From the Guidelines
Prediabetes is diagnosed when your A1C level falls between 5.7% and 6.4%. This range indicates that your blood sugar levels are higher than normal but not yet high enough to be classified as type 2 diabetes. For comparison, normal A1C levels are below 5.7%, while diabetes is diagnosed at 6.5% or higher 1. Prediabetes serves as an important warning sign that you're at increased risk of developing type 2 diabetes, heart disease, and stroke. The elevated A1C in prediabetes reflects that your body is having difficulty processing glucose efficiently, typically due to developing insulin resistance where your cells don't respond properly to insulin.
Key Points to Consider
- An A1C range of 5.7–6.4% identifies a group of individuals at high risk for diabetes and cardiovascular outcomes 1.
- Individuals with A1C levels above 6.0% should be considered to be at very high risk and require aggressive interventions and vigilant follow-up 1.
- Lifestyle modifications, including weight loss of 5-7% if overweight, regular physical activity, and dietary changes focusing on reduced calories and carbohydrates, can significantly reduce the risk of progressing to diabetes 1.
Recommendations for Management
- Regular monitoring of A1C levels every 6-12 months is recommended to track progress 1.
- Individuals with prediabetes should be informed of their increased risk for diabetes and cardiovascular disease and counseled about effective strategies to lower their risks 1.
From the Research
Definition of Prediabetes
Prediabetes is defined by a fasting glucose level of 100 to 125 mg/dL, a glucose level of 140 to 199 mg/dL measured 2 hours after a 75-g oral glucose load, or glycated hemoglobin level (HbA1C) of 5.7% to 6.4% or 5.5% to 6.5% 2, 3.
A1C Levels for Prediabetes
The A1C levels that indicate prediabetes are:
- 5.7% to 6.4% 2
- 5.5% to 6.5% 3
- 6.0% to 6.4% 2 Specifically, the risk of incident diabetes increases steeply with A1C across the range of 5.0 to 6.5% 3. Some key A1C ranges and their associated risks are:
- A1C range of 6.0 to 6.5%: highly increased risk of incident diabetes, 25 to 50% incidence over 5 years 3
- A1C range of 5.5 to 6.0%: moderately increased relative risk, 9 to 25% incidence over 5 years 3
- A1C range of 5.0 to 5.5%: increased incidence relative to those with A1C <5%, but the absolute incidence of diabetes is less than 9% over 5 years 3
Risks Associated with Prediabetes
Prediabetes is associated with increased risk of: