hba1c 48 currently, should l go onto medication immediately?

Unfortunately we are all different, so in general diet is more important than exercise. However for some, additional exercise makes all the difference whilst for others, probably the majority, reducing the carbohydrates does more to control our blood glucose than does exercise.

Do you have at least a 'finger-prick' Blood Glucose Meter? If not, then that could make all the difference to your willpower so far as diet is concerned.

So far as medication is concerned, for most people there is no urgent need to start taking medication at such relatively low Bg levels if you are willing to be serious about trying to control your BG by diet and/or exercise. However, there are exceptions who start to get diabetic complications at level barely out of the normal range - such as my fellow moderator @KennyA.

@Fighterofprediabetes,
Are you generally, otherwise healthy, and active? Do you have any other conditions, or are you on medications for anything at all? These things can make a difference to management of T2 and pre-diabetes. With respect, those of us of senior years (I include myself here) can have a bit more leeway with HbA1c levels. This is apparently due to risk of older folks having falls if blood glucose levels fall a bit too low. My own GP surgery considers HbA1c below 53 to be ok if on Metformin, and would not be concerned to prescribe for anyone over age 65 if their levels were in pre-diabetes range, or slightly above, as yours seem to be.

Some things to consider:
You should, perhaps be given a personal target level to aim for. Your HCP should discuss this with you at review, and taking into account results from your eye retinopathy screening, and the foot check, any other health issues, etc. then reach an agreement with you on how you want to proceed.

To be have slightly higher HbA1c levels than a younger person is of les concern, because, to put it bluntly, we older folks could have less time left for complications to set in than someone considerably younger.

Some info that may be of use, particularly the info for older people:

Not to confuse you @Fighterofprediabetes as your question is straightforward should I go on meds or not. It is a choice and you have had some good advice from previous posts.

Slightly off topic, but I think @sns3guppy makes a good point. You are clearly concerned at your HbAc1 results and whether or not to go on meds. Obviously preventing damage to your body is your number 1 priority. To that end @Pipp raises a good point about age. Our pancreas may not be as efficient as they once were, but diabetes is a slow horse.It takes time to damage your body.

I do agree with @sns3guppy. The HbA1c test is a crude way of determining and diagnosing diabetes and by extension limiting / preventing the damage raised blood sugars can do to your vascular system.

There are ways we can further help our aging bodies handle elevated blood sugars. Elevated blood sugar is not only about how high and for how long your blood sugars remain elevated for any given period, but how choppy the ups and downs of your blood sugar levels are throughout the day. Blood sugars that spike and drop throughout the day can do more damage over time than blood sugars that remain reasonably constant, even at an elevated level. And that really boils down to not eating high carb / sugary foods. Which as you say is what you are intending to do. So a diet with reasonably low cards and low sugar will prevent the damaging ups and downs. If you were to view your blood sugars in a 24 hour period as a graph , you would aim for blood sugars in a range between 4-6 or 5-7 or even 6-8 mmol/ls (Sorry I'm not sure what that is in mmol/ls mols. I live in Canada, we use mmol/ls.) Keeping one's blood sugars in a narrow range is better than a graph that's full of spikes. So as @sns3guppy says in his response, it's more than just a crude HbA1c number.

sns3guppy said:

A drug like Metform has no real drawbacks and may have some significant health benefits. It can however, result in cholesterol issues and is often prescribed with a statin. It's considerably better than most of the brand-name wonderdrugs today, which have numerous drawbacks, and which produce considerably lower results than plain-jane metformin.

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Interesting point on the Metformin, I’ve never heard or read this before. Can you post a link to this information? I’ve had a look around the internet myself and can’t find anything that says this, in fact I can only find links to the contrary saying that it is positive in lowering LDL cholesterol, one of the links I found below

I was diagnosed over five years ago with levels similar to yours. I've never used any diabetes-related medication. What worked for me, very quickly, was a low-carb diet aiming for around 20g carb/day. I was at normal HbA1c levels within four months.

Are you monitoring your blood glucose levels before and at two hours after food? That was probably the single most influential thing for me in working out what did (and didn't) affect my BG unacceptably. I kept a diary of food and BG readings, and after a few months of collecting info was able with some certainty to predict how well I'd deal with things.

Your BG will rise after eating anything with carb - that's perfectly natural. The key question is how quickly and efficiently your system can deal with the excess glucose, which is why you test at +2 hrs.