Your A1C Is Fine. What About Your Kidneys?
A1C is a 3-month average of blood sugar, not a report on your organs. About 4 in 10 US adults with diabetes have kidney disease, more than half have fatty liver, and about 1 in 4 have eye changes. Each is found early by a routine test, yet the kidney urine test (UACR) is often skipped.
Ask someone with diabetes for their numbers and you’ll usually hear one: A1C. It matters. But it’s an average of glucose, not a report on what that glucose has been doing to your liver, kidneys, eyes or blood vessels.
How common are diabetes complications?
| Complication | How common | How it’s found |
|---|---|---|
| Kidney disease | About 4 in 10 US adults with diabetes (CDC, 2026) | Urine albumin (UACR) and eGFR |
| Fatty liver (MASLD) | About 57% of adults with type 2 diabetes in a 2025 Indian review of 81,000 people | Liver tests and a fibrosis score (FIB-4) |
| Eye changes (retinopathy) | About 23% worldwide (2025 review) | Dilated eye exam or retinal photo |
For years most of these cause no symptoms. The good news is that each is picked up by a routine, inexpensive test. Fatty liver found early is often reversible, early kidney strain can be slowed, and eye changes caught early can be treated before they affect sight.
Which test gets skipped most?
The urine albumin test (UACR). A1C is ordered routinely; the kidney urine test often isn’t, even though it’s the earliest sign of kidney strain. A December 2025 review found only about 1 in 5 high-risk adults get it in routine care.
Which tests, how often?
| System | Test | How often |
|---|---|---|
| Blood sugar | A1C | Every 3–6 months |
| Kidneys | UACR and eGFR | Every year |
| Heart and vessels | Lipid panel, blood pressure | Every year |
| Liver | ALT, AST and FIB-4 | Every 1–2 years |
| Eyes and feet | Dilated eye exam, foot check | Every 1–2 years |
This follows the ADA Standards of Care; your doctor may test more or less often.
Why dates matter more than single results
A single result is a snapshot. What helps is knowing when each test was last done and when it’s due. In the Journey for Health app, each body system shows whether it has been read by recent tests, by glucose, or both, with last-done and next-due dates, and you can order due tests from local partner labs.
Read glucose and blood tests together. If your time in range has improved for three months, you want to see it reflected in your liver tests and lipids. When it is, that’s the strongest sign your changes are working.
What to do this week
- Find your last results and note the date of each.
- Compare them with the table above.
- Raise anything never done, or not done in over a year, with your doctor.
More on complications and early signs, lowering A1C and improving within months. This guide is for education and does not replace advice from your own doctor.
See which of your tests are due
Common questions
What is a UACR test?
A urine test that measures albumin, a protein that leaks into urine when the kidneys are under strain. The ADA recommends it at least once a year for people with diabetes.
How common is kidney disease in diabetes?
The CDC estimates about 4 in 10 US adults with diabetes have chronic kidney disease, and many don’t know it.
How often should I have an eye exam?
Usually every 1 to 2 years if earlier exams were normal, and more often if any changes were found. Your eye doctor will advise.
Is fatty liver common with diabetes?
Yes. Reviews find it in more than half of adults with type 2 diabetes. It often has no symptoms and is found with liver tests and a fibrosis score.
Sources
- CDC. Chronic Kidney Disease in the United States (2026 update)
- Prevalence of metabolic dysfunction-associated steatotic liver disease in type 2 diabetes mellitus in India: a systematic review and meta-analysis. Indian J Med Res 2025
- Owens DR et al. IDF Diabetes Atlas: a worldwide review of studies utilizing retinal photography to screen for diabetic retinopathy. Diabetes Res Clin Pract 2025
- Underutilization of albuminuria screening in adults with diabetes mellitus or hypertension: a systematic review and meta-analysis. BMC Nephrology 2025
- American Diabetes Association. 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes 2026. Diabetes Care 2026;49(Suppl 1):S132-S149
- American Diabetes Association. 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes 2026. Diabetes Care 2026;49(Suppl 1)
Last updated: . Educational information, not medical advice. Talk to your doctor before changing your treatment.