Version 2.77


Hemoglobin A1c refers to hemoglobin components formed by interaction of hemoglobin with glucose. This interaction is a non-enzymatic irreversible process that is dependent on glucose concentration. RBC half-life is approx 120 days so a measurement can yield the average glucose concentration over the last 8 to 12 weeks. Source: Regenstrief Institute

Currently (2010), four standardization protocols exist for measuring Hgb A1c:

1. IFCC - designated as a Reference Method or RM (
2. NGSP - the long standing protocol used in the US and most other countries since the DCCT study (
3.JDS/JSCC - a protocol used in Japan, Spain and possibly other countries
4. Swedish - used in Sweden at least

Protocols 2-4 are known as Designated Comparison Methods (DCM) and have been connected to the Reference Method and each other through various regression equations.

Because of the high degrees of standardization within protocol it should no longer be necessary to specify a LOINC code with a method such as "HPLC", "electrophoresis" or anything else. Analytical instruments will be designed so that an Hgb A1c result can be traced back to a specific standardization protocol, so the important distinction will be the standardization protocol as described above and which will be carried in the method field.

A meeting of instrument manufacturers (presumably including Japanese) in Milan, Italy, December 12, 2007, agreed (among other items) that:

-All manufacturers should implement worldwide the traceability to the IFCC reference system for Hgb -A1c.
-All new instruments sold after January 1st, 2011 will report (as a result of an Hgb A1c test) both SI (mmol/mol - no decimals) and NGSP derived units (percentage - one decimal), in agreement with the Consensus Statement.
-Note they only committed to supporting protocol (1) and (2)

Different countries are adopting the international harmonization recommendations in different ways. We have information from the NGSP that the US will continue to report only Hgb A1c/NGSP, with the unit percent - i.e., no change. In Great Britain, labs have already started to report all results both as Hgb A1c (NGSP) in % and Hgb A1c (IFCC) in mmol/mol. In Canada, they are awaiting a recommendation from an expert panel. Any of these measures could be reported in the same units, but the convention for the reporting Hgb A1c under the new IFCC protocol will be to use units of mmol/mol to avoid confusion between the DCCT/NGSP and the IFFCC protocol.

LOINC has defined 59261-8 (Hemoglobin A1c/ in Blood) by IFCC protocol.

These protocols produce different results when expressed in the same units. For example, the equivalent of Hgb A1c (NGSP) of 6.5% is Hgb A1c (IFCC) is 4.8%.

The NGSP web site ( suggests the use of alternate measures, such as glycated albumen, for patients with severe iron deficiency, dialysis patients, and those with SS SC CC because of over or under reading that can occur with these interferences. It also describes the effect of abnormal hemoglobins on results of HbA1c by instrument.

Studies have demonstrated racial and ethnic differences in the relationship between glucose levels and hemoglobin A1C [22238408], and it has been suggested that some descendants of sub-Saharan Africa may have higher levels of measured hemoglobin A1C compared to glucose levels due to hemoglobin variants PMID: 31675503. Source: Regenstrief Help

Glycated hemoglobin (hemoglobin A1c, HbA1c, A1C, or Hb1c; sometimes also HbA1c) is a form of hemoglobin that is measured primarily to identify the average plasma glucose concentration over prolonged periods of time. It is formed in a non-enzymatic glycation pathway by hemoglobin's exposure to plasma glucose. Normal levels of glucose produce a normal amount of glycated hemoglobin. As the average amount of plasma glucose increases, the fraction of glycated hemoglobin increases in a predictable way. This serves as a marker for average blood glucose levels over the previous months prior to the measurement.

The 2010 American Diabetes Association Standards of Medical Care in Diabetes added the A1c ≥ 48 mmol/mol (≥6.5%) as another criterion for the diagnosis of diabetes.

In diabetes mellitus, higher amounts of glycated hemoglobin, indicating poorer control of blood glucose levels, have been associated with cardiovascular disease, nephropathy, and retinopathy. Monitoring the HbA1c in type-1 diabetic patients may improve treatment. Copyright Text is available under the Creative Commons Attribution/Share-Alike License. See for details. Source: Wikipedia, Wikipedia

Basic Part Properties

Part Display Name
Hemoglobin A1c
Part Type
Component (Describes the core component or analyte measured)
Created On
Construct for LOINC Short Name

LOINC Terminology Service (API) using HL7® FHIR® Get Info

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Language Variants Get Info

Tag Language Translation
zh-CN Chinese (China) 血红蛋白 A1c
Synonyms: GHb;HA1c;HBA1c;Hgb A1c;糖化血红蛋白;糖基化血红蛋白;血红蛋白 A1c (糖化血红蛋白)
fr-CA French (Canada) Hémoglobine A1c
et-EE Estonian (Estonia) Hemoglobiin A1c
Synonyms: Glükohemoglobiin
es-ES Spanish (Spain) Hemoglobina A1c (Hemoglobina glicosilada)
it-IT Italian (Italy) Emoglobina A1c
Synonyms: Emoglobina A1c (HgB glicata )
el-GR Greek (Greece) Αιμοσφαιρίνη Α1c (γλυκοζυλιωμένη)
tr-TR Turkish (Turkey) Hemoglobin A1c
ru-RU Russian (Russian Federation) Гемоглобин А1с
nl-NL Dutch (Netherlands) hemoglobine A1c
fr-BE French (Belgium) Hémoglobine A1c
Synonyms: HbA1c
pl-PL Polish (Poland) Hemoglobina A1c