Is an Adult Patient with A1C of 6.9% Prediabetic?
No, an adult patient with an A1C of 6.9% is NOT prediabetic—this patient has diabetes. 1, 2, 3
Diagnostic Classification
An A1C of 6.9% exceeds the diagnostic threshold for diabetes mellitus:
- Diabetes diagnosis: A1C ≥6.5% on two separate occasions confirms diabetes 1, 2, 3
- Prediabetes range: A1C 5.7-6.4% 1, 2
- Normal range: A1C <5.7% 2, 3
Your patient's A1C of 6.9% falls 0.4 percentage points above the diabetes diagnostic threshold, placing them firmly in the diabetic range rather than the prediabetic category. 1, 3
Clinical Implications of This A1C Level
This patient requires diabetes management, not prediabetes prevention strategies. The distinction is critical because:
- An A1C of 6.5% has 98% specificity for detecting diabetes 3
- The diagnostic threshold of 6.5% was established based on the glycemic level at which retinopathy prevalence begins to increase linearly 3
- Patients with A1C 6.0-6.5% already have a 25-50% risk of developing diabetes over 5 years, with a 20-fold higher relative risk compared to A1C of 5.0% 1, 3
At 6.9%, this patient has crossed into diabetes territory and faces substantially higher risks for microvascular and macrovascular complications. 1
Important Diagnostic Caveats
Before finalizing the diabetes diagnosis, confirm:
- Repeat testing: Diabetes diagnosis requires confirmation with a second A1C ≥6.5% on a separate occasion (unless the patient has clear symptoms of hyperglycemia) 1, 3
- Laboratory method: A1C should be measured using a method certified by the National Glycohemoglobin Standardization Program (NGSP), not point-of-care testing 2
- Interfering conditions: Anemia and certain medications can affect A1C accuracy and should be ruled out 2
Next Steps
This patient needs:
- Confirmation testing with repeat A1C measurement 1, 3
- Initiation of diabetes management strategies including lifestyle modification and likely pharmacotherapy 1
- Counseling about diabetes complications and cardiovascular disease risk 1
- Screening for diabetes-related complications 1
The patient should be informed they have diabetes, not prediabetes, as this distinction affects treatment intensity, monitoring frequency, and insurance coverage for diabetes-specific interventions. 1