Health markers

HbA1c, the early warning sign of prediabetes – and how to reverse it

A simple HbA1c blood test can let you know if you have elevated blood sugar levels so you can take important steps to prevent diabetes

Prediabetes is a growing health concern for many adults. In Germany, 1 in 5 people are affected by this condition. It occurs when someone has high blood sugar levels, but not high enough to be diagnosed with type 2 diabetes. 

An estimated 37% of people with untreated prediabetes will develop type 2 diabetes within 4 years. Prediabetes often comes with no symptoms, so of people with the condition, more than 80% don’t know they have it. Over time, high blood sugar can damage the heart, kidneys, blood vessels, eyes, and nerves.

In recent decades, the prevalence of diabetes has risen dramatically across the globe. Worldwide, 415 million people are living with diabetes and that number is expected to increase to more than half a billion by 2040.

Basically, there are 4 types of diabetes:

  • Type 1 diabetes is an autoimmune condition in which the pancreas doesn’t make insulin, the hormone that helps glucose enter cells so your body can transform it into energy.
  • Type 2 diabetes is a metabolic condition that develops when the cells no longer respond as well to insulin (insulin resistance). The body’s cells absorb less sugar and the pancreas can’t produce enough insulin to take up the excess glucose in the cells, causing high blood sugar.
  • Gestational diabetes is a temporary form of diabetes that affects women during pregnancy and typically goes away after the baby is born. It develops when the body is unable to produce enough insulin to regulate blood sugar levels.
  • Prediabetes is a condition where blood sugar levels are higher than normal but not yet high enough to be diagnosed as diabetes. It is a warning sign of being at risk of developing diabetes or heart disease. Most importantly, when detected early and right actions are being taken, it is reversible.

Type 2 is by far the most common form of diabetes, accounting for 90% of all diabetes cases, according to the International Diabetes Federation.

One of the most important ways to prevent type 2 diabetes is to know your chance of developing it so you can take timely action. A simple hemoglobin A1c (HbA1c) blood test can let you know if you have prediabetes, which fortunately, can be reversed with healthy eating and lifestyle changes.

Read on to learn more about how HbA1c helps detect prediabetes, the underlying causes of the condition, and ways you can prevent and even reverse prediabetes.

What is HbA1c and how does it help detect prediabetes?

HbA1c stands for glycated hemoglobin, a protein found in red blood cells. As glucose circulates through your body, it attaches to hemoglobin. When blood glucose levels rise, more sugar sticks to hemoglobin and builds up in the blood. 

An HbA1c test shows your average blood sugar levels over the past 3 months by measuring the percentage of hemoglobin within red blood cells coated by glucose. Red blood cells live for about 3 months, and glucose binds to hemoglobin for as long as red blood cells stay alive.

High levels of HbA1c can indicate diabetes or prediabetes. According to health guidelines, ranges to diagnose these conditions include:

  • In range: HbA1c below 5,7%
  • Prediabetes: HbA1c between 5,7%—6,4%
  • Diabetes: HbA1c 6,4% or higher

You can get an HbA1c test at a doctor’s office or in a lab. If you live in Berlin, you can easily book an appointment in the Aware App and visit our lab in Mitte, no doctor’s note required. During the test, a healthcare professional will draw blood from your arm. If the results show that HbA1c levels are in the prediabetes range, a healthcare provider may recommend observation, lifestyle changes, and retesting in 3—6 months.

Elevated blood sugar and insulin resistance: The underlying causes of prediabetes

There are a number of factors that can increase the odds of developing prediabetes. It occurs when the body stops properly processing glucose.

When you eat, your body digests the food, and glucose among other nutrients enters the bloodstream. In response, the pancreas releases insulin, a hormone that leads to the uptake of glucose into the cells, for example, muscle cells. In consequence, blood sugar levels drop and the pancreas slows down its production of insulin.

But with prediabetes, this process gets disrupted. Insulin resistance leads to a build-up of glucose in the blood and the pancreas may not be able to make enough insulin to keep up. 

Certain factors can increase the chance that someone develops diabetes in their lifetime, including:

  • Family history: If a close relative has type 2 diabetes, this increases the odds of developing prediabetes.
  • Weight: Being overweight or obese greatly increases the chance of prediabetes. The more fatty tissue that’s in the body, the more resistant cells may become to insulin.
  • Diet:  A low-quality diet including a high consumption of red meat, and sugar-sweetened drinks, and sodium, as well as diets low in fruits, vegetables, fiber and whole grains is associated with a higher chance of diabetes. 
  • Physical inactivity: A lack of physical activity and sedentary lifestyle up the odds of diabetes.
  • Race/ethnicity: Research has found that people of South Asian, Sub-Saharan African, and Middle Eastern/North African origin living in Europe have a higher chance of type 2 diabetes compared to Europeans.

Certain conditions: High blood pressure, obstructive sleep apnea, polycystic ovary syndrome (PCOS), and gestational diabetes (diabetes during pregnancy) all increase the chance of developing diabetes.

While some of these factors are outside of our control, leading a healthy lifestyle goes a long way toward preventing prediabetes and diabetes.

What are the warning signs of prediabetes and diabetes?

Prediabetes doesn’t typically have any symptoms, which is why it’s so essential to test your blood sugar levels regularly so you can stay on top of your health. That way, you can learn if your blood glucose is higher than normal and make key changes to your lifestyle to help prevent diabetes. 

When it comes to type 2 diabetes, many people don’t get any noticeable symptoms, but classic signs include:

  • More frequent urination, especially at night
  • Increased thirst
  • Tiredness and fatigue
  • Blurred vision
  • Cuts and wounds that take longer to heal
  • Numbness or tingling in the hands or feet
  • Frequent infections
  • Weight loss without trying

7 ways to lower HbA1c levels and reverse prediabetes

If a recent blood test showed that you have high HbA1c, the good news is that you’re not doomed to a life with type 2 diabetes. With the right lifestyle changes, it’s completely possible to reverse prediabetes and improve glycemic control.

1. Eat a nutritious diet with lots of fiber

Incorporating nutrient-dense foods in all your meals is a top strategy to prevent and reverse prediabetes. 

Research shows that eating more fruits, vegetables, whole grains, nuts, legumes, and low-fat dairy products, and limiting intake of red meat, sugary drinks, and sodium is associated with lower odds of diabetes. 

Raspberries seem particularly helpful for managing glucose in people with prediabetes: A 2019 study published in Obesity found that eating raspberries decreases the amount of insulin needed to control blood sugar.

Increasing fiber in your diet can also help prevent diabetes because it doesn’t cause a spike in blood sugar like other carbohydrates. Plus, fiber keeps you feeling full longer, which helps with weight control, and can even prevent heart disease by lowering your cholesterol levels. You can up your fiber intake by swapping white rice for brown rice or quinoa, and eating more oats, bran, and leafy green veggies. 

2. Move your body

Regular exercise is another helpful way to ward off or reverse prediabetes.

The World Health Organization recommends that all adults get at least 150—300 minutes of moderate-intensity aerobic physical activity, such as brisk walking, water aerobics, or riding a bike on level ground, per week. Alternatively, you can choose vigorous-intensity aerobic physical activity, such as jogging, running, swimming, or riding a bike fast or on hills, for at least 75–150 minutes per week.

3. Stick to a healthy weight

For people that are overweight or obese, getting to a healthy weight will drastically reduce the chance of developing type 2 diabetes later on.

One study of more than 3,000 adults found that individuals with prediabetes who lost 5—7% of their body weight reduced their odds of developing diabetes by 54% 3 years later. What’s more, those who lost 10% or more of their body weight had an 85% reduced chance of developing diabetes over the same time.

4. Get the right amount of sleep

Quality rest sets us up for optimal health, and can help fight off diabetes. Health guidelines state that adults between the ages of 18–60 should aim for around 7 hours of shuteye per night. 

Getting much more or less sleep than that is associated with elevated glucose: A 2019 study in Diabetes Care including 962 overweight or obese adults aged 20–65 found that those who slept under 5 hours or over 8 hours per night had higher blood sugar and body mass index (BMI). 

Treating obstructive sleep apnea, a common sleep disorder in which breathing is repeatedly interrupted during sleep, can also help lower the chance of prediabetes. Research has shown that when people with this condition received 8-hour nightly continuous positive airway pressure (CPAP) treatment for 2 weeks, their blood sugar level improved.

5. Don’t smoke

Smoking cigarettes is a proven risk factor for insulin resistance. Smokers have a 30—40% higher likelihood of type 2 diabetes than nonsmokers, according to the U.S. Food & Drug Administration. If you have high HbA1c levels and smoke, quitting is a key way you can prevent diabetes and other associated health problems.

6.Try berberine 

Research suggests berberine, a bioactive compound found in a number of plants and used in Traditional Chinese Medicine, may effectively reduce blood sugar levels. A meta-analysis of 37 studies determined that taking berberine has a glucose-lowering effect both on fasting and long-term blood sugar levels. 

Talk to your doctor before starting to take any supplement. If you’re taking any medication, it’s important to speak to a healthcare professional about potential interactions.

7. Manage stress

Research has found that stress can increase the risk of prediabetes and type 2 diabetes. One study that followed more than 12,000 women for 12 years found that moderate to high stress levels were associated with a 2.3-fold increase in the odds of diabetes 3 years later.

Another study of 230 individuals found that stress management was linked to a reduction in HbA1c levels in people with type 2 diabetes.

If you’re struggling to manage your stress levels, weight, blood pressure, or a chronic condition like PCOS or sleep apnea, don’t hesitate to reach out to a healthcare professional for advice and guidance.

The bottom line:

Catching prediabetes early is vital to preventing future health problems like type 2 diabetes. Getting an HbA1c test is a quick and simple way to check the pattern of your blood sugar levels so you can get started on lifestyle changes right away and boost your metabolic health. Thankfully, with healthy living, it’s possible to reverse insulin resistance and improve blood sugar control.

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