A small percentage of Hb A is glycated.

Glycation is a posttranslational
modification formed by the nonenzymatic binding of various sugars to
globin chain amino groups over the life span of the RBC. The most
characterized of the glycated hemoglobins is Hb A1c , in which glucose
attaches to the N-terminal valine of the b chain. 1 Normally, about 4% to
6% of Hb A circulates in the A 1c form. In uncontrolled diabetes mellitus,
the amount of A 1c is increased proportionally to the mean blood glucose
level over the preceding 2 to 3 months.

Hemoglobin formed in new red blood cells enters the circulation with
minimal glucose attached. However, red cells are freely permeable to
glucose. As a result, glucose becomes irreversibly attached to hemoglobin
at a rate dependent upon the prevailing blood glucose concentration

Approximately 1 percent of erythrocytes are destroyed every day, while an

equal number of new ones are formed. Thus, the average amount of A1C
changes in a dynamic way and indicates the mean blood glucose
concentration over the lifespan of the red cell [7,8]. Although the A1C
reflects mean blood glucose over the entire 120-day lifespan of the red
blood cell, it correlates best with mean blood glucose over the previous 8 to
12 weeks

Method performed in HbA1c is National Glycohemoglobin Standardization

Program (NGSP) certified and the reagent used is standardized to the
Diabetes Control Complications Trial (DCCT)

A1C values are influenced by red cell survival. Thus, falsely high values in
relation to a mean blood glucose values can be obtained when red cell
turnover is low, resulting in a disproportionate number of older red cells.
This problem can occur in patients with iron, vitamin B12, or folate
deficiency anemia.

A1C values may be falsely elevated or decreased in those with chronic

kidney disease. False elevations may be due in part to analytical
interference from carbamylated hemoglobin formed in the presence of
elevated concentrations of urea, leading to false elevations in the A1C level
with some assays. False decreases in measured A1C may occur with
hemodialysis and altered red cell turnover, especially in the setting of
erythropoietin treatment.
 eAG is reported in mg/dL (mmol/L). This is the same measurement used in
home blood sugar meters.

eAG relates directly to your A1C results. Because it uses the same units as
home meters, eAG makes it easier for people to understand their A1C
values. Health care providers now use eAG to talk with their patients about
A1C results.

Knowing your eAg can help you:

 Track your blood glucose levels over time

 Confirm self-test readings
 Better manage diabetes by seeing how your choices affect blood sugar