Prediabetes and the Hemoglobin A1C Test

In this article, we will answer some of the most common questions about prediabetes and the hemoglobin A1C test…(continue reading)

If you have been diagnosed with prediabetes, it is important to understand what this means and what you need to do about it.

Prediabetes is a common condition of having a higher blood sugar level than normal, but not so high to be considered diabetes which is also called diabetes mellitus.

According to the Centers for Disease Control and Prevention (CDC), one in three adults in the United States has prediabetes which is around 96 million people, and most are unaware they have it.

The hemoglobin A1C test is one of the most common tests used to diagnose prediabetes and can be used to confirm and manage diabetes and prediabetes.

In this article, we will answer some of the most common questions about prediabetes and the hemoglobin A1C test and inform you of other tests available that monitor your blood glucose levels.

What is prediabetes?

Prediabetes, also called borderline diabetes, is a condition where your blood sugar level is higher than normal when measured by one of several blood sugar tests.

If you have prediabetes, it means that your body is not able to process glucose efficiently and that your blood sugar levels are at an increased risk for developing type 2 diabetes.

The hormone insulin is used by your cells to absorb glucose from your bloodstream so that it can be used for energy and when your body does not recognize insulin your cells become insulin resistant.

When your body has trouble metabolizing glucose for energy due to your cells not reacting to the insulin, it gets stored in your bloodstream instead causing your blood sugar levels to spike.

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Besides type 2 diabetes, prediabetes can lead to heart disease, damaged blood vessels, stroke, and many other serious medical conditions if left untreated.

Prediabetes is treatable and can even be reversed if you can make changes to your lifestyle to prevent or delay type 2 diabetes from developing.

According to the American Diabetes Association (ADA), if you have been diagnosed with prediabetes you need to receive a diabetes screening every year or two.

What are the symptoms of prediabetes?

There are most often no symptoms associated with prediabetes which is why it is important to get tested if you think you may be at risk.

If you do experience any symptoms of prediabetes, they will usually include:

  • Increased thirst
  • Frequent urination
  • Excessive hunger
  • Weight loss even if you are eating more
  • Velvety, dark spots on your skin called acanthosis nigricans which usually appear on your neck, groin, armpits, knees, elbows, or knuckles
  • Fatigue and tiredness
  • Blurred vision
  • Frequent infections
  • Slow-healing wounds or sores
  • Lack of feeling or tingling in your extremities

Please consult your doctor or health care provider if you are experiencing any of these symptoms.

What causes prediabetes?

The cause of prediabetes is not fully understood although there are a number of risk factors that can increase your risk of developing prediabetes.

The risk factors for prediabetes include:

  • Family history of type 2 diabetes or prediabetes
  • Obesity or being overweight, especially if you have excess belly fat
  • Having a large waist size above 40 inches for men and 35 inches for women
  • Physical inactivity
  • History of gestational diabetes or giving birth to a baby with a birth weight of more than nine pounds
  • Polycystic ovary syndrome (PCOS)
  • High blood pressure
  • High cholesterol
  • High triglyceride levels
  • Metabolic syndrome which is a combination of obesity and other health conditions
  • Ethnicity or race as you are more likely to develop prediabetes if you are of African American, Native American, Asian American, Latino, or Pacific Islander descent
  • Unhealthy diet featuring lots of unhealthy fats, processed foods, sugar, and sugary drinks
  • Being older than 45
  • Smoke tobacco
  • Have obstructive sleep apnea which is a sleep disorder where you have pauses in your breathing while sleeping

If you have any of these risk factors, it is important to speak with your doctor or health care provider about your risk for prediabetes and type 2 diabetes.

What is the glycated hemoglobin A1C test?

The glycated hemoglobin A1C test, also called an A1C test or an HbA1c test, is a blood test that measures your average blood sugar levels over the past two to three months.

The test works by analyzing your blood sample and measuring the amount of glucose that has attached itself to your red blood cells.

Hemoglobin is the protein in your red blood cells that carries oxygen to your tissues and organs and when glucose attaches itself to hemoglobin it becomes glycosylated or glycated.

Red blood cells have an average lifespan of around 120 days which corresponds to the length of time that can be measured with this test.

The higher your A1C level, the higher your blood sugar levels have been and vice versa.

The A1C test is used to diagnose prediabetes and diabetes as well as to help monitor diabetes treatment plans.

A1C Test for Diabetes: Alila Medical Media

When do I need to get an A1C test?

The A1C test is recommended for all adults with prediabetes or diabetes.

If you have been diagnosed with prediabetes, the CDC recommends getting an A1C test every one to two years to check if you have developed type 2 diabetes.

If your results are normal but you are over 45 or have some prediabetes risk factors, you are advised to get tested every three years.

However, if your results indicate prediabetes or type 2 diabetes yet you are showing no symptoms you may need to get retested.

Finally, if your results show prediabetes or diabetes and you have symptoms then you will need to talk to your doctor about a diabetes management treatment plan.

Are there any factors that can influence the results of my A1C test?

Yes, there are a number of factors that can influence the results of your A1C test which is why it is important to talk to your doctor about any medications or medical conditions you have.

The following can all affect your A1C test results:

  • Anemia such as sickle cell anemia
  • Kidney disease or kidney failure
  • Liver disease
  • Pregnancy
  • Having a certain type of hemoglobin which is most often found if you are of African, Mediterranean, or Southeast Asian descent or if you have blood disorders such as thalassemia
  • Medications including HIV related medications and opioids
  • Blood loss and blood transfusions

If you have any of these conditions or are taking any of these medications, it is important to talk to your doctor about how they may affect your A1C test results and you may need to take another test.

What is my goal for A1C test results?

The results for the A1C measurement will be displayed as a percentage.

Normal A1C levels are under 5.7% and are considered in the healthy range whereas results from 5.7-6.4% indicate you are in the prediabetes range.

Any result over 6.5% means you may have a diagnosis of diabetes.

If you have been diagnosed with prediabetes, the general goal is to keep your A1C levels below 7% although there are many factors that go into what your specific goal should be including your age and any other medical conditions you may have.

Talk to your doctor about your A1C treatment goals so you know what to expect specifically for you.

Are there other tests that can diagnose prediabetes?

There are a couple of other diabetes tests that may be used to diagnose prediabetes or type 2 diabetes.

These include the fasting plasma glucose (FPG) test and the oral glucose tolerance test (OGTT) and your doctor may use these instead of the A1C test.

The fasting plasma glucose test measures your blood sugar after you have fasted for at least eight hours and if your results are over 100 mg/dL (milligrams per deciliter) but under 126 mg/dL then it indicates you have prediabetes.

The oral glucose tolerance test measures your blood sugar after you have fasted for at least eight hours and then drink a sugary solution.

Results over 140 mg/dL but under 199 mg/dL after two hours indicate prediabetes.

How do you treat prediabetes?

If you have been diagnosed with prediabetes, there are a number of things you can do to prevent or delay the onset of type 2 diabetes.

These include:

If you implement these lifestyle changes and your A1C test results are still high, you may need to start taking medication for prediabetes such as metformin.


Prediabetes is a condition where your blood sugar levels are higher than normal but you do not have diabetes yet.

The hemoglobin A1C test is one way to diagnose prediabetes and diabetes and the results are generally used to set a goal for treatment.

There are other tests that can also be used to diagnose prediabetes as well as a number of factors that can affect the results of your A1C test.

If you have prediabetes, there are a number of things you can do to prevent or delay the onset of type 2 diabetes including making lifestyle changes and taking medication.

If you have any more questions regarding prediabetes or the A1C test, please consult with your doctor or health care provider.

References and sources:

American Diabetes Association

Mayo Clinic 


Fact Checked and Editorial Process is devoted to producing expert and accurate articles and information for our readers by hiring experts, journalists, medical professionals, and our growing community. We encourage you to read more about our content, editing, and fact checking methods here. This was fact checked by Jacqueline Hensler and medically reviewed by Dr. Angel Rivera. 

fact checked and medically reviewed

We are committed to providing our readers with only trusted resources and science-based studies with regards to medication and health information. 

Disclaimer: This general information is not intended to diagnose any medical condition or to replace your healthcare professional. If you suspect medical problems or need medical help or advice, please talk with your healthcare professional.

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