From the Guidelines
The optimal A1c level for reducing the risk of chronic diseases associated with hyperglycemia is generally below 7% (53 mmol/mol) for most adults with diabetes, as recommended by the most recent and highest quality study 1. For individuals without diabetes, maintaining an A1c below 5.7% is recommended to prevent progression to prediabetes and diabetes. However, target levels should be personalized based on individual factors. Some key points to consider when determining the optimal A1c level include:
- For younger patients without significant comorbidities, a stricter target of 6.5% or lower may be appropriate, while for elderly patients or those with multiple health conditions, a more relaxed target of 7.5-8% might be suitable to avoid hypoglycemia risks.
- These targets help minimize microvascular complications like nephropathy, retinopathy, and neuropathy, as well as reduce macrovascular risks including heart disease and stroke.
- The relationship between A1c and complications is progressive—each percentage point reduction in A1c correlates with approximately 25-35% reduction in microvascular complications, as noted in earlier studies 1. Regular monitoring every 3-6 months is essential to assess glycemic control and adjust treatment approaches as needed, which may include lifestyle modifications, oral medications, or insulin therapy depending on individual circumstances, with the goal of achieving the individualized A1c target while minimizing risks and maximizing benefits 1.
From the Research
Optimal A1c Level for Lowering Chronic Disease Risk
To lower the risk of developing chronic diseases associated with hyperglycemia, it is essential to maintain an optimal hemoglobin A1c (A1c) level.
- The American Diabetes Association (ADA) recommends an A1c goal of less than 7% for most adults 2.
- However, some studies suggest that an A1c level between 5.7 and 6.4% may be a marker for identifying pre-diabetes, insulin sensitivity and secretion, and cardiovascular risk factors 3.
- For individuals with prediabetes, an A1c level of 6.0-6.4% may be associated with a lower risk of developing diabetes and cardiovascular disease 4.
- For those with type 2 diabetes, an A1c level of less than 7% is generally recommended, but some studies suggest that an A1c level of less than 6.5% may be more beneficial for reducing the risk of chronic diseases 5, 6.
Factors Influencing Optimal A1c Level
Several factors can influence the optimal A1c level for an individual, including:
- Age and health status
- Presence of comorbidities, such as cardiovascular disease or kidney disease
- Medication use and adherence
- Lifestyle factors, such as diet and physical activity
Achieving Optimal A1c Level
To achieve an optimal A1c level, individuals can work with their healthcare provider to develop a personalized treatment plan, which may include: