be good qualities for a food product, but not for the human body. It is these jerky-like substances that interfere with blood flow and contribute to diabetes complications. Called advanced glycated end products, they eventually make cells so stiff that they do not work.

Back in 1993, the Diabetes Control and Complications Trial established the connection between HbA1c and complications saying that the risk of complications can be reduced by 60 percent by normalizing blood glucose levels. Yet today, many people with diabetes are still not getting the recommended two to four HbA1c tests per year.

Take the ADA’s advice, mine your prescription data and recommend HbA1c testing for every person with diabetes doing business with your pharmacy. Do your part to prevent complications, contain long-term health care costs and improve quality of life in the communities you serve.