From the Guidelines
A hemoglobin A1c level of 5.9% indicates prediabetes, which should be addressed primarily through lifestyle modifications rather than medications. The recommended approach includes adopting 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 of moderate exercise per week is essential. Weight loss of 5-7% of body weight is beneficial for those who are overweight. These lifestyle changes can effectively prevent progression to type 2 diabetes. Medications are generally not prescribed at this stage unless there are other compelling health concerns. Regular monitoring of blood glucose levels and follow-up HbA1c testing every 6-12 months is important to track progress. This approach is recommended because an HbA1c of 5.9% falls within the prediabetes range (5.7-6.4%), indicating higher-than-normal blood glucose levels that haven't yet reached the diabetic threshold of 6.5% 1.
Some key points to consider in managing prediabetes include:
- Lifestyle modifications are the first line of treatment
- Medications such as metformin may be considered in certain cases, such as a BMI ≥ 35 kg/m², aged ≥ 60 years, and women with prior GDM 1
- Regular monitoring and follow-up are crucial to track progress and prevent the development of diabetes and its complications
- The most recent guidelines suggest that GLP-1 RAs or dual GIP and GLP-1 RA may be considered for people with prediabetes who are at high risk of cardiovascular disease or have other compelling health concerns 1
It's essential to prioritize lifestyle modifications and regular monitoring over medication, unless there are other compelling health concerns. By doing so, individuals with an HbA1c level of 5.9% can effectively prevent progression to type 2 diabetes and its associated complications.
From the Research
Treatment Options for a Patient with a Hemoglobin A1c (HbA1c) Level of 5.9%
- The patient's HbA1c level of 5.9% is considered prediabetic 2.
- Treatment options for prediabetes include lifestyle modifications, such as diet and exercise, as well as medication.
- A personalized postprandial glucose response-targeting (PPT) diet has been shown to be effective in improving glycemic control in prediabetes, with greater reductions in daily time with glucose levels >140 mg/dL and HbA1c levels compared to a Mediterranean diet 2.
- Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have also been shown to be effective in improving glycemic control and reducing the risk of cardiovascular events in patients with type 2 diabetes, and may be considered as a treatment option for prediabetes 3, 4.
- The Mediterranean-style diet (MSD) has also been shown to improve glycemic control, weight loss, and cardiovascular risk factors in patients with type 2 diabetes, and may be considered as a treatment option for prediabetes 5.
Medication Options
- GLP-1 RAs, such as exenatide and liraglutide, have been shown to improve glycemic control and reduce the risk of cardiovascular events in patients with type 2 diabetes 3, 4.
- Metformin is also a common medication used to treat type 2 diabetes, and may be considered as a treatment option for prediabetes 4.
Lifestyle Modifications
- A healthy diet, such as the PPT diet or the MSD, can help improve glycemic control and reduce the risk of cardiovascular events 5, 2.
- Regular exercise, such as aerobic exercise and strength training, can also help improve glycemic control and reduce the risk of cardiovascular events.
- Weight loss, if necessary, can also help improve glycemic control and reduce the risk of cardiovascular events 5, 2.