Can an A1C level of 5.7 cause symptoms or damage?

Understanding A1C of 5.7: Symptoms and Damage Risk

An A1C of 5.7% does not cause current symptoms or organ damage, but it places you at the lower threshold of prediabetes with a significantly increased risk of developing type 2 diabetes and cardiovascular disease in the future. 1

What This Number Means

Your A1C of 5.7% falls into the prediabetes range (5.7-6.4%), which the American Diabetes Association uses to identify individuals at high risk for future diabetes. 1

• You are at the lowest end of the prediabetes spectrum, where the 5-year risk of developing diabetes ranges from 9-25%. 1
• Risk increases disproportionately as A1C rises: Those with A1C 6.0-6.5% face a 25-50% 5-year diabetes risk—20 times higher than someone with A1C of 5.0%. 1
• Your A1C predicts similar diabetes risk to high-risk participants in the Diabetes Prevention Program, a landmark study that demonstrated effective prevention strategies. 1

Current Symptoms and Damage

At 5.7%, you should not be experiencing symptoms or have diabetes-related organ damage. 1

• The diagnostic threshold for diabetes (A1C ≥6.5%) was established based on the glycemic level at which retinopathy (eye damage) begins to appear in population studies. 1
• Below this threshold, there is little prevalent retinopathy or other microvascular complications. 1, 2
• A1C reflects your average blood glucose over the past 2-3 months, and at 5.7%, your glucose levels are elevated but not high enough to cause the acute symptoms of diabetes (excessive thirst, urination, fatigue) or chronic complications. 1, 2

What You Should Do Now

The American Diabetes Association recommends referral to an intensive behavioral program targeting 7% body weight loss and at least 150 minutes weekly of moderate-intensity physical activity (such as brisk walking). 1, 3

Lifestyle Intervention Benefits

• Lifestyle modification reduces diabetes onset by 58% at 3 years, with sustained benefits: 43% reduction at 20 years (Da Qing study) and 34% reduction at 10 years (Diabetes Prevention Program). 1, 3
• This is first-line therapy for all individuals with prediabetes. 3

When to Consider Metformin

Metformin therapy may be considered if you have additional high-risk features: 1, 3

• BMI >35 kg/m² (where metformin was as effective as lifestyle modification) 3
• Age <60 years (metformin was not significantly better than placebo in those over 60) 3
• History of gestational diabetes (if applicable) 1, 3

Monitoring and Cardiovascular Risk

• Recheck A1C in 3 months to assess response to lifestyle changes. 3
• Annual monitoring for diabetes development is recommended going forward. 1, 3
• Screen for and treat cardiovascular risk factors including blood pressure, cholesterol, and smoking, as your baseline A1C is a strong predictor of future cardiovascular events. 1, 3

Important Caveats

The continuum of risk extends below 5.7%, meaning even "normal" A1C values carry some diabetes risk—it's not an all-or-nothing threshold. 1

• Your A1C is at the entry point where intensive prevention becomes most cost-effective and clinically beneficial. 1
• If your A1C rises above 6.0%, you should be considered at very high risk and interventions should become more intensive with particularly vigilant follow-up. 1
• Certain conditions can affect A1C accuracy (hemoglobin variants, anemia, recent blood loss), though this is uncommon. 1