What are the recommendations for a Hemoglobin A1c (HbA1c) level of 5.7, indicating Impaired Fasting Glucose?

From the Guidelines

An A1C of 5.7% indicates prediabetes, and I strongly recommend focusing on lifestyle modifications as the primary approach to prevent or delay the onset of type 2 diabetes. According to the most recent and highest quality study 1, patients with prediabetes should be referred to an intensive behavioral lifestyle intervention program to achieve and maintain 7% loss of initial body weight and increase moderate-intensity physical activity to at least 150 min/week.

Key Recommendations

• Start with a balanced diet emphasizing vegetables, lean proteins, whole grains, and healthy fats while limiting refined carbohydrates, sugary foods, and processed items.
• Aim for regular physical activity—at least 150 minutes of moderate exercise weekly, such as brisk walking, swimming, or cycling.
• Weight loss of 5-7% of body weight can significantly improve insulin sensitivity if overweight.
• Monitor blood glucose periodically, especially if other risk factors like family history of diabetes or high blood pressure are present.
• Stay well-hydrated and get adequate sleep (7-8 hours nightly) as poor sleep affects glucose metabolism.

Importance of Lifestyle Modifications

These recommendations work because they improve the body's insulin sensitivity, reduce inflammation, and help maintain stable blood glucose levels 1. Technology-assisted tools, including Internet-based social networks, distance learning, and mobile applications, may be useful elements of effective lifestyle modification to prevent diabetes 1. Given the cost-effectiveness of diabetes prevention, such intervention programs should be covered by third-party payers 1.

Follow-up and Monitoring

Regular follow-up with a healthcare provider every 6-12 months is important to track progress and adjust recommendations as needed 1. At least annual monitoring for the development of diabetes in those with prediabetes is suggested 1. Screening for and treatment of modifiable risk factors for cardiovascular disease is also recommended 1.

Medications

No medications are typically prescribed at this A1C level unless other health conditions are present. However, metformin therapy for prevention of type 2 diabetes may be considered in those with IGT, IFG, or an A1C 5.7–6.4%, especially for those with BMI > 35 kg/m2, aged < 60 years, and women with prior gestational diabetes mellitus (GDM) 1.

From the Research

Recommendations for A1C of 5.7

• An A1C level of 5.7 is considered prediabetic 2
• Lifestyle changes such as diet and exercise can help reduce the risk of developing diabetes 3
• Pharmacologic treatments such as GLP-1 receptor agonists and SGLT2 inhibitors may also be effective in preventing diabetes, particularly in individuals who are overweight or obese 3, 4, 5
• GLP-1 receptor agonists have been shown to be effective in reducing A1C levels and weight, with some agents also having cardiovascular benefits 4, 6, 5
• Metformin is also a common treatment for prediabetes and type 2 diabetes, and has been shown to be effective in reducing A1C levels and improving glycemic control 3, 6, 5

Treatment Options

• GLP-1 receptor agonists:
  • Effective in reducing A1C levels and weight 4, 6, 5
  • May have cardiovascular benefits 4
  • Associated with a reduced risk of additional glucose-lowering medication 5
• Metformin:
  • Effective in reducing A1C levels and improving glycemic control 3, 6, 5
  • Associated with better adherence in patients with prediabetes 5
• Lifestyle changes:
  • Diet and exercise can help reduce the risk of developing diabetes 3
  • Weight loss is a key component of diabetes prevention 3

Considerations

• The choice of treatment should be individualized based on the patient's specific needs and circumstances 3, 4, 6, 5
• Patients with prediabetes and an A1C level of 5.7 should be monitored regularly to assess their risk of developing diabetes and to adjust their treatment plan as needed 2