Prediabetic A1C Levels in Children (10 Years Old)
An A1C of 5.7-6.4% defines prediabetes in children aged 10 years and older, using the same diagnostic threshold as adults. 1
Diagnostic Criteria for Prediabetes in Children
The American Diabetes Association establishes clear criteria for prediabetes diagnosis in pediatric populations:
- A1C range of 5.7-6.4% (39-47 mmol/mol) identifies prediabetes in children 1
- This threshold is identical to adult criteria—there is no separate, higher cutoff for children despite physiological differences 1
- Alternative diagnostic criteria include fasting plasma glucose 100-125 mg/dL or 2-hour glucose during OGTT of 140-199 mg/dL 1
When to Screen Children
Screening should be considered in youth after puberty onset or after age 10 years, whichever occurs earlier, if they meet specific risk criteria 1:
- Overweight (≥85th percentile) or obesity (≥95th percentile) PLUS one or more of the following 1:
- Maternal history of diabetes or gestational diabetes during the child's gestation 1
- Family history of type 2 diabetes in first- or second-degree relative 1
- High-risk race/ethnicity (Native American, African American, Latino, Asian American, Pacific Islander) 1
- Signs of insulin resistance: acanthosis nigricans, hypertension, dyslipidemia, polycystic ovary syndrome, or small-for-gestational-age birth weight 1
Important Clinical Caveats
The statement that "children have higher A1Cs" is not reflected in current diagnostic guidelines. The prediabetes threshold remains 5.7% regardless of age 1. However, several nuances exist:
- For children with type 1 diabetes (not prediabetes), treatment A1C goals are indeed higher than adults—typically <7-8% depending on age and hypoglycemia risk 1
- These higher targets for established diabetes reflect hypoglycemia risk and developmental considerations, not a different diagnostic threshold for prediabetes 1
Risk Stratification Within Prediabetes Range
The diabetes risk increases disproportionately across the prediabetes spectrum 1:
- A1C 5.7-6.0%: Moderately increased risk, with 9-25% developing diabetes over 5 years 1, 2
- A1C 6.0-6.4%: Very high risk, with 25-50% developing diabetes over 5 years 1, 2
- A1C >6.0% warrants aggressive intervention and vigilant follow-up 1
Follow-Up Recommendations
- Children with prediabetes (A1C ≥5.7%) should be tested yearly 1
- If initial screening is normal, repeat testing at minimum 3-year intervals (or more frequently if BMI increasing or risk factors worsening) 1
Testing Methodology Considerations
A critical pitfall: A1C testing must be performed using an NGSP-certified method standardized to the DCCT assay 1, 3, 4. Point-of-care A1C assays lacking proficiency testing are insufficient for diagnostic purposes 1.
For children with hemoglobinopathies (e.g., sickle cell trait), use an A1C assay without interference from abnormal hemoglobins, or rely exclusively on glucose criteria if red cell turnover is abnormal 1, 3, 4.