Hemoglobin A1c is the gold standard for diabetes diagnosis.
It is the saturation or glycation of hemoglobin over the last 3 months.
There are certain situations that can affect A1C numbers.
Red blood cells turnover typically in about 90 days. But in diabetics, red blood cells turnover in as little as 81 days and in very insulin sensitive and metabolically healthy individuals, it can turnover as long as 146 days.
For these reasons, the A1c numbers may not be a true reflection of their metabolic health.
Also to note, people with anemia,may have their red blood cells turnover a little quicker than normal. So in such people, their a1c numbers may not be that reliable.
The Research:
1.https://pmc.ncbi.nlm.nih.gov/articles/PMC3912281/
2.https://diabetesjournals.org/spectrum/article/21/1/46/2191/Glycemic-Control-and-Hemoglobinopathy-When-A1C-May
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