From the Guidelines
Your hemoglobin A1c level of 5.6% is at the upper limit of the normal range, which is typically considered to be below 5.7%, and according to the most recent evidence, individuals with an A1C of 5.5-6.0% have a substantially increased risk of developing diabetes 1. This result indicates that your average blood glucose levels over the past 2-3 months have been well-controlled but are approaching the prediabetic range (5.7-6.4%). At this point, no medication is needed, but this is an opportunity to implement preventive measures. Some key points to consider include:
- Focus on maintaining a balanced diet rich in vegetables, lean proteins, and whole grains while limiting refined carbohydrates and sugars.
- Regular physical activity of at least 150 minutes per week of moderate exercise is recommended.
- Weight management is also important if you're overweight.
- Monitor your blood glucose periodically and have your A1c rechecked in 6-12 months, or sooner if you have risk factors for diabetes such as family history or obesity. As noted in a study published in Diabetes Care, an A1C range of 5.5–6.0% has a 5-year cumulative incidence of diabetes that ranges from 12 to 25% 1. It's essential to be aware of your increased risk for diabetes and cardiovascular disease and to take proactive steps to lower your risks. The continuum of risk is curvilinear, so that as A1C rises, the risk of diabetes rises disproportionately, and interventions should be most intensive and follow-up should be particularly vigilant for those with A1C levels above 6.0% 1.
From the Research
Hemoglobin A1c Levels
- A Hemoglobin A1c (HbA1c) level of 5.6% is below the threshold for prediabetes, which is defined as an HbA1c level of 5.7% to 6.4% 2, 3, 4, 5.
- According to the studies, an HbA1c level of 5.6% is considered normal, and individuals with this level are not typically considered to be at high risk for developing diabetes 2, 3, 4, 5.
Risk of Developing Diabetes
- Although an HbA1c level of 5.6% is considered normal, it is still important for individuals to maintain a healthy lifestyle, including a balanced diet and regular physical activity, to reduce their risk of developing diabetes and other health problems 2, 3.
- Studies have shown that intensive lifestyle modification, including calorie restriction, increased physical activity, and self-monitoring, can decrease the incidence of diabetes in individuals with prediabetes 2, 3.
Treatment and Management
- Metformin is a medication that is commonly used to treat type 2 diabetes, and it may also be prescribed for individuals with prediabetes who are at high risk for developing diabetes 2, 3, 4, 5, 6.
- However, the studies suggest that metformin is not typically prescribed for individuals with an HbA1c level of 5.6%, as this level is considered normal and not indicative of prediabetes or diabetes 4, 5.
- A study found that metformin use was associated with lower mean HbA1c levels at 18-24 months, suggesting that management with metformin could prevent further deterioration of glycaemic levels 6.
Key Findings
- The American Diabetes Association recommends that individuals with prediabetes be screened for diabetes with fasting plasma glucose and/or hemoglobin A1c, and that those diagnosed with prediabetes receive intensive lifestyle intervention to restore euglycemia 2, 3.
- Metformin may be considered for individuals with prediabetes who have additional risk factors, such as a body mass index (BMI) of 35 or greater, age less than 60 years, or prior gestational diabetes mellitus 2, 3, 4, 5.