How to bring down your A1c score
By Roberta Cannon, RN
Prediabetes is a significant health condition that occurs when you have higher than normal blood sugar levels that are not high enough to be diagnosed with diabetes. According to the Centers for Disease Control and Prevention (CDC), one in three people in the United States has prediabetes, which is a major precursor for developing diabetes type 2, heart disease and stroke.
A diagnosis of prediabetes can be made with a test called an A1c.
“The A1c (HbA1c) is a blood test that measures your average blood sugar over the past three months,” said Miguel Prieto, MD, an internist with Bourne Primary Care. “It measures the amount of sugar that attaches to your hemoglobin, which is the protein in your red blood cells that transport oxygen. The red blood cells last about three months and they get replaced by new red blood cells. The hemoglobin gives us an average of blood sugar levels over that period of time.”
A1c levels are measured in percentages and the higher the percentage, the higher your blood sugar levels have been over the past three months. The following are A1c levels, according to the American Diabetes Association:
Complications of Prediabetes and Diabetes Type 2
“Some of the complications can start with prediabetes before advancing to diabetes,” said Dr. Prieto. “You begin to have damage to the blood vessels, and it happens most often initially in the smallest blood vessels and then to bigger blood vessels.”
The following are some of the possible complications, according to Dr. Prieto:
Bigger blood vessel damage can cause:
Lifestyle Changes to Avoid Diabetes Type 2
“If you change your lifestyle and start doing all the right things, you can lower your A1c and avoid progressing to diabetes type 2 or having to take medications to control your blood sugar,” said Dr. Prieto. “These changes include eliminating processed foods from your diet, eating a plant-based diet and keeping physically active. It doesn’t mean you have to go to the gym every day, but an exercise routine that is sustainable for you is good.”
Dr. Prieto referenced a patient that had an A1c of 9.8. “He made lifestyle changes by adopting a plant-based diet, reducing his meat intake to just three times a month, incorporating regular walking into his routine and losing 30 pounds. By making these changes, he lowered his A1c to 7.2 without the use of medications in two months,” he said.
Once your A1c is under seven, your risk of complications is much lower. At that level, Dr. Prieto checks the A1c about twice a year. If the A1c is less than 5.7 and in remission, he checks the A1c once a year.
“Every point you drop your A1c, your death from all causes goes down 14 percent” said Dr. Prieto. “The risk of heart attack goes down 14 percent for each 1 percent decrease in A1c, and the risk for a diabetes-related death goes down 21 percent. The risk for microvascular (minute blood vessels) disease or peripheral vascular disease causing death goes down 43 percent. Any reduction in the A1c is great.”
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Originally published on Cape Cod Health News, March 11, 2025
A diagnosis of prediabetes can be made with a test called an A1c.
“The A1c (HbA1c) is a blood test that measures your average blood sugar over the past three months,” said Miguel Prieto, MD, an internist with Bourne Primary Care. “It measures the amount of sugar that attaches to your hemoglobin, which is the protein in your red blood cells that transport oxygen. The red blood cells last about three months and they get replaced by new red blood cells. The hemoglobin gives us an average of blood sugar levels over that period of time.”
A1c levels are measured in percentages and the higher the percentage, the higher your blood sugar levels have been over the past three months. The following are A1c levels, according to the American Diabetes Association:
- Normal level: Less than 5.7%
- Prediabetes: Between 5.7% and 6.5%
- Diabetes: 6.5% and higher
Complications of Prediabetes and Diabetes Type 2
“Some of the complications can start with prediabetes before advancing to diabetes,” said Dr. Prieto. “You begin to have damage to the blood vessels, and it happens most often initially in the smallest blood vessels and then to bigger blood vessels.”
The following are some of the possible complications, according to Dr. Prieto:
- Minute blood vessel damage can lead to microscopic strokes and chronic ischemic changes in your brain.
- Small blood vessel damage can lead to neuropathy causing weakness, numbness and pain in the hands and feet.
Bigger blood vessel damage can cause:
- Diabetic retinopathy that can lead to blurred vision, vision loss and blindness.
- Kidney disease that can interfere with removing waste products from the bloodstream, making red blood cells, balancing minerals, and help with maintaining blood pressure.
- Cardiovascular disease can lead to heart attacks, stroke, heart failure, abnormal heart rhythms, and heart valve problems.
Lifestyle Changes to Avoid Diabetes Type 2
“If you change your lifestyle and start doing all the right things, you can lower your A1c and avoid progressing to diabetes type 2 or having to take medications to control your blood sugar,” said Dr. Prieto. “These changes include eliminating processed foods from your diet, eating a plant-based diet and keeping physically active. It doesn’t mean you have to go to the gym every day, but an exercise routine that is sustainable for you is good.”
Dr. Prieto referenced a patient that had an A1c of 9.8. “He made lifestyle changes by adopting a plant-based diet, reducing his meat intake to just three times a month, incorporating regular walking into his routine and losing 30 pounds. By making these changes, he lowered his A1c to 7.2 without the use of medications in two months,” he said.
Once your A1c is under seven, your risk of complications is much lower. At that level, Dr. Prieto checks the A1c about twice a year. If the A1c is less than 5.7 and in remission, he checks the A1c once a year.
“Every point you drop your A1c, your death from all causes goes down 14 percent” said Dr. Prieto. “The risk of heart attack goes down 14 percent for each 1 percent decrease in A1c, and the risk for a diabetes-related death goes down 21 percent. The risk for microvascular (minute blood vessels) disease or peripheral vascular disease causing death goes down 43 percent. Any reduction in the A1c is great.”
View Physician Profile
Originally published on Cape Cod Health News, March 11, 2025