For a 71-year-old male 30 days after dermablade excision of a right lower eyelid skin tag, does he need any further local treatment, and how should his glycated hemoglobin (A1c) of 6.2% be managed?

Management of Healed Skin Tag Removal and A1C of 6.2%

Skin Tag Removal Follow-Up

No further local treatment is required for the healed dermablade excision site at 30 days post-procedure. 1, 2, 3

• The 30-day timeframe is sufficient for complete epithelialization and healing of simple dermablade excisions in the periorbital region 1
• Routine monitoring for any signs of recurrence, infection, or scarring complications is appropriate, but active intervention is not indicated if the site has healed without complications 1, 2
• Patients should be counseled that additional skin tags may develop over time, but the excised lesion itself should not recur 1

---

Management of A1C 6.2%

An A1C of 6.2% indicates prediabetes and requires lifestyle intervention with annual monitoring; pharmacologic therapy is not yet indicated. 4, 5

Diagnostic Classification

• A1C of 6.2% falls in the prediabetes range (5.7-6.4%), which reflects average blood glucose levels over the preceding 2-3 months 5
• This value indicates impaired glucose regulation and significantly elevated risk for progression to type 2 diabetes 5
• The patient does not meet diagnostic criteria for diabetes (A1C ≥6.5%) 5

Recommended Interventions for A1C 6.2%

Lifestyle modifications are the cornerstone of management at this stage:

• Weight management: Even 5-7% weight loss can significantly reduce diabetes risk 4
• Physical activity: At least 150 minutes per week of moderate-intensity exercise (such as brisk walking) distributed over at least 3 days per week with no more than 2 consecutive days without activity 4
• Dietary counseling: Focus on reducing refined carbohydrates, increasing fiber intake, and portion control 4
• Smoking cessation if applicable 4

Monitoring Schedule

• Repeat A1C in 12 months to assess progression or improvement 4, 5
• Consider more frequent monitoring (every 6 months) if the patient has additional risk factors such as obesity, family history of diabetes, or metabolic syndrome 4

When to Consider Pharmacologic Intervention

• Metformin may be considered for prediabetes in patients with A1C ≥6.0%, particularly if they have additional risk factors (BMI ≥35 kg/m², age <60 years, history of gestational diabetes, or progressive A1C elevation despite lifestyle intervention) 4
• At A1C 6.2%, the decision to initiate metformin should be individualized based on the presence of these additional risk factors 4

Screening for Diabetic Complications

At A1C 6.2%, screening for diabetic retinopathy is not yet indicated 4

• Diabetic retinopathy screening should begin once diabetes is diagnosed (A1C ≥6.5%) 4
• However, cardiovascular risk factor management (blood pressure control, lipid management) remains important even in the prediabetes stage 4

Common Pitfalls to Avoid

• Do not dismiss A1C 6.2% as "borderline" or insignificant—this represents a critical window for preventing progression to diabetes 4, 5
• Do not delay lifestyle intervention—the earlier these changes are implemented, the greater the likelihood of preventing diabetes 4
• Do not assume the patient understands what A1C means—provide clear education that this reflects a 2-3 month average of blood glucose levels and indicates prediabetes 5