Prediabetes: what a borderline HbA1c means and what to do in the next three months
The reading that comes back as borderline is the most useful one you will ever be handed. Here is what the numbers mean, and what to do with the three months before the next test.
Prediabetes means your blood sugar is higher than normal but not yet in the diabetes range: an HbA1c of 5.7 to 6.4%, or a fasting glucose of 100 to 125 mg/dL. It usually has no symptoms, and it is the stage at which diabetes is most preventable. The next three months are the most useful time to act.
The reading that comes back as borderline is the most useful one a person will ever be handed. It is also the one most likely to be folded into a file and left until the next annual check, by which point the window it described has narrowed.
That second number is the one worth sitting with. It describes people who have no diagnosis, usually no symptoms and often no idea, and who are nonetheless already on the path.
What counts as prediabetes
These are the ranges most labs and doctors in India work from, taken from the American Diabetes Association’s Standards of Care.
- HbA1c: below 5.7% is normal, 5.7 to 6.4% is prediabetes, 6.5% or above is diabetes.
- Fasting glucose: below 100 mg/dL is normal, 100 to 125 mg/dL is prediabetes, 126 mg/dL or above is diabetes.
- Two hours after a glucose drink (OGTT): below 140 mg/dL is normal, 140 to 199 mg/dL is prediabetes, 200 mg/dL or above is diabetes.
A diagnosis is made by your doctor, usually on repeat testing. These numbers are here so you can read your own report, not to replace that conversation.
Why prediabetes is a window, not a waiting room
Prediabetes is not a mild version of diabetes. It is the period during which the body is still compensating, and compensation is exactly the thing that responds to being helped. What we see in practice is that this stage is where the work is cheapest. The changes that hold a borderline reading steady are smaller than the ones needed to bring a diagnosed reading down, the medication conversation has usually not started, and the person still has room to absorb an imperfect week.
The large prevention trials say the same. In the US Diabetes Prevention Program, lifestyle change cut the number of people who went on to develop diabetes by 58% over about three years. In the Indian Diabetes Prevention Programme, run in Chennai, lifestyle change lowered the risk by about 28%. Both were built on ordinary changes to food and movement, not on anything extreme.
What to do in the next three months
If you want to read further on the two eating changes, start with the plate method for Indian meals and why food order changes blood sugar.
Common questions
Can prediabetes be reversed?
For many people, yes. Readings often return to the normal range when food, activity, sleep and weight change together and are kept up. The earlier the change, the more room there is for it to work.
Do I need medication for prediabetes?
That is your doctor’s decision. Some people are offered metformin, particularly with other risk factors. Lifestyle change is the first step either way, and it works alongside medication rather than instead of it.
How often should I retest?
After three months of changes, to see whether they are working. Once readings are steady, your doctor will usually suggest testing at least once a year.
If your last report came back borderline, this is the stage we most like to see people at. Read how we work with diabetes and prediabetes.