All about prediabetes and HbA1c

Prediabetes is quite common as its estimated prevalence is 14% in India, which translates to approximately 1 in every 6 adults having diabetes. Prediabetes could go unrecognised for years because the blood glucose levels are not that high to be considered type 2 diabetes. The glycated haemoglobin (HbA1c) test is a widely accepted and reliable test to diagnose prediabetes.

The HbA1c test provides an average of the blood glucose levels over the past 3 months and gives a better picture of the blood glucose control. Let’s delve deeper to understand prediabetes, symptoms of prediabetes, what is the HbA1c diabetes test and prediabetes, prediabetes levels for HbA1c, and treatment for prediabetes.

What is prediabetes?

Prediabetes is a metabolic disorder that is characterised by high blood glucose levels (hyperglycemia); however, the glucose levels are lower than those seen in diabetes. Prediabetes is due to poor glucose metabolism. If left untreated, prediabetes can progress to diabetes.

Prediabetes also increases the risk of heart attacks and other cardiovascular diseases. Due to a paradigm shift in lifestyles these days, such as sedentary desk jobs and increased inclinations toward eating junk and processed foods, diabetes is anticipated to affect around 79.4 million individuals in India by 2030.

Prediabetes is usually caused by reduced insulin sensitivity or an increase in insulin resistance, which leads to high blood glucose and high insulin levels. This can lead to a burnout of the pancreas. People with a family history of diabetes are at increased risk of developing prediabetes and subsequently diabetes.

Symptoms of prediabetes

Signs and symptoms of prediabetes are common with diabetes; however, the blood sugar levels are different. Prediabetes can present the following symptoms:

  • Excessive hunger even after meals
  • Excessive thirst
  • Frequent and increased urination
  • Blurring of vision
  • Excessive tiredness
  • The appearance of dark patches on the skin of the armpits and neck

Serious symptoms could include the following:

  • Numbness or tingling sensations in the lower limbs
  • Frequent infections
  • Non-healing ulcers or sores
  • Impaired eye function
  • Impaired kidney function

HbA1c testing in diagnosing prediabetes

  • What is the HbA1c test?

The HbA1c test is an important test for prediabetes and diabetes to assess the blood glucose control and the working of the pancreas. This test is also used in the assessment of insulin resistance. Another name for the HbA1c test is the glycosylated haemoglobin and glycohaemoglobin test, and it gives a clear picture of the blood sugar levels across the past three months of the person tested.

  • How does it work?

The HbA1c test requires blood sampling at any time during the day, and fasting is not mandatory. HbA1c levels are not affected by daily fluctuations in blood glucose levels or diet. The result report is usually available on the same day and gives the estimation of the glucose control.

  • What does it measure?

The HbA1c test measures the extent of glycosylation (sugar coat) of haemoglobin. When the blood glucose levels rise, the haemoglobin becomes more glycated. The glycosylation reduces when blood glucose levels are better controlled.

HbA1c prediabetes range

HbA1c test results are indicative of the glucose being carried by haemoglobin. The prediabetes HbA1c range is from 5.7% to 6.4%. It is less than the HbA1c level for diabetes, which is equal to or greater than 6.5%.

HbA1c level Interpretation
Less than 5.7% Normal
5.7%-6.4% Prediabetes
Equal to or more than 6.5% Diabetes

Limitations of the HbA1c test

The HbA1c test for prediabetes is a reliable test to show glucose control over the past 90 days for a person. An HbA1c test is not recommended for the following people:

  • Children below 18 years of age
  • Pregnant women
  • Postpartum mothers for the first two months after delivery
  • People who have had diabetes symptoms for less than two months

What are the other tests for prediabetes?

Other tests for prediabetes include the following:

  • Fasting blood glucose test: This test involves measuring blood sugar levels after at least eight hours of fasting (usually overnight). The prediabetes range for fasting blood glucose levels is 100-125 mg/dL.
  • Oral glucose tolerance test: In this test, you will be required to drink a sugary syrup, and blood glucose levels are measured before and at designated intervals for the next two hours after drinking the syrup. The prediabetes range for blood glucose levels is 140-199 mg/dL. A blood glucose level greater than 200 mg/dL indicates diabetes.

How is prediabetes treated?

Lifestyle changes are very effective in reversing the symptoms of prediabetes and controlling blood sugar levels. The following lifestyle changes are helpful in treating prediabetes naturally:

  • Maintaining a healthy weight: You should try to maintain a healthy weight and a body mass index (BMI) of less than 25. The aim should be to have a waist circumference of fewer than 40 inches in men and less than 35 inches in women.
  • Eating right: Eat a balanced diet with a good mix of fruits, vegetables, and nuts. Avoid meats, junk foods, sugary or alcoholic beverages, and processed foods. Also, avoid skipping meals.
  • Daily exercise: Regular exercise is crucial to reverse prediabetes and increase insulin sensitivity. Aim for at least 30 minutes of exercise daily or 150 minutes in a week. Getting physically active is also an effective measure to reduce blood glucose levels.
  • Quitting smoking: Smoking increases the risk of prediabetes and diabetes through various inflammatory mechanisms. Quit smoking and indulge in calming activities such as deep breathing, yoga, and meditation.


Prediabetes is when your blood has higher glucose levels than normal, but these are not high enough to qualify as type 2 diabetes; however, prediabetes certainly puts you at an increased risk of developing diabetes if left untreated. The symptoms of prediabetes are the same as that of diabetes; therefore, it is important to get an HbA1c screening done to understand your blood glucose activity over the past three months. HbA1c is an important test to diagnose prediabetes; however, this test cannot be used for certain population groups. Other tests for diagnosing prediabetes include the fasting blood sugar test and the oral glucose tolerance test. Prediabetes can be reversed by lifestyle changes such as regular exercise, a healthy Pre diabetes diet, quitting smoking and weight management.


  • How can I lower my prediabetes HbA1c level?

The prediabetes HbA1c level can be lowered naturally by incorporating an active lifestyle, eating nutritious food, and maintaining a healthy weight. These lifestyle changes are effective in reducing blood glucose levels and, subsequently, reducing the glycosylation of haemoglobin.

  • Can the HbA1c level be high in the absence of diabetes?

The HbA1c level can be high in people with prediabetes, which is also known as borderline diabetes. The levels are higher than the normal value of less than 5.7% and less than the diabetes HbA1c level of 6.4%. If left untreated, prediabetes will progress to diabetes, and the HbA1c levels will increase further.

  • What are the warning signs of prediabetes?

The warning signs of prediabetes could include increased thirst, excess hunger, frequent urination, blurring of vision, increased susceptibility to frequent infections, and non-healing sores. Other signs could include skin changes such as increased skin tags and colour changes in the armpit or neck region.

  • Can prediabetes go away?

Prediabetes is a disorder that can be reversed before it progresses to diabetes or other metabolic disorders. It can be eradicated with lifestyle modifications and behaviour changes, including eating healthy food, exercising regularly, and maintaining a healthy weight.

  • Are there any risks with the HbA1c test?

The HbA1c test is quite safe; however, you might experience slight pain or a bruise at the site where the needle pricked your arm to withdraw the blood, but these go away very quickly.