From the Guidelines
I would explain to the patient that their A1c of 5.7% indicates they have prediabetes, which means their blood sugar levels are higher than normal but not yet high enough to be diagnosed with type 2 diabetes. I would recommend they make lifestyle changes including regular physical activity (aim for 150 minutes per week), adopting a balanced diet rich in vegetables, fruits, and whole grains while limiting processed foods and sugars, and losing 5-7% of body weight if overweight, as these measures can effectively prevent progression to diabetes and even return blood sugar levels to normal range, as suggested by the American Diabetes Association standards of medical care in diabetes-2018 1.
Key Recommendations
- Regular physical activity for at least 150 minutes per week
- Balanced diet with emphasis on vegetables, fruits, and whole grains
- Weight loss of 5-7% of body weight if overweight
- Annual monitoring for development of diabetes in those with prediabetes, as recommended by the standards of medical care in diabetes-2012 1 and standards of medical care in diabetes-2014 1
Rationale
The patient's A1c level of 5.7% puts them at high risk for developing type 2 diabetes, and lifestyle interventions have been shown to be effective in preventing or delaying the onset of diabetes, as demonstrated by the Diabetes Prevention Program (DPP) and other studies 1.
Additional Considerations
- Metformin therapy may be considered for prevention of type 2 diabetes in those with prediabetes, especially for those with BMI ≥ 35 kg/m², aged < 60 years, and women with prior gestational diabetes mellitus (GDM), as suggested by the standards of medical care in diabetes-2012 1 and standards of medical care in diabetes-2014 1
- Screening for and treatment of modifiable risk factors for cardiovascular disease is also recommended, as suggested by the standards of medical care in diabetes-2014 1 and diagnosis and classification of diabetes mellitus 1
From the Research
Patient Information for A1c Level of 5.7
- Your A1c level is 5.7, which is below the threshold for diabetes diagnosis, but slightly above the normal range, indicating prediabetes 2.
- You should be aware that this level suggests an increased risk of developing type 2 diabetes, and lifestyle changes or metformin therapy may be recommended to prevent or delay its onset, as seen in studies where metformin reduced the risk of type 2 diabetes in people with increased risk 3, 4.