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What is Estimated Average Glucose (eAG)?

Estimated Average Glucose (eAG) is a calculated value derived from your HbA1c (hemoglobin A1c) test results. While HbA1c is reported as a percentage, eAG translates that percentage into the same units used by home blood glucose meters: milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). This conversion makes it easier for people to understand their long-term blood sugar control in relation to the numbers they see during daily glucose monitoring. The formula used to calculate eAG was established by the A1c-Derived Average Glucose (ADAG) study, which included 507 subjects from 10 international centers: eAG (mg/dL) = (28.7 x A1C) – 46.7.

Why is Estimated Average Glucose (eAG) important?

Tracking your eAG helps you understand your average blood sugar levels over the past two to three months, providing valuable insight into how well your diabetes management plan is working. Unlike a single fasting glucose test, eAG reflects glucose levels throughout the day, including after meals and overnight. This comprehensive view makes eAG a useful tool for both patients and healthcare providers when assessing glycemic control.

High eAG values indicate chronically elevated blood sugar, which increases the risk of diabetes complications such as cardiovascular disease, kidney damage (nephropathy), nerve damage (neuropathy), and eye problems (retinopathy). Symptoms of consistently high blood sugar may include increased thirst, frequent urination, fatigue, blurred vision, and slow-healing wounds. Low eAG values in people with diabetes may indicate well-controlled blood sugar, but excessively low values could suggest frequent hypoglycemic episodes, which can be dangerous and may cause confusion, shakiness, sweating, and in severe cases, loss of consciousness. If you are concerned about your eAG levels, it is important to consult with your physician.

How can I better understand my Estimated Average Glucose (eAG) levels?

According to the American Diabetes Association and MedlinePlus:

  • Normal (non-diabetic): 70-126 mg/dL (corresponds to A1C of 4-6%)
  • Prediabetes range: 117-137 mg/dL (corresponds to A1C of 5.7-6.4%)
  • Diabetes target for most adults: <154 mg/dL (corresponds to A1C <7%)
  • Diabetes diagnosis threshold: >140 mg/dL (corresponds to A1C >6.5%)

Common A1C to eAG conversions:

  • A1C 5%: eAG 97 mg/dL
  • A1C 6%: eAG 126 mg/dL
  • A1C 7%: eAG 154 mg/dL
  • A1C 8%: eAG 183 mg/dL
  • A1C 9%: eAG 212 mg/dL
  • A1C 10%: eAG 240 mg/dL

It is important to note that your eAG may not match the average of your home glucose meter readings. This is because most people tend to check their blood sugar before meals or when they feel low, which does not capture post-meal spikes or overnight glucose levels. eAG provides a more complete picture of your 24-hour glucose exposure.

Certain conditions and medications can affect the accuracy of eAG calculations, including anemia, kidney disease, sickle cell disease, thalassemia, and recent blood transfusions. If you have any of these conditions, discuss with your healthcare provider how to best interpret your results.

How can I maintain optimal eAG levels?

If you need to maintain or improve your eAG levels, consider the following strategies:

Dietary Changes: Focus on a balanced diet rich in fiber from vegetables, whole grains, and legumes. Limit refined carbohydrates, sugary beverages, and ultra-processed foods. The American Diabetes Association recommends following the Diabetes Plate Method: fill half your plate with non-starchy vegetables, one quarter with lean protein, and one quarter with whole grains or starchy foods. Pairing carbohydrates with protein, fiber, and healthy fats can help prevent blood sugar spikes.

Physical Activity: Regular exercise improves insulin sensitivity and helps your body use glucose more efficiently. Aim for at least 150 minutes of moderate-intensity aerobic activity per week, such as brisk walking, swimming, or cycling. Incorporating two to three sessions of resistance training weekly can further improve blood sugar control. Physical activity can lower blood glucose for up to 24 hours after your workout.

Lifestyle Changes: Managing stress through meditation, yoga, or deep breathing exercises can help lower blood sugar, as stress hormones cause glucose levels to rise. Prioritize quality sleep of seven to nine hours per night, as poor sleep negatively impacts blood sugar regulation. If you smoke, quitting can significantly improve your diabetes management and reduce the risk of complications.

Medication Adherence: If your healthcare provider has prescribed diabetes medications or insulin, take them exactly as directed. Missing doses can lead to blood sugar fluctuations that will raise your eAG over time. Discuss any concerns about side effects or costs with your doctor before making changes.

Where can I learn more?

DISCLAIMER: This information is for educational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider for interpretation of your eAG results and for personalized diabetes management recommendations.