I got tested and it showed my A1C as 5.8, which surprised me as it was quite higher than expected. Technically it’s still within normal range, but it’s uncomfortably close to prediabetic, right?
And some sources say that *is *prediabetic and that normal is 5.4 or lower. But other sources insist that 5.8 is fine.
Are the “5.8 is fine” folks being too blithe about A1Cs of this level?
I’m a not-thin not-fat person in my 20s.
I don’t know what the people advising you have been smoking, but an A1c between 5 and 7 is ideal. Below 4 lies hypoglycemia, above 7 requires sugar control.
The numbers keep getting tighter (without a lot of evidence that leads to better outcomes). Last I heard, 6.5 twice is now diabetes, while 5.7-6.4 is “prediabetes” among those that believe prediabetes is a thing. A1C test - Mayo Clinic
Prediabetes is fairly controversial. Some doctors are very “ya either got diabetes or ya don’t, prediabetes is nonsense.” Others see numbers in the 5.7-6.4 range as not needing medication intervention, but a sign that lifestyle changes and diet education is probably a good idea.
Only one who can tell you personally what to do about it is your doctor. It’s going to depend on your other risk factors for developing full blown, actual diagnosis of diabetes how aggressively she wants to monitor or suggest diet and lifestyle change.
But, y’know, I’ve yet to meet anyone for whom achieving and maintaining a healthy body weight is a bad idea…
I will stand by the advice of a long list of endocrinologists I’ve seen, all of whom advise 5-7. The one I’m seeing now is fresh from her residency, FWIW.
I just checked my last physical report and my doctor is using from 4-6 as being in the normal range. So according to scale you are fine but should start to be aware that you are approaching the upper limit and at least consider a lifestyle change such as exercising more and eating less refined sugars. Good advice for just about anybody really.
The consensus at UpToDate.com (with which I agree on this matter) is as follows:
So based on your A1C alone, you’re in the ‘glucose intolerance’ zone.
I don’t understand why an endocrinologist would base their diagnosis of diabetes on a Hgb A1C range from 5 to 7.
QtM, physician to many, many diabetics.
Definitely this!
In my experience, an A1c of 5-7% is the desired range for someone who has already been diagnosed with diabetes, not the diagnostic range. I’ve worked with people with this bit of confusion before - not understanding the difference between the diagnostic levels and the maintenance levels, and had to explain it. And the large majority of endocrinologists I’ve encountered are of the firm opinion that 7% is too high anyhow; most of them subscribe to the ‘tight control’ theory of preventing complications.
The ADA has an A1c-to-estimated average glucose conversion tool on their website:
8.1–>7.1 three months!
Wait, this isn’t MPSIMS?
Medical advice is best suited to IMHO.
Colibri
General Questions Moderator
They’re moving away from the ‘tight control’ lately; too many brain injuries from hypoglycemia, for folks on insulin, or even sulfonylureas like glyburide or glipizide. We shouldn’t have the cure be worse than the disease.
Of course, if you can get the A1C lower using just diet/exercise/metformin, go for it! You won’t get dangerously hypoglycemic on those therapies.
Current practice is trending towards keeping HgbA1C around 7, LDL below 70, and systolic BP <130. Complications drop waaaay off if you hit those targets.
Recent similar discussion about the various definitions of “pre-diabetes” here.
Linked to in that thread was this article that may interest some - defining pre-diabetes as any one of fasting glucose is 100 to 125 mg/dL, or A1C is 5.7 to 6.4 percent or an oral glucose tolerance test result of 2-h plasma glucose values ranging from 140 to 199 mg/dL would label 36.7% of the American adult population as pre-diabetic; only 3.2% are positive on all three. Between the fasting glucose and impaired glucose tolerance test which one begins to become abnormal first seems to be a function of the pathophysiology within the individual some - with impaired fasting glucose reflecting liver insulin resitance and impaired glucose tolerance test results reflecting more whole body insulin resistance. Not sure what that implies about future risks and best interventions.
The point though is that a huge mess of adult Americans are likely not perfectly normal on one or the other screen and being normal on one does not mean that you wouldn’t be abnormal if another one had been used.
QtM (and others) - any thoughts on where the line is between good case finding and excessive pathologizing?
Velocity, some people are BMI of 30 to 35 and think they are “not thin not fat” … and it matters where your fat is. You are in your 20s? If you do not exercise regularly and pay adequate atttention to eating a healthy diet, you may want to consider starting now. Just sayin’
I just popped in to brag that I’ve been at 5.6 for two tests in a row (three months apart), after a decade of being around 5.8 or 5.9. Exercise is a wonder drug.
My evidence based medicine employer would likely hire QtM (if they haven’t already ;))in a heartbeat. We are blessed with a diabetologist who contributes to UpToDate and who is in favor of moderation. He is also possessed of a very sweet accent and there are one or two quotes that are favorites- “Met forrrmeen’s sooch a safe drug; ye can tak it throoo th’ entire pregnancy” being one of them 
And how often should you be doing testing if you are below that range? I thought an annual A1C was pretty normal.
Annual screening would be rather excessive for most at-risk folks. Once again from UpTodate.com, here’s their expert consensus on DM screening:
It should be noted that a variety of different groups have somewhat different recommendations for screening. Particularly for screening people without risk factors.
American Diabetes Association: In individuals without risk factors, the ADA recommends that testing begin at age 45 years.
US Preventive Services Task Force: concluded that there was insufficient evidence to recommend for or against screening for diabetes in nonpregnant adults without hypertension.
Centers for Disease Control: Test individuals 45 years or older regardless of risk factors.
National Institute for Health and Care Excellence (NICE): Has more definitions of what constitutes a risk factor, but does not suggest screening people without risk factors.
So, the science about who to test when is still evolving.
Most worthy observations, DSeid!
It’s hard to figure out where to draw the line. I’m not unhappy with the current standards; it does identify a lot more at-risk folks. Earlier diagnosis and intervention, or even just earlier lifestyle modification upon being made aware of increased risk does modify the disease course for a lot of folks, reducing their lifetime risk of DM complications.
BUT it also tags a lot of folks who are not going to develop significant disease as ‘at-risk’, and once you have that label, it has implications for health insurance and other things.
That’s why I tend to favor the approach taken by the US Preventive Services Task Force, with DM and in general. They like to wait for more hard evidence to accrue regarding risks/benefits of screenings before making recommendations. They are not yet recommending wholesale screening of a normal risk population.
The more I learn about DM, the longer I take care of people with it, the more and more complex it gets, and the more challenging it is to figure out the right thing, especially as regards populations as a whole. A lot of folks had bad outcomes due to the ‘tight control’ recommendations of previous years. I wonder what other ‘right things’ we’re doing now that are causing more harm than good. Overaggressive screening can certainly be one candidate.