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You get your lab results, and there it is: A1C: 5.9%, flagged in yellow or red, with a note that says "consistent with prediabetes." Maybe this is the first time you're hearing that word. Maybe you've been working at this for years. Either way, there's a lot of confusion about what an A1C means for you. Let's unpack it.

Inside this issue:

• What A1C measures, and what pushes it up

• Why 5.7% and 6.3% are not the same story, though both get labelled "prediabetes"

• When your A1C can mislead you

• What to do if your number is creeping up

BEST FINDS
Nutrient-Dense Recipe Roundup: Six recipes, zero added sugar. The idea throughout: steady energy comes from what you pair carbohydrate with, not from cutting it out. Breakfast: Whipped Ricotta Toast with Roasted Berries. A sweet breakfast that still hits 22g protein and 11g fiber. Sun-Dried Tomato & Goat Cheese Egg Muffins. Three muffins, 24g protein, 6g net carbs. Bake Sunday, freeze the rest. Lunch: Mediterranean Quinoa Bowls with Roasted Red Pepper Sauce. Chickpeas and feta do the work at 21g protein; the quinoa stays small on purpose. Dinner: Braised Chicken with Butter Beans & Fennel. One pot, 41g protein, 9g fiber. Mashed beans thicken the sauce, no flour. Spaghetti Squash with Turkey Meatballs. 38g protein, 19g net carbs, and a scratch sauce so nothing is hiding in a jar. Side: Charred Broccoli Salad with Orange & Almonds. 11g net carbs, sweetened by whole orange segments instead of honey.

What Your A1C Is Really Telling You About Prediabetes

What A1C Measures: Your Two-to-Three-Month Blood Sugar Average

A1C (also written HbA1c) measures the percentage of your hemoglobin, the oxygen-carrying protein in your red blood cells, that has glucose attached to it. Glucose sticks to hemoglobin over the roughly 120-day life of a red blood cell, so the result reflects your average glucose exposure over the past two to three months, not what your blood sugar was doing on the morning of the draw.

What raises your A1C? 

At its core: glucose building up in your blood faster than your body can clear it. On the intake side, that's not just what you eat (fast carbs like soda, processed bread, or candy on its own) but how much lands in one sitting, how it arrives (naked, or slowed by fiber, protein, and fat), and when. On the other side is how effectively your body handles that glucose: muscle is a major site of glucose disposal, and muscle health matters. Regular movement and resistance training can improve how effectively your muscles take up and use glucose. And even that is only part of the picture. Underneath sits insulin resistance, your cells responding sluggishly to insulin, driven in part by excess fat stored in places like the liver and muscle, along with the rest of your metabolic picture: lipids, stress, sleep, and the genetics you were dealt. Your liver's glucose output and your pancreas's ability to produce enough insulin also matter. Until that deeper metabolic picture improves, A1C can stay stubbornly elevated even when every meal looks right. Read: The #1 Exercise Mistake Prediabetic Women Make 

The ranges, per American Diabetes Association criteria:

How is A1C measured? A regular blood draw, usually from a vein, analyzed on a certified laboratory instrument. No fasting, no prep, any time of day, which is why it's often the test your doctor reaches for first. Finger-stick and at-home A1C kits exist too, with widely varying accuracy; we'll cover them in a separate issue.

A1C of 5.7% vs 6.3%: Why Not All Prediabetes Is the Same

Here's the part most lab reports won't tell you: 5.7% and 6.3% both get the same yellow "prediabetes" flag, and they do not carry the same risk.

A systematic review of prospective studies found that the risk of developing type 2 diabetes rose substantially as A1C increased. Across the studies reviewed:

• A1C of 5.5 to 5.9%: roughly 9 to 25% developed diabetes within five years

• A1C of 6.0 to 6.4%: roughly 25 to 50% did

That's a real difference. Risk climbs steeply and continuously across the range. There's no biological cliff at 5.7%, and no safe plateau just below 6.5%. A reading near the top of the prediabetes range generally means more risk than one near the bottom.

Two things follow. First, know your exact number, not just the label. Second, don't panic over a tenth of a point: the data can't separate a 5.8% from a 5.9% in any meaningful way. What they can separate is the lower part of the range from the upper part. Read: Rethinking Prediabetes 

A1C accuracy: when your number wobbles, or lies

Repeat tests scatter on their own. Test the same person twice with nothing changed and the numbers may not match. 5.8% one year and 5.9% the next can be hard to distinguish from ordinary biological and measurement variation. What deserves attention is a jump of several tenths, or readings that keep moving in the same direction.

Some conditions skew the result. A1C lives on red blood cells, so anything affecting those cells can move the number without your glucose moving with it: iron deficiency anemia (which can read falsely high, and treating it may lower the A1C on its own), inherited hemoglobin variants (which interfere with some testing methods), pregnancy, recent blood loss, and other causes of altered red cell turnover. If any apply to you, ask whether a different test would read you more accurately.

The A1C-to-average-glucose relationship also varies from person to person. If your home readings and your A1C consistently disagree, neither is necessarily wrong, but the ADA recommends investigating substantial, consistent disagreement, so raise it with your clinician.

Read: Stop guessing what's spiking your blood sugar: track it instead

Can Your A1C Come Down? More Good News Than You'd Think

An A1C in the prediabetes range identifies a higher-risk state, not an inevitable progression to diabetes, and there's more good news in everything above:

If you're in the lower band, you have more room than you think. If you've been stuck at 5.7% or 5.8% and beating yourself up over it, look back at the risk numbers: the odds of developing diabetes are substantially higher toward the upper end of the range than the lower end. That's not a reason to coast, but it is a reason to drop the self-blame and work from a calmer place.

This doesn't have to be a progressive condition. In the long-term follow-up of the Diabetes Prevention Program, participants whose glucose returned to normal at any point, even once, had roughly half the subsequent risk of developing diabetes compared with those who consistently remained in the prediabetes range.

It's not a simple carb battle, and that's actually good news. Many things move this number: what and how you eat, muscle health, insulin resistance, liver glucose production, pancreatic function, and the wider metabolic picture. More factors means more levers. A comprehensive plan beats band-aid fixes every time.

Timelines differ, and that's normal. Because those factors weigh differently in different people, some see their A1C move within a test cycle or two; for others it takes longer. A slower change is not proof your plan is failing.

Read: Is Your Prediabetes Getting Better Even When You Can't Tell? 

Have questions? We got answers. Email [email protected]