has been exposed during its life-cycle. Measuring glycated hemoglobin assesses the effectiveness of therapy by monitoring long-term serum glucose regulation. A1c is a weighted average of blood glucose levels during the life of the red blood cells (117 days for men and 106 days in women). Therefore, glucose levels on days nearer to the test contribute substantially more to the level of A1c than the levels in days further from the test. This is also supported by data from clinical practice showing that HbA1c levels improved significantly after 20 days from start or intensification of glucose-lowering treatment. Measurement Several techniques are used to measure hemoglobin A1c. Laboratories may use high-performance liquid chromatography, immunoassay, enzymatic assay, capillary electrophoresis, or boronate affinity chromatography. Point of care (e.g., doctor's office) devices use immunoassay boronate affinity chromatography. In the United States, HbA1c testing laboratories are certified by the National Glycohemoglobin Standardization Program to standardize them against the results of the 1993 Diabetes Control and Complications Trial (DCCT). An additional percentage scale, Mono S has previously been in use by Sweden and KO500 is in use in Japan. Switch to IFCC units The American Diabetes Association, European Association for the Study of Diabetes, and International Diabetes Federation have agreed that, in the future, HbA1c is to be reported in the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) units. IFCC reporting was introduced in Europe except for the UK in 2003; the UK carried out dual reporting from 1 June 2009 until 1 October 2011. Conversion between DCCT and IFCC is by the following equation: Interpretation of results Laboratory results may differ depending on the analytical technique, the age of the subject, and biological variation among individuals. Higher levels of HbA1c are found in people with persistently elevated blood sugar, as in diabetes mellitus. While diabetic patient treatment goals vary, many include a target range of HbA1c values. A diabetic person with good glucose control has an HbA1c level that is close to or within the reference range. The International Diabetes Federation and the American College of Endocrinology recommend HbA1c values below 48 mmol/mol (6.5 DCCT %), while the American Diabetes Association recommends HbA1c be below 53 mmol/mol (7.0 DCCT %) for most patients. Results from large trials in suggested that a target below 53 mmol/mol (7 DCCT %) for older adults with type 2 diabetes may be excessive: Below 53 mmol/mol, the health