From the Guidelines
A prediabetic A1C level ranges from 5.7% to 6.4%. This range indicates that your blood sugar levels are higher than normal but not yet high enough to be diagnosed as type 2 diabetes [ 1 ]. If your A1C reaches 6.5% or higher, you would be diagnosed with diabetes. For those with prediabetes, lifestyle modifications are the primary recommendation, including:
- losing 5-7% of body weight if overweight
- engaging in at least 150 minutes of moderate physical activity weekly
- following a balanced diet rich in vegetables, fruits, whole grains, and lean proteins while limiting refined carbohydrates and added sugars [ 1 ]. In some cases, especially for those at higher risk, medications like metformin may be prescribed at a typical starting dose of 500 mg once or twice daily. Regular monitoring is essential, with A1C testing recommended every 6-12 months to track progress [ 1 ]. Prediabetes is reversible with appropriate interventions, and addressing it promptly can prevent progression to type 2 diabetes, which would require more intensive management and carries greater health risks including cardiovascular disease, kidney damage, and nerve problems [ 1 ].
From the FDA Drug Label
For patients who had not been previously treated with antidiabetic medication (24%), mean values at screening were 10.1% for HbA1c and 238 mg/dL for FPG. For patients who had not been previously treated with antidiabetic medication (40%), mean values at screening were 10.3% for HbA1c and 240 mg/dL for FPG.
The HbA1c values mentioned for patients who had not been previously treated with antidiabetic medication are 10.1% and 10.3%. These values are above the normal range and indicate prediabetes or diabetes, but the labels do not explicitly define the HbA1c value for prediabetes. Prediabetes is generally defined as an HbA1c level between 5.7% and 6.4%. Since the provided HbA1c values are above this range, they indicate diabetes, not prediabetes 2 2.
From the Research
Prediabetic A1C Levels
- Prediabetes is defined by a glycated hemoglobin level (HbA1C) of 5.7% to 6.4% or 6.0% to 6.4% 3
- The American Diabetes Association (ADA) goal hemoglobin A1c (A1c) is less than 7% 4
- A meta-analysis found that prediabetes at baseline was associated with increased mortality and increased cardiovascular event rates 3
Treatment and A1C Reduction
- Intensive lifestyle modification decreased the incidence of diabetes by 6.2 cases per 100 person-years during a 3-year period 3
- Metformin decreased the risk of diabetes among individuals with prediabetes by 3.2 cases per 100 person-years during 3 years 3
- The addition of pioglitazone to maximal/highest tolerated doses of sulfonylurea and metformin combination therapy resulted in a mean reduction in A1c of 0.67% and 0.78% at 3 and 6 months, respectively 4
- Sitagliptin and pioglitazone were equally effective in improving HbA1C, with no significant difference in HbA1C reduction between the two treatment groups 5
A1C Goals and Treatment Outcomes
- The percentage of patients achieving the ADA goal A1c of less than 7% after the addition of pioglitazone reached statistical significance at both 3 and 6 months post TZD initiation 4
- Pioglitazone as an add-on to either failing metformin or sulfonylurea therapy improved post-load glucose excursions without affecting insulin secretion 6
- Treatment with pioglitazone was associated with significant improvements of lipid and glycemic parameters that are linked to insulin resistance and cardiovascular risk in patients with T2DM 7