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What's a Prediabetic A1C? What's A1C Anyways?

Prediabetes A1c

You are likely to learn a whole new set of terms if you have prediabetes or are worried about it. You might hear about type 2 diabetes, a prediabetes diet, and blood sugar or blood glucose, and you are certain to hear about “A1c.”

What is hemoglobin A1c, and what does it have to do with prediabetes and diabetes? Learn what your numbers mean and why your doctor focuses on it in this article. Plus, find out what you can do to manage your A1c with healthy lifestyle changes and help from Lark Diabetes Prevention Program.

What Is A1c?

Your A1c is also known as your glycated hemoglobin, hemoglobin A1c, HbA1c, or glycohemoglobin.[1] It is related to the amount of glucose (a type of sugar) that is in your blood over time. Hemoglobin is a protein in your red blood cells. As blood glucose circulates in your bloodstream, some of it attaches, or binds to, hemoglobin.  

Once your hemoglobin has glucose attached to it, it has been “glycated,” and is known as glycated hemoglobin or glycohemoglobin, or is abbreviated as HbA1c or A1c. Your A1c value is the percent of your hemoglobin that has glucose molecules attached to it.

A1c, Prediabetes, and Diabetes

Prediabetes is a condition with above-normal blood sugar levels, and in diabetes, your blood sugar levels are higher than in prediabetes. In general, the higher your blood sugar levels, the higher your A1c. That is why healthcare professionals use A1c as a test for prediabetes and diabetes.

Your A1c is considered a long-term indicator of your body’s blood sugar control. This is possible for a few reasons.

·      Your hemoglobin-containing red blood cells live for 120 days.

·      Glycosylation, or binding of glucose to hemoglobin, is permanent.

·      More sugar in your blood leads to more glycosylation.

Healthcare professionals consider A1c to be a good overview of the past three months of blood sugar levels in your body.

Reasons for High Blood Sugar and A1C in Prediabetes

You have prediabetes if your blood sugar and A1c are above normal levels. The reason for an increase in blood sugar is because of insulin resistance, which develops over time. Once you have insulin resistance, your cells have more trouble taking up glucose to use for fuel or convert to and store as fat. This means that more of the glucose stays in your blood.

Having prediabetes does not mean you need to sit and wait for type 2 diabetes to come, and it does not usually mean that you need to depend on medication to lower blood sugar. Instead, your lifestyle choices can greatly affect your blood sugar levels if you have prediabetes. Losing weight and eating right with a prediabetes diet, being physically active, and lowering stress can help lower A1c. On the other hand, these factors could raise blood sugar and A1c.

·      Maintaining a high weight or gaining unwanted weight.

·      Eating a high-glycemic diet with too many sugars or refined starches.

·      Not getting enough sleep, due to poor sleep hygiene or a sleep disorder.

Measuring Your A1c

Your A1c is easy to measure. All you need is a simple blood test. The lab where you get your other blood tests, such as your routine cholesterol test, should offer the A1c test for prediabetes. Just ask your doctor for the lab order.

When to Measure A1c

You should get your A1c tested when checking for prediabetes or diabetes, or when you are monitoring your condition to see how your treatment plan is doing. You might need an A1c test if:

·      Your doctor recommends one.

·      You have risk factors for prediabetes or type 2 diabetes risk factors, such as being overweight or obese, having a family history of diabetes, or being over age 45.

·      You had a high value on a random or fasting plasma glucose test and your doctor wants to check your blood sugar in a different way.

·      Your cholesterol, triglycerides, or blood pressure are high.

Your doctor might suggest testing your A1c:[2]

·      Every three years if you do not have prediabetes.[3]

·      Every year if you have prediabetes.

·      Every 6 months (twice a year) if you have diabetes and are meeting your treatment goals.

·      Quarterly (every 3 months) if you have diabetes and are not meeting your treatment goals.

How to Get A1c Tested

It is easy to get your A1c test done. After your doctor puts in the order or gives it to you, you can go to your regular lab for a blood draw. It can be at any time of the day, and it does not matter if you have eaten or not – it does not need to be a fasting blood test.

Your A1c Test Results

Your prediabetes A1c test result can come back within days or weeks. When you get your result, you can discuss it with your doctor. Find out:

·      What the result means. Do you have prediabetes?

·      Whether you need any follow-up tests or appointments.

·      If you should you start a prediabetes diet, or make any changes to yours.

·      When you should get your next prediabetes A1c test.

A1c Values in Prediabetes

Your A1c results come back as a percent (%). These are the values that are used.

·      Normal: under 5.6%

·      Prediabetes: 5.7 to 6.4%.

·      Diabetes: Over 6.5%.

Alternatives to A1c for Prediabetes Testing

The A1c test provides a long-term estimate of how well your blood sugar levels are controlled, but it is only one possible test for prediabetes. Do not be surprised if your healthcare provider orders one of the following tests instead of, or in addition to, your A1c test.

·      Fasting blood glucose. You fast overnight, or for at least 8 hours, and get your blood drawn.

·      Oral glucose tolerance test. This is a check of how well your body processed glucose after you consume it. With the test, you need to drink a solution containing 75 grams of glucose – the equivalent of the amount of sugar in 5 pop-tarts or 5 cups of Lucky Charms – and get your blood drawn 2 hours later. Your blood sugar levels spike after drinking that glucose load, but should fall significantly again within 2 hours.

·      Random blood glucose. This test cannot be used to diagnose prediabetes, but it can give a quick hint as to whether you may be having trouble controlling blood sugar. Your doctor might order it on the spur of the moment, since it is inexpensive and you can take it anytime and need not be fasting.

Benefits of the A1c Test for Prediabetes

There are many reasons to choose the prediabetes A1c test over fasting blood glucose or OGTT.


It is easy. All you have to do is get your blood drawn once, at any time. In contrast, the fasting blood glucose test requires you to be…fasting. That may mean you need to take it in the morning, which could be inconvenient. If you are hooked on coffee, it can be a drag if your doctor tells you to skip the caffeine until after your test.

The prediabetes A1c test is far more convenient than the OGTT because you need only get a single blood draw. With the OGTT, you need to drink the solution, hang around for 2 hours, and then get your blood drawn. It takes planning, not to mention that drinking that much glucose makes some people feel nauseous. Plus, the OGTT is more expensive than the A1c.

Long-Term Nature

While the OGTT and fasting blood glucose tests provide snapshots of how much sugar is in your blood right now, the A1c test shows how much sugar has been in your blood, on average, over the past three months. That can be helpful because a single high or low value from a blood glucose test may not tell the whole story about how high or low your blood sugar is the rest of the day.


You can try to control the factors that affect your blood sugar before your prediabetes test, but it is difficult to control all of them. That is because there are so many different factors, such as the following:

·      Whether you have eaten recently.

·      Whether you have been smoking.

·      Whether you slept adequately last night.

·      If you are experiencing high amounts of stress.

·      What time of day it is.

·      If you exercised intensely within the past day.

·      And more…

The benefit of A1c is that it does not respond to any of those factors in the short term. You can eat a big meal morning of your test, or go for a jog, and your A1c will not change. This means that your A1c may be more representative than a blood glucose test of your overall average.

Limitations of the A1c Test for Prediabetes

No single test is perfect, and that is true of the A1c test. It has a few drawbacks, which is why your doctor might recommend a fasting blood glucose test, too.[4]

·      It is less sensitive, which means that it may not catch prediabetes as early.[5]

·      Compared to OGTT, A1c is less specific to pancreatic beta cell health because it does not measure post-meal blood sugar, which is when beta cells release insulin.

·      A1c is affected not only by “glycation,” but also by “hemoglobin,” so conditions such as anemia (low hemoglobin) can affect your A1c result without being related to glucose.

Lowering a Prediabetic A1c

You can take charge if your A1c shows that you have prediabetes. Your diagnosis can be the cue to take steps to improve your health. A digital Diabetes Prevention Program (DPP) can offer you the tools you need to lower your risk for type 2 diabetes or delay its onset.

The DPP is proven to be effective at delaying or preventing type 2 diabetes, with an average of 58% lower risk for diabetes development among prediabetes patient who participated in the program. The program includes curriculum on:

·      Losing weight.

·      Eating healthier.

·      Increasing physical activity.

It is designed to fit into your lifestyle and lead to long-term, sustainable changes – not be a fad diet that lasts only days or weeks. To further fit into your lifestyle, you can choose a digital DPP, such as Lark DPP. With Lark, all you need is your smartphone to connect anytime for support in making those healthy lifestyle changes. You can Sign up for Lark whenever you are ready.


What is Lark?

A new study reveals that artificial intelligence could be a useful tool to help patients prevent Type 2 diabetes. The study, published in the Journal of Medical Internet Research, showed that patients at risk of Type 2 diabetes who used the Lark Weight Loss Health Coach AI, dropped 2.38 percent of their baseline weight and increase the percentage of healthful meals they ate by 31 percent. 

“I’m really excited,” Lark CEO and cofounder Julia Hu told MobiHealthNews. “I think stepping back and looking at pre-diabetes, it really is such a crushing and chronic condition. Eighty-six million people in the US have pre-diabetes and it costs the health industry billions of dollars a year.”

The longitudinal observational study was a partnership between six primary care offices in Nevada and southern California and Lark Technologies. The study examined 239 overweight and obese patients at risk of Type 2 diabetes. Participants were offered the app free of charge by their primary care physician. No further physician support was given to the patients, according to the study. The retrospective study looked at users from July 2016 to January 2017.

The app is personalized to meet patients’ needs and goals. The user can enter their age, gender, weight, height, and goals.

“This is really AI coaching and mimicking healthcare at its best, but the cool thing about AI is that it is infinitely scalable,” said Hu. 

The study, noted that one of its limitations was the fact that it did not have a control group to directly compare the results to. In addition, the study was observational and not experimental, which meant it was not able to determine causality. 

Lark’s HCAI has been on the market since 2015 and currently has about a million users, according to Hu. It provides weight loss coaching through modules on an array of topics in unlimited text-based counseling sessions. The modules take about 16 weeks depending on whether users miss a week of the classes or decide to rewatch a module. 

According to the study, the design takes a holistic approach to weight loss and management. It allows users to report feelings, such as guilt, and then gives the user encouraging advice based on that situation. 

“I grew up with a chronic disease all my life,” said Hu. “I had an amazing care team, my pediatrician and my dad. They were there for me not just medically but emotionally … so that made a huge impact on me, people struggling with chronic conditions could really use a friend and someone who is there for them when they need it. We wanted to scale that sense of compassion and relationship.”

The company has a healthcare committee of 15 members, including several Harvard and Stanford faculty members that specialize in psychology of some kind. 

Lark Technologies debuted in 2011 and was originally focused on sleep technologies, but have pivoted, or as Hu says, evolved. Now there are no longer field devices but the technologies sit on top of 70 different health monitors. 

“The idea was, can we create an AI coach that coaches on several different aspects of your health,” said Hu. “We started with sleep then, went to exercise, then went to nutrition and that helped us really build for chronic conditions. They are diseases that require lifestyle changes, behavioral health change, and self efficacy.”

Currently, Lark has four products on the marketing including a wellness, diabetes prevention, diabetes management, and hypertension management platforms. 

“This study demonstrates AI’s potential to provide compassionate care that is associated with weight loss, increased healthy lifestyle behaviors, and user trust that can reduce diabetes risk,” the study reads. 


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