Director Huang Xinwen picked up a lab report in the consultation room and said to the patient in front of him, "Look, this indicator is like a 'report card' of your blood sugar over the past three months—it doesn't lie."

Huang Xinwen is the Deputy Chief Physician at Lanzhou Ruijing Diabetes Hospital. Every day, he faces the most pressing question from diabetic patients: "Doctor, how is my blood sugar control?" In his consultation room, there is always a mirror. He often tells patients, "This mirror reflects your current state, while glycated hemoglobin is like a 'blood sugar memory mirror' that reveals your blood sugar condition over the past two to three months."

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01 A "Blood Sugar Memory Mirror" That Never Lies


In Director Huang Xinwen's consultation room, glycated hemoglobin is likened to a "blood sugar memory mirror." He explains that this indicator does not become distorted due to a patient's occasional dietary indulgence or emotional fluctuations; it reflects the blood sugar control situation over the past 2 to 3 months.Reliable Indicator。

The formation process of glycated hemoglobin is actually quite simple: when glucose in the blood remains at high levels for an extended period, it "sticks" to hemoglobin, forming glycated hemoglobin. This process is slow and irreversible, much like spreading syrup on bread—once it sticks, it is difficult to separate.

The average lifespan of red blood cells in each person is approximately 120 days, so the detected glycated hemoglobin can inform us about blood glucose levels over a past period. Director Huang Xinwen added that it reflects a weighted average over a period of time, with 50% of the value determined by blood glucose concentrations in the most recent month.

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02 What Should the Target Level of Glycated Hemoglobin Be?


Regarding the target value for glycated hemoglobin, Director Huang Xinwen pointed out that both the Hong Kong Diabetes Federation and the Mayo Clinic recommend that the glycated hemoglobin target for most adult diabetes patients should beBelow 7%。

However, the latest Chinese Diabetes Prevention and Treatment Guidelines (2024 Edition) introduces a new concept, emphasizing a shift from a "disease-centered" approach to a "patient-centered" individualized treatment.

A one-size-fits-all standard is no longer applicable, explained Director Huang Xinwen. We need to establish personalized goals based on factors such as the patient's age, disease duration, and complications.

For young patients with a short disease duration, no complications, no cardiovascular disease, and a low risk of hypoglycemia, a glycated hemoglobin level below 6.5% may be considered. For elderly patients with multiple complications, a high risk of cardiovascular disease, or a susceptibility to hypoglycemia, the blood glucose target may be appropriately relaxed.

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03 Why Must Testing Be Conducted Every Three Months?


The frequency of glycated hemoglobin testing is a crucial aspect of diabetes management. Director Huang Xinwen emphasizes that this testFasting is not required.It can be performed at any time, which provides great convenience for patients.

It is generally recommended to test every 3 months, which amounts to 4 times per year. However, Director Huang Xinwen pointed out, "If blood sugar control is stable, checking every 6 months is also acceptable."

Why three months? Because the average lifespan of red blood cells is about 120 days, and the measurement of glycated hemoglobin precisely covers this period, providing a comprehensive reflection of the patient's blood glucose control status. Such regular testing helps both doctors and patients promptly understand treatment effectiveness and adjust the treatment plan when necessary.

In certain special circumstances, such as pregnancy, severe blood loss, post-transfusion, anemia, or certain blood conditions, the glycated hemoglobin value may not be sufficiently accurate and should be evaluated in conjunction with other indicators.

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04 The "Invisible Killer" Effect of Long-Term Exceeding Standards


When glycated hemoglobin remains elevated over an extended period, it acts like a silent "invisible killer," causing systemic damage to the body. Director Huang Xinwen seriously points out that long-term high glycated hemoglobin levels willDecrease the affinity of red blood cells for oxygenleading to hypoxia in tissues and cells.

The Diabetes Control and Complications Trial in the United States and the United Kingdom Prospective Diabetes Study, two landmark studies, have confirmed the close relationship between blood glucose control and complications.

Specific data show that for every 1% reduction in glycated hemoglobin,Stroke risk decreased by 12%The risk of myocardial infarction decreased by 15%, amputation and fatal peripheral vascular lesions decreased by 43%, and microvascular complications decreased by 37%.

Even more startling is that for every 1% reduction in glycated hemoglobin,The risk of diabetes-related mortality can be reduced by 21%.These data fully illustrate the importance of controlling glycated hemoglobin.

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05 Personalized Blood Sugar Control Is More Than Just Taking Medication


When facing the question of how to lower glycated hemoglobin, Director Huang Xinwen emphasized, "Blood sugar control is not simply about taking medication; it is a 'marathon' that requires comprehensive management."

According to the new guidelines, treatment decisions should be based on the patient'sCardiorenal Risk and Body WeightStratify the situation. For patients with atherosclerotic cardiovascular disease or those at high risk, prioritize medications with cardiovascular protective effects.

Director Huang Xinwen pointed out that patients with type 2 diabetes who are capable of self-monitoring blood glucose should undergo a structured assessment at least annually, including self-monitoring skills, test quality and frequency, and the ability to interpret results.

For newly diagnosed type 2 diabetes patients with severely elevated blood glucose, when glycated hemoglobin >9.0%, or fasting blood glucose >11.1 mmol/L, accompanied by significant hyperglycemia symptoms, short-term intensive insulin therapy lasting 2 weeks to 3 months may be initiated.

It's like a 'metabolic reboot' that can effectively reverse the damage caused by high glucose toxicity to pancreatic islet cells, Director Huang Xinwen analogized.

In front of the mirror in the consultation room, Director Huang Xinwen pointed to the glycated hemoglobin test report and said to the patient, "This 'blood sugar memory mirror' does not lie; it faithfully records your life over the past three months. Below 7% is the goal, but this is just the beginning."

He pointed to the follow-up plan in the patient's file, "We'll meet again in three months to see what this mirror will reflect of you." Outside the window, the sunlight was just right, while in the hospital corridor, another patient was holding a newly issued test slip, scheduling the next "memory mirror" examination.