My hemoglobin A1c (HbA1c) is 5.7%; what does this indicate and how should I be managed?

HbA1c 5.7%: Prediabetes Diagnosis and Management

An HbA1c of 5.7% indicates prediabetes, placing you at the lower threshold of increased diabetes risk and requiring immediate lifestyle intervention to prevent progression to diabetes. 1, 2

What This Result Means

• You have prediabetes, defined by the American Diabetes Association as an HbA1c between 5.7-6.4% (39-47 mmol/mol). 1, 2
• At 5.7%, you are at the lower end of the prediabetes spectrum, which means your risk is elevated but more modest compared to those with HbA1c closer to 6.4%. 1
• Individuals with HbA1c 5.5-6.0% have a 9-25% probability of developing diabetes within 5 years. 1
• Risk increases continuously across the HbA1c spectrum—even values previously considered "normal" carry some risk when combined with other factors like obesity or family history. 1, 2

Recommended Management Strategy

No Medication Required

• Do not initiate pharmacologic therapy at an HbA1c of 5.7%. 3
• The American College of Physicians recommends focusing exclusively on lifestyle measures at this level. 3

Intensive Lifestyle Modification (Primary Intervention)

You must implement aggressive lifestyle changes immediately:

• Weight reduction: Achieve and maintain a healthy BMI through caloric restriction. 1
• Regular physical activity: Engage in structured exercise programs with both aerobic and resistance training. 1
• Dietary modification: Adopt a balanced diet emphasizing whole foods, reduced refined carbohydrates, and appropriate portion control. 3

Monitoring Schedule

• Repeat HbA1c testing annually at minimum for all individuals with prediabetes. 1
• Consider testing every 6 months if you have additional risk factors (obesity, strong family history, increasing BMI). 1
• More frequent monitoring (every 3 years) may be acceptable only if your risk profile is stable or improving. 1

Risk Stratification You Need

Assess these specific factors to determine your individual risk:

• Family history of diabetes: First-degree relatives with type 2 diabetes significantly increase risk. 3
• Body composition: Calculate your BMI and measure waist circumference. 3
• Physical activity level: Sedentary lifestyle amplifies risk. 3
• Cardiovascular risk factors: Hypertension, dyslipidemia, and prior cardiovascular events predict both diabetes and cardiovascular complications. 1, 3

Cardiovascular Considerations

• Baseline HbA1c predicts future cardiovascular events, not just diabetes progression. 1
• Systematic cardiovascular risk assessment should be performed now, including lipid panel, blood pressure monitoring, and evaluation for metabolic syndrome. 1

Critical Pitfalls to Avoid

• Do not dismiss this result as "borderline normal"—you have a defined disease state (prediabetes) requiring intervention. 1, 2
• Avoid overtreatment with medications at this HbA1c level, which could cause unnecessary harm including hypoglycemia. 3
• Do not delay lifestyle intervention—the window for preventing diabetes is now, and progression accelerates as HbA1c rises. 1
• Ensure accurate measurement: HbA1c should be measured by a certified clinical laboratory (not point-of-care testing) using NGSP-standardized methods. 1, 2
• Be aware of measurement interference: Anemia, hemoglobin variants, iron deficiency, and certain medications can affect HbA1c accuracy. 1, 4, 5, 6

What Happens Without Intervention

• Risk escalates rapidly as HbA1c increases from 5.7% toward 6.0-6.4%, where 5-year diabetes risk reaches 25-50%. 1
• Once HbA1c reaches 6.0-6.5%, relative risk becomes 20-fold higher compared to HbA1c of 5.0%. 1, 2
• Microvascular and macrovascular complications can begin even in the prediabetes range, making early intervention critical for long-term outcomes. 7