What is the hemoglobin A1c (HbA1c) level for prediabetes?

From the Guidelines

Prediabetes is diagnosed when A1c levels fall between 5.7% and 6.4%. This range indicates that 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. If you have prediabetes, it's essential to take action immediately as you have a higher risk of developing type 2 diabetes, heart disease, and stroke.

Key Points to Consider

• Lifestyle modifications are the primary treatment approach, including losing 5-7% of body weight if overweight, engaging in at least 150 minutes of moderate physical activity weekly, and following a balanced diet rich in vegetables, fruits, whole grains, and lean proteins while limiting refined carbohydrates and added sugars.
• Regular monitoring of A1c levels every 6-12 months is recommended to track progress.
• Prediabetes is reversible with these interventions, and addressing it early can prevent progression to diabetes.
• The elevated A1c in prediabetes reflects that glucose is consistently attaching to hemoglobin in red blood cells at a higher rate than normal, indicating that your body is having difficulty properly regulating blood sugar levels 1.

Importance of Early Intervention

As A1C rises, the risk of diabetes rises disproportionately, making it crucial to intervene early and aggressively for those considered at very high risk, such as those with A1C >6.0% 1.

Screening and Diagnosis

The American Diabetes Association (ADA) recommends screening for prediabetes in asymptomatic adults using the ADA risk test, which is an additional option for assessment to determine the appropriateness of screening for diabetes or prediabetes 1.

Management and Prevention

Individuals with prediabetes should be informed of their increased risk for diabetes and cardiovascular disease and counseled about effective strategies to lower their risks, including lifestyle modifications and, if necessary, pharmacological interventions 1.

From the Research

Prediabetes A1c Level

• The A1c level for prediabetes is defined as 5.7% to 6.4% or 6.0% to 6.4% 2, 3, 4
• This definition is based on the American Diabetes Association (ADA) criteria and the National Institute for Health and Care Excellence (NICE) guideline 4
• Prediabetes is an intermediate stage between normal glucose regulation and diabetes, affecting 1 in 3 adults in the US and approximately 720 million individuals worldwide 2
• The health risk associated with prediabetes might be increased in people with a fasting glucose concentration as low as 5.6 mmol/L or HbA1c of 39 mmol/mol 4

Diagnostic Criteria

• Prediabetes can be diagnosed using different criteria, including:
  • Fasting glucose level of 100 to 125 mg/dL
  • Glucose level of 140 to 199 mg/dL measured 2 hours after a 75-g oral glucose load
  • Glycated hemoglobin level (HbA1C) of 5.7% to 6.4% or 6.0% to 6.4% 2, 3
• The choice of diagnostic criteria may depend on the individual's risk factors and medical history 3

Risk Factors and Complications

• Prediabetes is associated with increased risk of diabetes, cardiovascular events, and mortality 2, 4
• The risk of progression from prediabetes to diabetes varies widely, depending on the definition of prediabetes and individual risk factors 5
• Prediabetes is also associated with increased risks of cardiovascular disease, nonalcoholic fatty liver disease, and nonalcoholic steatohepatitis 5