IGeL: diabetes screening with HbA1c test

Detecting diabetes early: the health insurance fund does not pay for the HbA1c test. Is it still worth investing in early diabetes detection? We do the check

What is being done there?

HbA1c sounds complicated. It refers to the red blood pigment that changes due to blood sugar. Sugar molecules cling to what is known as hemoglobin. The HbA1c value indicates what percentage of the blood pigment is "saccharified". In healthy people this is around five percent, and 6.5 percent or more is referred to as diabetes.

The HbA1c value can provide information about the average blood sugar over the past eight to twelve weeks. "For patients who are already diagnosed with diabetes, the value for treatment is very important," says Dr. Hans-Martin Reuter from the German Diabetes Society

The information can help to better control the therapy. Then the health insurance pays for the test. If there is no medical reason, the patient will be billed for the laboratory analysis.


  • The test is easy. Blood is drawn from the patient for this. He doesn't even have to come to the doctor's office sober.
  • According to current studies, the test can detect diabetes just as reliably as the otherwise common fasting blood sugar test.
  • The result provides information about the long-term sugar - i.e. whether the blood sugar has been high or low on average in the last few weeks. In the case of diabetics, it also reveals whether their therapy is well adjusted.
  • In patients with an increased risk of diabetes who have already had a high blood sugar level, the attending physician may also order an HbA1c test. In these cases, the health insurance will reimburse the costs.


  • The HbA1c is only an average. "A value that is actually good can also hide strong fluctuations," says diabetologist Reuter.
  • Depending on the method, the accuracy of the HbA1c measurement can also vary.
  • If the value is only slightly increased, the test alone is not sufficient for a diagnosis. As a rule, a sugar load test is then also done to reliably diagnose diabetes.
  • In Germany there is so far no guideline in which experts only recommend the HbA1c test for early detection.


According to the medical fee schedule, the test including blood collection costs between 12 and 16 euros. It can be more expensive if the laboratory analysis is offered as part of a diabetes prevention package. Some health insurance companies cover the costs as part of their Check-up 35 offers.


The determination of the HbA1c value makes sense if there is already a suspicion of diabetes and the doctor wants to confirm his diagnosis. The test is also recommended for monitoring therapy in diabetics. "Then it is a cash benefit anyway," says Reuter. The test alone, without a medical reason, is of little use. Whether it detects diabetes more reliably than the fasting blood sugar test has not yet been scientifically proven.