A client with type 2 diabetes has a hemoglobin A1c (HbA1c) of 9.8%. What does this value tell the nurse?

HEMOGLOBIN A1c (HbA1c or glycated hemoglobin) reflects average blood glucose over the PRECEDING 2-3 MONTHS because: glucose binds irreversibly to hemoglobin in red blood cells (RBCs); RBCs have a lifespan of approximately 90-120 days; the percentage of HbA1c reflects average glucose exposure during that period. NORMAL VALUES: Normal (non-diabetic): below 5.7%; Prediabetes: 5.7-6.4%; Diabetes diagnosis: 6.5% or above on two separate tests; ADA TREATMENT TARGET for most non-pregnant adults with diabetes: below 7.0%; Individualized targets: less stringent (7.0-8.0%) for elderly, extensive comorbidities, hypoglycemia unawareness; more stringent (<6.5%) for young, newly diagnosed, no significant CVD. CONVERTING A1c TO AVERAGE GLUCOSE: formula: eAG (mg/dL) = 28.7 × A1c - 46.7; A1c 9.8% = approximately 235 mg/dL average; CLINICAL IMPLICATIONS: A1c 9.8% indicates poor glycemic control over the past 3 months — associated with increased risk of: diabetic retinopathy, nephropathy, neuropathy, and cardiovascular disease; this client needs medication review, diabetes education reinforcement, and lifestyle coaching; PN TEACHING: Explain that A1c reflects their average glucose (not just one moment), so short-term improvements in behavior WILL improve the next A1c; reinforce that even partial improvements reduce complication risk; the value does not define the person — it is a target to work toward.