From the Guidelines
An A1c of 5.8% indicates prediabetes, which requires immediate attention to prevent progression to type 2 diabetes and its associated complications. According to the most recent guidelines from the Diabetes Care journal 1, an A1C range of 5.7–6.4% identifies individuals at high risk for diabetes and cardiovascular outcomes. This means that your blood sugar levels are higher than normal but not yet high enough to be diagnosed as type 2 diabetes. You should focus on lifestyle modifications including:
- Regular physical activity (aim for at least 150 minutes of moderate exercise per week)
- Weight loss if overweight (even 5-7% of body weight can help)
- Dietary changes (reduce refined carbohydrates and sugars, increase fiber, choose whole foods) Monitor your blood glucose regularly and schedule follow-up testing in 6-12 months. No medications are typically prescribed at this stage unless other risk factors are present. The A1c test reflects your average blood glucose over the past 2-3 months by measuring the percentage of hemoglobin proteins in your blood that have glucose attached to them. Taking action now can prevent progression to diabetes and its associated complications, as evidenced by studies such as the Diabetes Prevention Program (DPP) 1. It is essential to be proactive and make lifestyle changes to reduce your risk of developing diabetes, as the risk of diabetes with any measure or surrogate of glycemia is a continuum, extending well into the normal ranges 1.
From the Research
HbA1c Level of 5.8
- An HbA1c level of 5.8 is considered to be in the prediabetes range, according to the American Diabetes Association criteria 2.
- Prediabetes is defined as an HbA1c level of 5.7% to 6.4% or 6.0% to 6.4% 2.
- Individuals with prediabetes are at increased risk of developing type 2 diabetes and cardiovascular disease 2, 3, 4.
Risk of Cardiovascular Disease and Mortality
- Studies have shown that prediabetes is associated with an increased risk of cardiovascular disease and mortality 3, 4.
- A meta-analysis found that prediabetes was associated with an increased risk of composite cardiovascular disease, coronary heart disease, stroke, and all-cause mortality 4.
- The risk of cardiovascular disease and mortality increases with higher HbA1c levels, even at levels below 6.0% 4.
Lifestyle Modification and Treatment
- Intensive lifestyle modification, including calorie restriction, increased physical activity, self-monitoring, and motivational support, can decrease the incidence of diabetes in individuals with prediabetes 2.
- Metformin can also decrease the risk of diabetes in individuals with prediabetes, particularly in women with prior gestational diabetes and individuals younger than 60 years with a body mass index of 35 or greater 2.
- Exercise training and physical activity advice can also improve glycemic control in individuals with type 2 diabetes, with high-intensity interval training being the most effective treatment for HbA1c reduction 5.