Questions to Ask Your Doctor About A1c and eGFR

A1c, eGFR and UACR are three of the numbers that come up most when you have type 2 diabetes and care about your kidneys. This page explains what each one is, what two guideline groups say about testing, and what you might ask at your next visit. Your doctor decides what your numbers mean for you.

What each number is

• A1c is a blood test. The American Diabetes Association (ADA) calls it an indirect measure of average blood sugar. It is reported as a percent.
• eGFR (estimated glomerular filtration rate) is calculated from a blood test for creatinine. NIDDK says it checks how well your kidneys are filtering your blood.
• UACR (urine albumin-to-creatinine ratio) is a urine test. NIDDK says it compares the amount of albumin with the amount of creatinine in your urine sample.

Lab reports print their own reference ranges. When your result looks off, check the range on your own report and ask what it means for you. Our pages on HbA1c and eGFR explain each test in more detail.

What the guidelines say about testing

• A1c frequency (ADA, section 6): assess at least two times a year, and more often, for example every 3 months, if you are not meeting your glycemic goals or have had treatment changes, frequent or severe low or high blood sugar, or changes in health.
• A1c goal (ADA, section 6): the ADA describes a goal below 7 percent as appropriate for many non-pregnant adults without severe hypoglycemia or hypoglycemia that affects health or quality of life. Ask what goal fits you.
• Kidney testing (ADA, section 11): assess UACR and eGFR at least once a year in all people with type 2 diabetes, whatever the treatment. In people who have chronic kidney disease, monitor them one to four times a year depending on the stage.

How the kidney numbers are grouped

KDIGO, an international kidney guideline group, classifies kidney disease by both eGFR (G categories) and albuminuria (A categories). The groups below are descriptions of levels, not targets.

• eGFR, in mL/min/1.73 m2: G1 is 90 or above (normal or high), G2 is 60 to 89 (mildly decreased), G3a is 45 to 59, G3b is 30 to 44, G4 is 15 to 29, and G5 is below 15.
• Albumin in urine (ACR): A1 is below 30 mg/g (normal to mildly increased), A2 is 30 to 300 mg/g (moderately increased), and A3 is above 300 mg/g (severely increased).
• One result is not a diagnosis. KDIGO defines chronic kidney disease as abnormalities of kidney structure or function present for at least 3 months, and says not to assume it from a single abnormal eGFR or ACR.

Why UACR matters

KDIGO says to test people at risk for kidney disease using both urine albumin and eGFR, and its staging uses both. So a result on one test does not stand in for the other. The ADA lists both in the same yearly check.

Questions to bring

• What were my latest A1c, eGFR and UACR results, and on what dates?
• What A1c goal is right for me, and why?
• How often should each of these be tested for me?
• When was my last UACR? Is one due now?
• Has my eGFR changed since last year, and by how much?
• If a result is outside the range printed on my lab report, what does it mean for me and what happens next?
• Do my other conditions or medicines affect how to read these numbers?
• Is there a test I should have had by now that I have not?
• Who on my care team looks at my kidney results, and do they see the same numbers?

Tracking over time

KDIGO's guidance on people who already have kidney disease says that a change in eGFR of more than 20 percent on a later test, or a doubling of ACR, goes beyond normal test-to-test variation and warrants evaluation. That is one reason to keep results together, with dates, in one place.

What to do with the files

Phi Longevity PRISM can build a one-page Care Team Brief from your lab reports, with each result's date, trends over time, and the guideline behind each flag. For type 2 diabetes it also checks your results against the ADA's schedule and points out tests that look overdue. See the one-page diabetes and kidney summary and our guide for people with chronic conditions.

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What Phi Longevity PRISM does not do

It does not diagnose, and it does not tell you what a number means for you or what to change. It uses the range printed on your own lab report and never swaps in its own. Your doctor decides what you need.