From the Guidelines
Pre-diabetes is diagnosed when a person's A1C level falls between 5.7% and 6.4%. This range indicates that blood sugar levels are higher than normal but not yet high enough to be classified as type 2 diabetes. For comparison, normal A1C levels are below 5.7%, while diabetes is diagnosed at 6.5% or higher 1.
Key Points to Consider
- The American Diabetes Association (ADA) recommends using an A1C range of 5.7–6.4% to identify individuals at high risk for diabetes and cardiovascular outcomes 1.
- Individuals with an A1C level in this range should be informed of their increased risk for diabetes and cardiovascular disease and counseled about effective strategies to lower their risks.
- Lifestyle modifications, including losing 5-7% of body weight if overweight, engaging in at least 150 minutes of moderate physical activity weekly, and following a balanced diet, are the primary recommendations for managing pre-diabetes.
- In some cases, medication like metformin may be prescribed, particularly for those at higher risk of developing diabetes 1.
- Regular monitoring of A1C levels every 6-12 months is important to track progress and adjust treatment plans as needed.
Importance of Early Intervention
Pre-diabetes is reversible, and early intervention can prevent or delay the progression to type 2 diabetes by addressing insulin resistance and improving the body's ability to regulate blood glucose levels 1.
Recommendations for Screening and Testing
The ADA risk test is an additional option for assessment to determine the appropriateness of screening for diabetes or prediabetes in asymptomatic adults 1.
Conclusion is not needed as per the guidelines, the above information is sufficient to make a decision.
From the Research
Definition and Diagnosis of Prediabetes
- Prediabetes is defined by a fasting glucose level of 100 to 125 mg/dL, a glucose level of 140 to 199 mg/dL measured 2 hours after a 75-g oral glucose load, or glycated hemoglobin level (HbA1C) of 5.7% to 6.4% or 6.0% to 6.4% 2.
- Approximately 1 in 3 adults in the US and approximately 720 million individuals worldwide are affected by prediabetes 2.
Risk of Progression to Diabetes and Cardiovascular Events
- Approximately 10% of people with prediabetes progress to having diabetes each year in the US 2.
- Prediabetes at baseline is associated with increased mortality and increased cardiovascular event rates (excess absolute risk, 7.36 per 10 000 person-years for mortality and 8.75 per 10 000 person-years for cardiovascular disease during 6.6 years) 2.
Treatment and Management of Prediabetes
- Intensive lifestyle modification, consisting of calorie restriction, increased physical activity (≥150 min/wk), self-monitoring, and motivational support, decreased the incidence of diabetes by 6.2 cases per 100 person-years during a 3-year period 2.
- Metformin decreased the risk of diabetes among individuals with prediabetes by 3.2 cases per 100 person-years during 3 years 2.
- Metformin is most effective for women with prior gestational diabetes and for individuals younger than 60 years with body mass index of 35 or greater, fasting plasma glucose level of 110 mg/dL or higher, or HbA1c level of 6.0% or higher 2.
- Adding metformin to lifestyle interventions may improve glycemic control in individuals with prediabetes and reduce their risk of progression to diabetes, compared to lifestyle interventions alone 3.
- However, some studies suggest that metformin should not be used to treat prediabetes, as approximately two-thirds of people with prediabetes do not develop diabetes, even after many years, and metformin treatment will not affect the microvascular complications of diabetes 4.
Glycemic Control with Metformin
- Metformin use was associated with lower mean HbA1c mmol/mol at 18-24 months (ATE -1.1,95% CI -2.0; 0.1) than those unexposed 5.
- Management with metformin could prevent further deterioration of glycaemic levels 5.
- A meta-analysis found that adding metformin to lifestyle interventions significantly reduced HbA1c levels (SMD = -0.10,95% CI [-0.19, -0.01], P = 0.03) and the incidence of type 2 diabetes (RR = 0.85,95% CI [0.75,0.97], P = 0.01) 3.