Why do the Americans diagnose pre diabetes with an HbA1c result of 5.7/42

Cut off points are decided on the evidence by committees so the actual point can be a bit arbitrary.
The American diabetes association decided on a cut off point for HbA1c before the World Health organisation (which most other places tend to follow) made their report.The UK and many other countries don't actually use the term pre diabetes either .
The WHO report said

Levels of HbA1c just below 6.5% may indicate the presence of intermediate hyperglycaemia. The precise lower cut-off point for this has yet to be defined, although the ADA has suggested 5.7 – 6.4% as the high risk range .While recognizing the continuum of risk that may be captured by the HbA1c assay, the International Expert Committee recommended that persons with a HbA1c level between 6.0 and 6.5% were at particularly high risk and might be considered for diabetes prevention interventions

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http://www.who.int/diabetes/publications/report-hba1c_2011.pdf

Really though there isn't a lot of difference between 5.9% and 6%. Diabetes UK does say that people with an HbA1c of less than 6% (42mmol/mol) may still be at high risk of developing diabetes.
http://www.diabetes.org.uk/About_us...vention/New_diagnostic_criteria_for_diabetes/
It's a good thing that you were aware of the risk , in spite of your doc not mention it (though did he suggest that losing weight etc might improve your health?)
Well done on your weight loss and BP reduction, don't worry too much about the appointment. Losing weight and lowering blood pressure must be a good thing whatever side of the line you fall on.

As Phonex says, the WHO (World Health Orginasation) have published guidelines that define what they consider as the upper and lower limits for defining diabetes yes/no.
Several countries have their own idea as to what these limits should be and may adjust their thresholds from the WHO recomendations.
I know that Japan and one of the Scandanavian countries (I think it's Sweeden) have completely differing threshold limits that are vastly different from those recomended by the WHO.

In addition to the other comments, it might have something to do with bringing more people into the (pre)diabetic range so that more drugs can be prescribed....one does wonder....

gardengnome said:

Well I got my results yesterday and was cross because they are exactly the same as 11 months ago. Low carb diet, no salt, added sugar, v. little alcohol bmi <19 and an HbA1c of 41 mmol/mol.
No idea how I can improve these figures and feel very fed up. Does pre diabetes inevitably turn into Type 2 ?

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That is low isn't it? Got my results yesterday also and mine was 54 and everyone says that is very good.. Is 41 conciderd pre diabetic? I find it all very confusing!

HbA1C of 41 is very good.

I can understand how you may be feeling frustrated at the moment.

You have been "good", you have done all the right things so why did you not get the rewards that you deserved. Why did your Hba1c number not improve? I wish life were always fair and we always got our just rewards but unfortunately it is not.

But did you really not get rewarded? You lost weight, you improved your lipid counts and your blood pressure, you are eating healthy and you are exercising more. Seen in a positive frame of mind, all of these are rewards in themselves and will all benefit your health.

I know that the doctor's letter makes it sound inevitable that you will develop diabetes and that you will have to go on to medication, which must be very disheartening and demotivating news to receive. Please bear in mind that the letter you received is probably a "standard" letter sent to all your doctor's patients who have similar hba1c results, many of whom probably lead much less healthy lifestyles than you, rather than one dealing with your own individual circumstances in particular.

I do not have a crystal bowl and so do not know if you will go on to become diabetic. For that matter neither does your doctor!

If you continue to be "good" you may be able to keep diabetes at bay....or not. No one knows the future. All I do know is that your chances of staying clear are better if you keep living healthy.

Even if you do go on to develop diabetes ( sometimes this is a matter of genetics and should not be seen as some kind of punishment for an unhealthy lifestyle), you have an advantage over a lot of us, as you have had advance warning and you have already implemented the lifestyle changes that will help you deal with and control the diabetes. A lot of us only find out about our condition when it actually makes us sick and then struggle to bring about the necessary lifestyle changes to control it.

So please keep a positive outlook and stick with your healthy lifestyle, which should benefit your health irrespective of whether you do or, as i sincerely hope, do not go on to develop diabetes.


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My original OGTT reading was a scary wake up call for me and although I was only just in the "obese" range, I was not one to regularly eat or drink junk. I cut down on the carbs and lost nearly 2 stone to get to a healthy BMI.

I got my last HbA1c result and thought that was it...my reward has come through. Indeed I was rather pleased after a year of strict eating.

Now since the pain in my big toe and numbness in my hand, the first thing I feared was neuropathy and I thought OMG, I am not in the clear! At least I could rule out gout and hypertension (as I had my BP checked). But I could be wrong and be panicking over nothing especially as the hand thing could be nerve entrapment or vitamin B deficiency, but haven't found out about the toe yet.

So I'm one to preach but don't despair. You have done very well indeed

The tip-over numbers I was given, here in the States, is 70-99 range for mg/dL blood glucose. I have been considered pre-diabetic for over a year, with the following climbs and dips :

Although my BG has not been stable, neither stable high nor stable low, I was given the Diabetes diagnoses last week because the numbers have been consistently too high.
I don't know if this helps.

gardengnome said:

I do hope the pain in your toe and numbness in your hand turns out to be nothing serious. Were you only given the diagnosis in June via the OGTT and subsequently in November given the HbA1c or have you had diabetes longer than that? I don't really understand all these numbers, they seem confusing. It seems to me if you are once tipped over the diabetic level [HbA1c 48mmol/mol or 6.5%] that is it, there can be no going back - is that right? Also I see quite a lot of people have much lower HbA1c levels than I have, presumably due to medication of some sort ? The rules regarding these numbers seems so rigid. My doc seems convinced that my A1c will rise which isn't really reassuring is it? He also said when he diagnosed me with hypertension that I wouldn't be able to do enough myself to sort it and would need medication. He was right there. All in all with the weight I lost and dietary changes etc it should have gone down but it didn't.

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My OGTT reading of 6.3 in June was my first ever test - hence the diagnosis of prediabetes, then in November, the HbA1c "replaced" at OGTT at my test centre hence the 5.7 reading. So my GP reassured me that I DONT have diabetes. The numbness felt like I'd slept on my hand (hence circulatory) and although better, still lingers in the background

gardengnome said:

Thank you for the reply and I'm sorry to hear of your diagnosis. I think your symptoms are fairly typical of T2 from what I read. I do seem to have blurry vision too and some foggy thinking but wonder if that is my age [71] !! I suspect too that diabetes was in both sides of my family but am not sure. I'm trying to understand your numbers and graph as I understand it a diagnosis of T2 is given after a fasting blood glucose test of 126 > mg/dl or an A1c of 6.5%>.The numbers of 70-99mg/dl range as a tipping point - what does that indicate? Hope you are coping OK but I guess if you've had pre diabetes for some time it gives time to get used to the idea of T2 and it isn't too great a shock. I had an NHS health check a year ago and they found hypertension stage 2 which they homed in on and I never knew the A1c number until very recently, when the doc agreed it was too high and did it again and it was just the same. All this despite losing about 18 kilos and exercising and altering my diet. The numbers should have dropped significantly my doc says and he says they will inevitably get worse.

A1c 5.9% Feb 2013
pre diabetic with A1c 5.9% Jan 2014
significant dietary changes over 12 months - no change

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The blood-glucose range 70-99 mgdL was to given me as the target to shoot for; whether this is reasonable or not is left to be seen, I guess. I am also going to request that all of my lipid panels, BG and A1C test results from as far back as 10 years ago, be forwarded to my current GP so I can analyze the patterns thoroughly.

Unfortunately, looking back I think I have been in a pre-diabetes state for a long time, much longer than before a GP called it to my attention. After I view a graph covering a 10-year duration I'll know. If I have been it might be why I developed an inflammatory digestive system condition. I have to also watch for hyper-tension because my father had it. All of these ailments are related because they are dependent on the functions of the pancreas, kidney, liver and hypothalamus.

Regarding your still-within-normal-range A1c of 5.9%, perhaps your doc is taking all of your other health factors into consideration and merely warning you that you are at risk for going past the tipping point.? It could be a form of erring on the side of caution.

Here's a link for a site that gives me a lot to think about, esp. how problems like risk of heat-attacks develop regardless of whether one has crossed the line to actual diabetes. Having "abnormal" Ac1 readings seem to be enough.
http://www.phlaunt.com/diabetes/15945839.php