From the Guidelines
An A1C of 6.7% is above the normal range and indicates an increased risk for developing diabetes, but it does not meet the diagnostic criteria for diabetes, which is an HbA1c level of 6.5% or greater, as stated in the guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus 1.
Diagnosis and Recommendations
According to the guidelines, an HbA1c level between 5.7% to 6.4% is considered prediabetes, but since the given A1C is 6.7%, it is essential to consider it as a high-risk category for developing diabetes.
- The patient should undergo lifestyle modifications, including a balanced diet low in refined carbohydrates and sugars.
- Regular physical activity, aiming for at least 150 minutes of moderate exercise weekly, is recommended.
- Weight loss is advised if the patient is overweight.
- Monitoring blood glucose regularly and rechecking the A1C in 3-6 months is crucial.
- Typically, no medications are prescribed at this stage unless other risk factors are present, as per the guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus 1.
Importance of Early Intervention
It is vital to take this result seriously, as an elevated A1C indicates a higher risk for developing diabetes and its associated complications, such as heart disease, kidney problems, and nerve damage.
- Early intervention can prevent the progression to diabetes.
- The goal is to bring the A1C below 5.7% to reduce the diabetes risk, as recommended by the guidelines and supported by recent studies 1.
From the Research
A1C Level of 6.7
- An A1C level of 6.7 is considered elevated, and individuals with this level are at risk of developing type 2 diabetes and cardiovascular disease 2.
- According to the study published in Diabetes Care, approximately 90% of individuals with an A1C level >6% had fasting glucose >or=100 mg/dl, indicating impaired fasting glucose 2.
- The American College of Cardiology recommends that adults with diabetes should aim for an A1C level <6.0% to reduce the risk of major adverse cardiovascular events 3.
Risk Factors Associated with Elevated A1C
- Older age, male sex, non-Hispanic black race/ethnicity, hypercholesterolemia, higher BMI, and lower attained education are significantly associated with having a higher A1C level 2.
- Individuals with prediabetes, which is a combination of excess body fat and insulin resistance, are at increased risk of developing type 2 diabetes and cardiovascular disease 4.
Management of Elevated A1C
- Lifestyle modifications, such as weight loss through exercise and dietary modifications, can decrease the rate of progression to diabetes by approximately 58% in patients with prediabetes 4.
- Metformin can be considered for patients who do not achieve goals with lifestyle modifications, and weight loss drugs and bariatric surgery may be appropriate for select patients 4, 5.
- Antihyperglycemic agents with proven cardiovascular benefit, such as glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors, may be recommended for patients with type 2 diabetes and high risk of or established cardiovascular disease 6.